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One Supportive Adult

April 30, 2022 — Out For Health Conference, Texas Christian University, Fort Worth TX


I suspect every one of you remembers the day you took the Hippocratic Oath to do no harm. I took that oath in 1983. I was called to medicine, as many of you were, by my desire to help people and work towards the common good.

Our medical education gives us important skills. What makes us physicians is our choice to spend our days, and sometimes our nights, helping our fellow human beings live well. As we all know, medicine is about saving lives and also about improving quality of life.

We are there for emergencies and pandemics. But we’re also there whenever you need us. We make sure the sick and the unwell get better, and we help healthy people stay healthy. We make sure that those who need professional medical help receive that help, no matter who they are or what their life circumstances might be.

Our oath is thousands of years old. It tells us to treat patients without discrimination. I have loved being a doctor since the day I took that oath. I have believed in it — all of it — for as long as I can remember. We work every day to benefit the sick, to protect people from harm, and to make our community whole. We can do that with medicine, and we can do that with warmth, empathy, compassion and understanding.

Our communities need healing. They have always needed healing. On some days, like today, they need it more than ever.

Today, many of our fellow human beings across the country call for our attention because they’re being attacked, and they see few places to turn. I want to say this very, very clearly: lesbian, gay, bisexual, transgender and queer Americans are committing suicide at a rate that should shock our conscience. Even after decades of progress, the most vulnerable among us continue to suffer, including LGBTQI+ individuals of color, LGBTQI+ youth, LGBTQI+ seniors, and LGBTQI+ immigrants. Transgender women of color not only continue to be harassed, but are more likely than the population at large to suffer violence and even murder.

I firmly believe that we as a society have not made progress unless we have all made progress. Acts of intolerance damage our nation’s health and wellbeing, including our mental health. Anyone who believes that words are not the same as actions, who believe that LGBTQI+ people should just toughen up, should walk a mile in our shoes. Personally, I have no room in my heart for hatred and I have no time for intolerance. Not everyone in our country feels that way. We need to continue to work against intolerance until everyone living in America can live their life openly and freely, without fear of prejudice, scorn or attack.

President Biden and his administration see the LGBTQI+ community in all its diversity. We have a president who supports equality and works to ensure everyone is represented. That approach to governing gives people a voice, a chance to effect change, and an opportunity to help people understand the diverse needs of our nation. That includes their health needs. At HHS, Secretary Becerra and I are committed to doing everything we can to help vulnerable patients and their families get the medical care they need, no matter where they live and no matter their life circumstances. We believe medical and political discrimination against LGBTQI+ people has to end.

We’re clearly not there yet. Today, many politicians and their supporters are describing our LGBTQI+ community, in public, as a blight on our culture. Many of the targets of this kind of speech are driven to kill themselves. We know as a medical fact that trans youth in particular are being hounded in public and driven to the depths of despair at an alarming rate. Fifty-two percent of all transgender and nonbinary young people in the U.S. seriously contemplated killing themselves in 2020. Think about how many of them thought it was better to die than to put up with any more harassment, scapegoating and intentional abuse.

I want to point out here that if you’re an LGBTQI+ child, adolescent or teenager having a mental health crisis, the difference between life and death is often a single caring adult. It doesn’t have to be a parent or a family member. It makes all the difference in the world to hear just one supportive person reminding you that you are a valuable human being, that your life is important, that you have no less dignity than anyone else. It is a great shame that anyone should ever feel so low that they would need to hear those words. But they do. They need to hear those words every single day, all over this country. Having a supportive person to bring them through difficult times has saved the lives of more LGBTQI+ people than we will ever know, and when we realize that we’re not all so different from each other, becoming that supportive person for someone is easier.

One supportive adult.

Trans people are doctors and lawyers and teachers. They run businesses and drive taxis. I do not see enough warmth, empathy, compassion or understanding on their behalf. I certainly have not seen it from those who target them for isolation, bullying, rejection, anti-trans legislation and anti-trans actions. I want us all to consider that our children are watching. They are watching what we do, and they are watching how we act. We need to say publicly to every LGBTQI+ person living in this country that it is okay to be you, and it is the right thing to do to stand up for your dignity and your freedoms.

Gender-affirming care is medical care. It is mental health care. It is suicide prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice. The World Professional Association for Transgender Health published evidence-based standards of care more than a decade ago, in 2011, and is planning to release a full update this year. Rather than relying on a few cherry-picked reports to make a political argument, WPATH assesses the full state of the science and provides substantive, rigorously analyzed, peer-reviewed recommendations to the medical community on how best to care for patients who are transgender or gender non-binary. There is nothing one-sided about their approach. It is founded on a vast body of medical literature. It is free of any agenda other than to ensure that medical decisions are informed by science. This is the way medicine is supposed to be practiced, and it is the way doctors are supposed to care for their patients.

For almost forty years, I’ve considered it an honor to be a doctor. I believe in our role as healers, and I believe in our role as truth-tellers. The truth we need to confront right now is that medicine and science are being politically perverted around the country in ways that destroy human lives. We have reached a tipping point for the role of medicine in civic life and for the health and wellbeing of LGBTQI+ Americans.

A paper published just two months ago in the Journal of the American Medical Association found that receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60 percent lower odds of moderate or severe depression and 73 percent lower odds of suicidality over a 12-month follow-up. The positive value of gender-affirming care is not in serious scientific or medical dispute.

Those who now attack our LGBTQI+ community are driven by an agenda that has nothing to do with medicine, nothing to do with science, and nothing to do with warmth, empathy, compassion or understanding. They’re rejecting the value of supportive medicine, rejecting well-established science and rejecting basic human compassion. They prefer slander, bigotry and gender-baiting hate speech. When they attack trans people as brainwashed, or worse, and call anyone who disagrees with them a pedophile, we have to admit to ourselves what’s happening.

We, as doctors and as people who love our communities and our nation, have to confront the fact that the language of care and compassion that we take for granted is being used to tear our communities apart. The language of medicine and science is being used to drive people to suicide. The mantle of concern for children is being claimed to destroy children’s lives.

We have to stand up. We have to take a stand on behalf of those who are being hurt. We have to be doctors. This is what we do, even when it’s difficult.

Remember: One supportive adult.

Thank you so much.



Source: Office of the Assistant Secretary for Health, US Department of Health and Human Services.