Harassment prompts children’s hospitals to strip websites, threatening access to gender-affirming care

Children’s hospitals that have been targeted on social media for providing gender-affirming care — and even some that haven’t — are stripping information about those services from their websites. Advocates fear the changes could make it even harder for transgender adolescents to get care.

Though the harassment has been most pronounced at Boston Children’s Hospital, right-wing pundits have singled out at least 20 other children’s hospitals on social media. All but three have modified the information that’s available about gender-affirming care for their patients, often by removing information about physicians or the services offered, according to a STAT analysis of their websites.

Doctors and advocates say they’re concerned the changes will prevent some transgender adolescents from learning about the care that’s available locally. Though advocates speculated that hospitals might be taking down information to keep their employees safe, they also said the effect is to eliminate reputable sources of information about gender-affirming care in an internet landscape where misinformation runs rampant.

“It’s very concerning,” said Eli Erlick, co-founder of Trans Student Educational Resources and a trans woman who received hormone therapy from a children’s hospital as a minor. “By the different hospitals responding by removing information, the far-right pundits have already succeeded by unfortunately potentially preventing trans youth from accessing necessary medicine.”

It’s one of several ways this fraught, at times dangerous, environment could make it even more difficult for transgender and nonbinary adolescents to obtain necessary services. Patients also may not feel safe visiting hospitals. Their parents may have second thoughts. Providers might stop offering services.

“Those types of attacks send messages to young people everywhere, not just specifically where they’re happening, that they’re not safe,” said Meredithe McNamara, a pediatrician and assistant professor of pediatrics at Yale School of Medicine. “That they’re not welcome and that there are people out there that hate that they exist. That sends such dangerous messages at such a pivotal period in one’s cognitive and social development.”

STAT reached out to 40 children’s hospitals to ask whether they’d experienced harassment and, if so, how they responded. None of the hospitals agreed to interviews, citing the desire to stay out of the spotlight and keep details about their security precautions under wraps.

Compared to the difficulties and barriers that transgender people face when looking for gender-affirming care — and increasing challenges to hospitals that could provide that care — changes to websites may seem like a less significant effect of harassment.

But experts say the material found on hospitals’ websites can actually influence whether someone feels comfortable seeking care that they need in the first place. And hospitals’ gender program websites are important sources of information for people who need services, so removing information logically poses a barrier to access, said Joshua Safer, executive director of the Mount Sinai Center for Transgender Medicine and Surgery.

Safer, an endocrinologist, said he’s especially worried about transgender youth who don’t yet feel safe at home and search the internet for credible resources.

“I am then made further nervous if the most reputable resources are no longer visible,” he said.

Experts said that hospitals must balance two critical priorities: the safety of their staff and their responsibility to communicate with the public. Most said removing information about specific health care professionals could be acceptable in the face of threats. That said, they were less comfortable with hospitals removing information about health care services.

“I think there is a balance,” said Amanda Yarnell, senior director of the Harvard T.H. Chan School of Public Health’s Center for Health Communication. “You want to make sure patients feel seen and can access care. But at the same time, you want to make sure that you’re safeguarding the staff that provide that care so you can continue doing so even in the circumstances today.”

Removing too much information comes with its own risks. Taking down an entire site “can oftentimes make the story even bigger,” noted Alejandra Caraballo, a trans rights advocate who is also a clinical instructor at the Cyberlaw clinic at Harvard Law School. “Then it invites accusations by bad-faith actors that they’re hiding something. And often, they’re acting to protect the providers and patients.”

At least 21 hospitals have recently made changes to the sections on their websites describing their gender-affirming care services, out of a STAT analysis of the websites of 34 hospitals across the country. (Some of those differences may not have been motivated by harassment; websites change for a variety of reasons, including routine maintenance — or lack thereof — or changes to a hospital’s operations or staff.)

The modifications they made varied widely. About a quarter of those 34 hospitals removed information about specific doctors, therapists, and other personnel, while others removed information or entire web pages about gender-affirming care. Others added paragraphs that seemed intended to clarify the kinds of services the hospitals offer, in response to false accusations on social media.

One New England hospital removed testimonials from previous patients, while another scrubbed the name of the gender clinic’s coordinator and the facility’s address from its website. A hospital in the Midwest took a similar approach, removing the names of psychologists and social workers who worked at the gender clinic as well as the name and contact information of the person who coordinated training for medical students and residents. (The coordinator’s last name has also been removed from other areas of the website.)

Three hospitals removed entire pages about their services, and three more removed information about what time slots were available for appointments and the location of facilities. Two made educational YouTube videos private.

Vanderbilt University Medical Center in Nashville, for example, dismantled the web page for its Clinic for Transgender Health following a cable news segment and social media posts that cast the program in a negative light. (VUMC has since stated that the segment and posts misrepresent facts about the care it provides.) As of Thursday evening, the page was back up.

As a group, hospitals targeted on social media seemed more likely to change their websites than those that were not. Seventeen of the 20 hospitals that had been specifically named in harassing tweets online had made changes, compared with 5 of the 14 that had not been specifically named in tweets.

Six children’s hospitals decided to add material to pages describing the gender-affirming care they offered. On Penn State Health’s webpage, for example, a newly added section states that the hospital’s services are in line with several professional organizations’ standards of care. “We are committed to protecting the privacy and dignity of patients receiving gender-affirming care and counseling and their families. Penn State Health does not permit intolerance directed at any individual patient, family member or caregiver based on aspects of diversity such as race, ethnicity, gender identity or religion,” it adds.

“We routinely evaluate and update content on patient-facing web pages — including the one you reference — to ensure the information is timely and accurate,” a hospital spokesperson told STAT.

Even at institutions that haven’t been threatened, staff are looking for ways to feel safer. At Safer’s center — which he was not aware of being targeted — a handful of caregivers in the gender-affirming care program have had their photos removed from the website.

Communities expect hospitals to show compassion for their patients and take stands on key issues, said Jon Pushkin, president of Pushkin PR, which specializes in crisis and health care communication. Taking information off of websites could send the opposite message.

“In general, it’s not a smart strategy to constantly be changing what information you provide to the public based on politics or other kinds of things you might be concerned about,” Pushkin said.

That strategy could even have long-term ramifications for people who need other health care that becomes controversial, said Jessica Fishman, the director of the Message Effects Lab at the University of Pennsylvania’s Annenberg School of Communication and Penn Medicine.

“If this kind of silence becomes common, it could be ingrained into the institutional practices and become self-reinforcing, which would be unfortunate,” she said. “Because if [that happens], every time a type of care is politically sensitive – whether it’s abortion or gender related care — the information available to the public will become more and more restrictive.”

Advocates’ concerns about how the ongoing harassment could disrupt care go much further than website changes.

Lots of parents need time to accept their transgender kids. Adding fears about safety on top of that could be enough to make parents think twice about bringing their children in for treatment, said Chris Barcelos, assistant professor of women’s, gender, and sexuality studies at the University of Massachusetts Boston. Parental consent is required for the majority of medical services until the age of 18 in most states.

There’s also the question of whether the harassment will cause doctors, hospitals, and clinics to stop providing gender-affirming care out of fear, or to avoid the negative attention, similar to what’s happened with abortion providers, Barcelos said.

The University of Oklahoma Medical Center, for example, said it plans to stop offering some gender-affirming services after state lawmakers threatened to withhold millions of dollars in funding.

There’s already a dearth of physicians trained to provide gender-affirming care, said McNamara, the Yale pediatrician. In her experience, wait lists for care at gender clinics can run between 6 to 12 months.

Advocates are also concerned about harm to transgender adolescents’ mental health, much like when legislation is introduced seeking to ban gender-affirming care for people under 18.

“If it’s bad enough for this to happen to children’s hospitals, imagine how bad it is to exist as a trans or nonbinary young person in today’s social climate,” McNamara said.

Erlick said she feels lucky to have transitioned in the late 2000s, as the landscape has become increasingly stigmatized since then.

Growing up in rural Mendocino County in California, Erlick said it was difficult to learn about gender-affirming care. When she began to transition in her early teens, she drove three hours to a children’s hospital where a doctor prescribed her estrogen and testosterone blockers. Before that, she’d driven five hours to a Planned Parenthood clinic, only to learn it did not provide hormone medications to patients under 16 at the time.

“Transitioning as a young person can be very stressful,” Erlick said. “It can be hard.”

The vast majority of health care providers are holding firm in their support for transgender youth and finding creative ways to ensure they are safe and cared for, said Sam Ames, director of advocacy and government affairs for The Trevor Project, a nonprofit focused on LGBTQ+ youth suicide prevention. The Trevor Project operates a 24/7 crisis line staffed by counselors.

Much of the harassment is based on misinformation, such as the suggestion that hospitals routinely perform genital surgery on children or that doctors urge children to undergo such surgeries. Genital surgeries on minors are very rare and go against widely accepted medical guidance, although chest surgeries are sometimes performed on patients younger than 18.

The World Professional Association for Transgender Youth uses scientific evidence to set standards of care for medical providers who treat transgender and gender nonconforming people. The current guidelines say adolescents may be eligible as soon as puberty begins for medications that delay the physical changes of puberty by suppressing estrogen or testosterone production. After a few years, the next step is either feminizing or masculinizing hormones.

The guidelines say genital surgery should not happen until patients can legally make medical decisions, which is 18 in most U.S. states. Chest surgery could happen earlier, per the guidelines.

Despite some opposition to gender-affirming care before age 18, research has shown it dramatically lowers the risk of suicide. Having received puberty blockers or hormone therapy correlated with 73% lower odds of suicidality over a 12-month period, according to a 2022 study of more than 100 transgender and nonbinary youth ages 13 to 20.

“This type of medication is health care and it’s in some cases life saving health care and really important for teenagers to be able to access,” said Angela Kade Goepferd, medical director of the Gender Health Program at Children’s Minnesota. At Children’s Minnesota, parental consent is always required for gender-affirming care when patients are under 18, unless they have been legally emancipated from their parents, they said.

When it comes to keeping staff and patients safe, some providers say they’ve turned to Planned Parenthood for guidance. Marilyn Hollier, a consultant with Security Risk Management Consultants, used to work for the reproductive health provider, and said some of the measures its clinics use could apply elsewhere. For example, it’s always important to control access by having a checkpoint where visitors are screened and badged. Many hospitals started doing this during the Covid-19 pandemic.

Hollier also recommends securing waiting rooms from the care areas, putting protective barriers in front of check-in staff, and installing panic buttons. She also thinks gender programs could benefit from Planned Parenthood’s approach of having volunteers escort patients from their cars into the building, sort of like a “welcome wagon.”

It’s also important that hospitals address the fear that threats can prompt among staff, as that presents a patient care risk, said former AdventHealth security administrator William Marcisz.

“When you have health care workers who are focused on not getting shot at work, maybe their head isn’t in the game and they’re not focused on caring for patients,” said Marcisz, president of Strategic Security Management Consulting. “That could translate to medical errors.”

Marcisz counseled hospitals during the Covid-19 pandemic that were getting threats because of a false conspiracy theory that they were harvesting patients’ organs to sell abroad. He also worked with a Florida hospital where an employee’s disgruntled ex-boyfriend showed up with a gun. Both cases caused a lot of fear among employees, and the hospitals spent tens of thousands of dollars on protective services for staff plus security officers and attorneys.

Caraballo, the advocate and cyberlaw expert, said that hospitals and clinics may also want to consider implementing additional digital security practices. That could mean giving staff access to services that remove personal information from the internet or setting policies about how to respond to future threats or harassment.

Advocates don’t think it’s a coincidence the attacks are happening in the run-up to a major election in November. Many view them as a tool for political gain. Goepferd, of Children’s Minnesota, also said she thinks the new levels of vitriol around gender-affirming care are related to the Supreme Court’s overturning of Roe v. Wade, which took protections away from reproductive health care providers.

“It feels as if in some ways a door has been opened to attack health care providers,” she said, “whether it’s for providing reproductive health care or gender-informed health care.”