For series on gender-affirming care, a reporter seeks to keep trans voices front and center

Published on
May 22, 2024

When I embarked on my reporting for the Center for Health Journalism’s 2023 National Fellowship, I had been a local health reporter for about a year and a half. I hadn’t done much reporting on trans youth and gender-affirming care. But I knew that gender care providers were extremely busy and that so many young trans or queer people seek care that they’ve had to create waitlists, which can span anywhere from three to six months, or more. 

The long waits are just one part of what can be a challenging journey to access necessary medical care, providers told me early on. Insurance denials, political vitriol, bullying and a lack of parental consent can also prevent young people from seeking or receiving gender-affirming care, several trans youth told me.

Given the rising demand for this care, the difficulty queer and trans youth face in trying to access it, and the pressing concerns it raises about health equity, I thought this would be an important topic to tackle. 

There were myriad challenges from the beginning. I was keenly aware of my inexperience, which fueled by self-doubt in the early stages of reporting. Doctors who provided gender-affirming medical care, including puberty blockers and top surgeries, were initially hesitant to talk with me. They were often worried their words would be taken out of context — like they had seen so many other news reports do in the past — or that they would be attacked for their work by those who disagreed with it. Many therapists, community advocates and families with trans youth were also nervous about talking on the record. 

And there’s a lot of misinformation out there — some included in news stories that have made providers, community organizations and trans youth extremely distrusting of journalists. I would have to work through all of this to deliver the project. 

The first big question I faced was how to shape this story. 

It’s impossible to ignore the politics swirling around the issue of gender-affirming care throughout the country. I hear the concerns of parents who want to affirm their kids’ developing gender identities, but aren’t sure how, and want to make sure they’re not rushing into big, medical decisions. There aren’t as many large, peer-reviewed studies about long-term effects of hormone therapy as some families would like to see. 

But I was more interested in first explaining how this type of health care works, why it can be hard to access, and why young people say they need it. The goal, I decided, would not be to explore the merits of these political debates. I understand there can be value in these types of articles, but not every story can capture it all, I realized. This one would prioritize trans voices. 

This decision was a departure from usual journalistic practice. Journalists are generally taught to prioritize every perspective. In journalism school, professors berated us when we only included “one side” of an issue. At my college newspaper, we were required to include at least three interviews in every article and were encouraged to have them represent different points of view.

While those practices are still generally upheld in newsrooms, they’ve become more nuanced. There are instances where we might prioritize the perspective of an under-covered community to build back trust. This was one of them.

It might mean the final project wouldn’t include everything I planned for — ranging from the intricacies of insurance battles to including a greater number of photos — but I was committed to centering gender-affirming providers and young people.

Then, I had to gain the trust of providers and queer and trans youth and their families. With some sources, it took several conversations before they felt comfortable enough to go on the record. But by showing up in person at providers’ speaking engagements, touring local LGBTQ+ community centers, and attending events that trans teens told me were important to them, I tried to show my intent to treat sources’ stories with care and respect.

Prioritizing sources’ comfort also guided the visual side of this project, which became a challenge for me and Daniel Kim, the photographer. Because gender-affirming care clinics were not comfortable with us sitting in on patient consultations, photographing a young person with a provider was not possible. Several youth, especially those under 18, and their families also preferred that their faces not be shown in photos to protect their privacy. In the end, we asked providers and patients what visual opportunities they would be proud to share, and — even if they were tough photo assignments or we wanted more “active” shots — Daniel expertly made it work.

Ashton, one of the teens we talked to, wanted us to photograph one of his drag shows. The shots ended up beautiful and vivid, but even after the project posted, I received some disappointed emails — from those who supported gender-affirming care — about having a drag show represent trans communities, when they felt it was a stereotype that not all trans people identified with. I understood the frustration. It had been on my mind. But Ashton was proud of his performance and thrilled to see his face, done up in drag makeup, on the front page. And I wanted to respect that.

There was also the question of how to convey the host of medical issues.  

At an annual conference for the Washington State Psychologists Association last fall, the topic of gender-affirming care was front and center. One three-hour workshop guided attendees through definitions of gender-affirming care and gender dysphoria, and facilitated discussions about how the room full of psychologists might think more deeply about how they were delivering culturally competent care to queer and trans patients.

“This is the issue of the time,” the facilitator told the room. 

He was met with dozens of questions from workshop attendees. What happens when you take a kid off puberty blockers? Is there liability in providing medical recommendations, especially for gender-affirming care? How do you know if a kid is “just flirting with gender” or if they need medical interventions? 

One of his responses stood out, something he says he asks young patients when they come in immediately asking for medical recommendations: “Help me understand how your life’s going to change when you get the medical treatment you’re looking for.” It’s not an exact science, he said, but he balances trust in his patients when they tell him what they need.

The range of questions at the conference reminded me that, while there are clear, established recommendations for best practices, many in the medical and mental health field are still learning how to best deliver care for queer and trans patients. Every patient is different and might have different needs. There’s no one way to be trans, one 15-year-old told me. 

In the end, it didn’t look quite like the project I had initially set out to publish. That’s common in many months-long reporting endeavors. I was hard on myself about the seemingly obvious shortcomings at first — then I started wading through the avalanche of source and reader responses. Many were angry. Many disagreed with the framing and the angle of my stories about gender-affirming care for youth in Washington state. But many were also kind. Many were grateful. 

The overall response was a reminder that, when tackling hard topics that require an immense amount of emotional sensitivity, not everyone will be happy. The story will change over the course of months of reporting. But to those who found some value in the reporting, the project was meaningful. 

Coverage of this topic should continue to evolve and become more nuanced. One story, or two or five, might not touch on every detail of complicated topics, but as long as we’re listening to the sources we prioritize and allowing them to guide our coverage, we can continue to build trust, open space for more honesty and help tell their stories more accurately.