Clinic business

Alabama doctor: ‘Panic energy’ at clinic in days before treatment ban for transgender youth

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Dr Hussein Abdul-Latif is now regularly counting 14-hour days as he tries to book appointments with patients over the past few days. Alabama allows gender-affirming care for transgender children.

He and his colleagues at the Gender Clinic at the University of Alabama at Birmingham see children and adults with gender dysphoria. They provide counseling and courses of treatment, which may include medication. Over the past two weeks, they’ve contacted about 100 recent patients to make sure they have the prescriptions they need to keep treatment going into the next year.

Beginning May 8, unless a federal judge intervenes, under a new law, Alabama health care providers could face criminal penalties if they continue to prescribe or administer hormonal treatments or puberty blockers to minors. Even if the judge suspends enforcement, the law has impacted his clinics’ ability to provide care, Abdul-Latif said.

“The law really intimidated the clinic even before it came into effect,” he said. “Nurses came into my office crying when the law was first signed, saying I didn’t want to go to jail. Am I responsible in triaging patients for you to see? »

There is “panicked energy” among parents and an urgency to get appointments before Sunday. The parents are asking for the orders to be transferred to other states and for help planning the future of their child’s treatment if the judge decides not to issue an injunction in the coming days, he said.

He saw eight patients this week and 14 patients last week when it’s typical to see just one. Patients administer their treatments at home and do not need to come to the clinic except for an assessment or advice with a psychiatrist.

But many families needed reassurance, with one mum saying she hadn’t slept for three nights because she feared her daughter, who is six months past her 19th birthday, might go without estrogen until his birthday.

“Usually the first question on a date is how are you? Or how can I make your life better? Now the first question is, where do we go from here? ” he said.

A ticking clock

On April 8, Governor Kay Ivey signed into law the Alabama Vulnerable Compassion and Protection Act, along with a bill to prevent transgender people from using school restrooms and locker rooms that match their gender identity. gender.

“Our young people face very real challenges, especially with societal pressures and today’s modern culture. I firmly believe that if the Good Lord made you a boy, you’re a boy, and if he made you a girl, you’re a girl,” Ivey said at the signing of the law. “We should especially protect our children from these radical, life-changing drugs and surgeries when they are at such a vulnerable stage in their lives.”

U.S. District Judge Liles Burke is hearing witnesses in Montgomery this week in Eknes-Tucker v. Ivey, where families of transgender minors, a doctor, a psychologist and a pastor are seeking an injunction on the ban before it takes effect on Sunday. Abdul-Latif is not a plaintiff in the lawsuit, although his co-lead at the clinic, Dr. Morissa Ladinsky, is.

According to the American Academy of Pediatrics, puberty blockers and hormone therapy are considered safe and effective “evidence-based care” for children and adults, in appropriate situations. Gender-affirming surgeries for minors are not performed in Alabama.

Many of Abdul-Latif’s patients were first referred to him by the University of Alabama Psychiatric Unit at Birmingham Hospital, where they were admitted after suicide attempts. According to the Trevor Project, an Alabama suicide hotline has supported more than 2,600 LGBTQ youth crisis contacts who have reached out over the past year, but not always related to the laws.

“Recent political attacks targeting transgender and non-binary youth have not only threatened their access to health care, support systems and affirmation spaces in school, they have also had a negative impact on their mental health” , said Jonah DeChants, researcher at the Trevor Project, in a recent report.

Some patients have been referred to Abdul-Latif’s clinic because they have discovered that eating disorders stop menstruation.

“Some children will go to very dangerous lengths to control their dysphoria,” he said.

In the 48 hours since the legislation was passed, Abdul-Latif said there had been a “great increase” in visits to the children’s hospital emergency room from patients presenting with suicidal thoughts.

“There is great anxiety among patients,” he said of the mental health impacts of recent legislation.

A 16-year-old came to Abdul-Latif this week to try to start treatment before the law came into effect.

“I had the painful task of writing to him that if the law comes into force I cannot prescribe you any medicine, but I would like to see you and help you in any way,” he said. declared. “This teenager was kind and patient, saying he still really wanted to see me even though you don’t give me the prescriptions until I was 19. That was a huge degree of maturity, which is different from the image the authors of the law painted of these patients.

For now, it can only predict a switch to counseling services and tell existing patients that their renewals have been called.

Calling prescriptions is usually part of a nurse’s job, but many of them expressed fear of going to jail if they did, so Abdul-Latif took on the task himself.

Abdul-Latif tried to assure nurses that such treatments were still legal, but one employee left the unit altogether, he said.

His new task of asking for prescriptions was made more difficult by pharmacies refusing to fill them, falsely saying it was illegal to do so.

A father who tried to collect his son’s testosterone on the Friday morning before the ban came into force was refused by his pharmacist.

“Please can you call a pharmacy in Georgia or Mississippi and I’ll drive there,” he told Abdul-Latif.

It’s unclear which pharmacy made the mistake, but a CVS spokeswoman said the company has yet to tell pharmacists in Alabama to stop prescribing treatments to minors. Walgreens did not respond to a request for comment.

“We do not have a policy prohibiting our pharmacists from dispensing gender-affirming drugs to minors in Alabama,” said Amy Thibault of CVS.

The last few days have weighed on Abdul-Latif. When he’s not seeing patients or dealing with pharmacies, he watches the news to see if there are any updates on the court hearing.

He said he was trying to focus on his current patients instead of thinking about the potential consequences of continuing treatments last Sunday.

“My concern is that I will suffer from post-traumatic stress disorder in a few weeks,” he said. “It’s very painful to think that if I refuse care, I’m hurting my patients.”

Savannah Tryens-Fernandes is a child health and wellbeing reporter for The Alabama Education Lab at AL.com. Its position is supported by a partnership with Report for America. Contribute here.