[Editor note: This article is relevant to Florida’s “Don’t say gay” law.]
By Scott E. Hadland, M.D., M.P.H.
When Mx. E. told me, “It’s hard being an LGBTQ professional in America right now,” I knew what they meant. A 26-year-old who identifies as gender nonbinary and uses they/them pronouns, Mx. E. is a patient in our youth primary care clinic and works as a middle school teacher. Two weeks earlier, Florida Governor Ron DeSantis had signed into law the state’s controversial Parental Rights in Education bill limiting classroom education on sexual orientation and gender identity. One month before that, Texas Attorney General Ken Paxton had issued a legal opinion that gender-affirming care for transgender persons younger than 18 years of age constituted “child abuse.”
Such legal actions already seem to be having a chilling effect. In Florida, teachers are reportedly uncertain about what they are permitted to discuss in the classroom. The state’s policy, which opponents have dubbed the “Don’t Say Gay” law, is written vaguely. It forbids “classroom instruction by school personnel or third parties on sexual orientation or gender identity” in kindergarten through third grade but does not codify what constitutes “instruction”; it also prohibits such instruction for older grades if it is not “developmentally appropriate for students in accordance with state standards,” although these “standards” are not clearly defined. It is unclear whether teachers can, for example, acknowledge that some children might have same-sex parents or provide support to children experiencing distress over their gender identity. In Texas, physicians have halted gender-affirming medical and surgical interventions considered the standard of care by professional organizations such as the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association.1
For Mx. E., me, and, I’m sure, other professionals throughout the United States who work with children and adolescents, these policies have outsized cruelty — even beyond the enormous harm I know they will do to the young people we serve. These policies and lawmakers’ rhetoric have marked professionals like us as targets for harassment and abuse, especially when we ourselves identify as lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ).
At the heart of the Florida and Texas policies is the idea that professionals who work with young people somehow manipulate them to become LGBTQ. Supporters of these policies are now referring to this practice as “grooming,” a term used to describe the behavior of an adult who slowly earns the trust of young persons with the goal of initiating a sexual relationship with them. Of course, decades of data show that the development of gender identity and sexual orientation is immensely personal. Although professionals should support children and adolescents during this process, a young person cannot be “turned” LGBTQ by an adult — just as an LGBTQ person cannot be made cisgender or heterosexual by means of (scientifically disproven) conversion therapy.
Making the political discourse yet more inflammatory, the policies’ supporters have begun to equate any opposition to them with child abuse. During the bill-signing ceremony for Florida’s law, DeSantis stated that the policy’s opponents “support sexualizing kids in kindergarten” and are “trying to camouflage their true intentions.” Weeks earlier, his spokesperson tweeted that anyone against the bill was “probably a groomer.”
I learned firsthand how this framing turns professionals who support LGBTQ young people into targets. An outspoken LGBTQ advocate and an openly gay physician, I posted a tweet2 highlighting my opposition to Florida’s bill. I received mostly positive responses, as well as the usual barrage of threats and homophobic slurs I’ve become accustomed to in my social media accounts, email, work voicemail, and even home mailbox. But mixed into the vitriol, an outlandish and heinous word kept cropping up, piercing the emotional armor I’ve built: “pedophile.”
This grotesque accusation causes me enormous anguish as a pediatrician and a father of two young children. It does Mx. E., too, who told me that several middle school students look to them as a role model — an out, gender nonbinary person they could turn to for support — but who now worries about false, vile allegations of “grooming.” Mx. E., like me, is afraid that these laws have already conflated our mere existence as LGBTQ professionals with sexual predation. This abhorrent conflation is not new. In the late 1970s, the so-called Save Our Children campaign infamously led by Anita Bryant ran newspaper ads proclaiming that “since homosexuals cannot reproduce, they must recruit, must freshen their ranks.”
For me, this battle has always been about protecting young people. In April, the Centers for Disease Control and Prevention reported that during the Covid pandemic, more than one in four lesbian, gay, or bisexual adolescents nationwide attempted suicide.3 Rates may be even higher among transgender and gender nonbinary adolescents.4 The Florida and Texas policies implicitly send young people the message that being LGBTQ is morally wrong — something that must be prevented. Data show that state policies and school environments that are hostile to LGBTQ people are linked to suicide, as is limiting access to gender-affirming medical care.1,5 According to data from the Williams Institute at UCLA, more than 300,000 LGBTQ adolescents live in Florida and Texas. The two states’ policies have already triggered a cascade of similar laws introduced in more than a dozen state legislatures, threatening the health of hundreds of thousands more LGBTQ young people nationwide. Even when these anti-LGBTQ laws are not adopted, the public debate they incite can worsen the mental health of LGBTQ young people.4
All of us — health care providers, teachers, and professionals of all kinds — can and should support LGBTQ people. But those of us who identify as LGBTQ ourselves have the additional responsibility of ensuring this support not only as professionals but also as adult members of the LGBTQ community. Many LGBTQ young people seek out health care providers whose personal lives mirror their own. I contend that it sometimes has as great an impact on my LGBTQ patients that I am visible as an out, gay professional as it does that I’m their doctor — Mx. E., in fact, has told me that this is true of our relationship. But LGBTQ professionals need to be safe to continue our work. Wrongly and viciously comparing our support for young people with pedophilia could cost us our jobs or even foment violence against us.
LGBTQ physicians need our colleagues to stand up as our allies. Professionals who work with LGBTQ young people, especially those who identify as LGBTQ themselves, are facing serious peril. We have seen the politicization of health care and the vilification of professionals play out before; one need only recall the everyday risk faced by our colleagues who provide abortions to understand how rhetoric can escalate to violence. And even when we are not the direct recipients of harassment, LGBTQ professionals may be struggling as we see lawmakers scapegoating our community. Many of us survived despite enormous stigma against LGBTQ people during our own youth, and we are hurting as we try to protect a new generation of children and adolescents from the same experiences. We need our physician colleagues to speak up when they witness us being targeted, to counter intolerant public speech, to support us when we face hate and discrimination — and more broadly, to stand up for all professionals fighting to safeguard the health of the LGBTQ community.
During my pediatric residency, I often wondered what the parents of my patients would think if they knew I was gay. Long-standing, hateful tropes about LGBTQ people and pedophilia hung over my head. Somehow, first as a junior faculty member and now as a hospital leader, I moved past these fears and became open with my patients and their families about the fact that I have a husband and children. Years later, I feel the fears resurfacing. I hope my colleagues will stand with me and other professionals as we advocate for rational policy, evidence-based care, and the well-being of young people during a time when all three are in jeopardy.
Disclosure forms provided by the author are available at NEJM.org.
This article was published on August 13, 2022, at NEJM.org.
From the Division of Adolescent and Young Adult Medicine, Mass General for Children, and the Department of Pediatrics, Harvard Medical School — both in Boston.
- Gordon CM. Caught in the middle: the care of transgender youth in Texas. Pediatrics 2022;149(6):e2022057475-e2022057475.
- @DrScottHadland. Dear Florida lawmakers: This is what a family looks like. You can’t silence or erase us. #DontSayGay. March 8, 2022
- Jones SE, Ethier KA, Hertz M, et al. Mental health, suicidality, and connectedness among high school students during the COVID-19 pandemic — adolescent behaviors and experiences survey, United States, January–June 2021. MMWR Suppl 2022;71:16-21.
- The Trevor Project. 2022 National survey on LGBTQ youth mental health. 2022
- Aivadyan C, Slavin MN, Wu E. Inclusive state legislation and reduced risk of past-year suicide attempts among lesbian, gay, bisexual, and questioning adolescents in the United States. Arch Suicide Res 2021 August 24 (Epub ahead of print).
Image Credits: New England Journal of Medicint