10/01/2021

Healthcare Is Hard Enough To Get. If You’re A Trans Youth, It’s Even Harder

12:03 minutes

A black young transgender woman looking at her face in the bathroom mirror at school.
Credit: Zackary Drucker/Broadly’s Gender Spectrum Collection

Healthcare can be difficult to access for anyone—that’s been made clear during the COVID-19 pandemic. But for transgender youth, the barriers are exponentially higher. A new study from the journal JAMA Pediatrics shows that trans youth don’t get the care they need because of a variety of obstacles. Those range from laws that prevent them from advocating for themselves, to stigma from doctors.

Joining Ira to talk about this story and other big science news of the week is Sabrina Imbler, science reporting fellow for the New York Times based in New York City. Ira and Sabrina also discuss the massive undertaking of COVID-19 testing in school districts, and the impacts ivermectin misinformation is having on the livestock and veterinary industries.


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Segment Guests

Sabrina Imbler

Sabrina Imbler is a Science Fellow at the New York Times in New York, New York.

Segment Transcript

IRA FLATOW: This is Science Friday. I’m Ira Flatow. This morning, drug maker Merck says it has an experimental pill that effectively combats the COVID-19 virus, cutting the risk of death or hospitalization in half. It’s made for people who have become ill from COVID, not a substitute for the vaccine, and has not yet been approved by the FDA. We will have more on this story as it unfolds.

Speaking of health care, we know it can be difficult to access for anyone. And that’s been made clear during the COVID-19 pandemic. But for transgender youth, the barriers are exponential. A new study shows that trans youth don’t get the care they need because of a wide variety of obstacles, from legal barriers to stigma from doctors. Joining me today to discuss this story and other big science news of the week is my guest Sabrina Imbler, Science Reporting Fellow at The New York Times, based in New York City. Welcome to Science Friday, Sabrina.

SABRINA IMBLER: Thank you, Ira. It’s great to be here.

IRA FLATOW: Nice to have you. Let’s start with the story you reported for The Times about the barrier trans youth face when it comes to getting health care. What kind of barriers are we talking about?

SABRINA IMBLER: We are talking about almost every kind of barrier. There are systemic barriers, geographic barriers, family barriers. And these obstacles, they exist both for gender-affirming health care, which for trans youth means puberty blockers or hormone therapy, as well as regular health care, just, like, being seen for an ear infection. And a lot of these exist because young people under the age of 18 are under the age of independent medical consent in most states.

So parents need to be involved with these process. But if a parent isn’t on board with a child’s medical transition, then that transition can’t happen. There are also in insurance barriers. Coverage for gender-affirming treatments can be spotty. Many insurance plans don’t cover puberty blockers. And they’re very expensive if they’re not covered.

And puberty blockers can pause the onset of puberty and give adolescents more time to figure out the kind of puberty they do want to have. There’s also just– there isn’t a lot of research on the long-term effects of gender-affirming treatments on young people. So oftentimes these folks are in a place where they need to make a decision about their medical future without a lot of research to go off of.

One person I spoke with was given different advice from two clinics about how going on testosterone would affect his future fertility. And he ultimately just had to make a gut call, which is never really something you want to do in medicine. And there’s also just the general omnipresent stressor for any trans person going into a health care setting, which is the possibility of being misgendered, such as being called him the wrong name or the wrong pronouns.

IRA FLATOW: I would think that another issue is that doctors who are known to have experience with trans patients get all booked up because there are very few of them.

SABRINA IMBLER: Definitely. It can be hard enough to find a trans-friendly provider in your area, but even harder to find a pediatric endocrinologist, which is the kind of doctor that can prescribe gender-affirming treatments for trans youth. And a lot of this care is actually delivered through pediatric gender clinics, which tend to be located in big cities. So youth that are living in more rural areas often have to travel hours to get this care. And the wait list can be long, 50 to 100 people in certain clinics, which can mean wait times of months.

IRA FLATOW: Mm-hmm. We’ve heard a lot about anti-trans bills in the states over the past few years. Do these play in here, too?

SABRINA IMBLER: Oh, absolutely. Piper, who is a 17-year-old trans girl I spoke with in this story, she lives in Georgia. And Georgia is one of 20 states that has introduced anti-trans legislation that’s specifically targeting young people’s access to gender-affirming care. And this bill didn’t pass, but Piper is planning on leaving the state for college because she fears she won’t be able to get the care that she needs. And that’s not to mention the greater psychological toll of being told you can’t play sports because of your gender, which is something other bills are targeting.

IRA FLATOW: Is there a way that experts are suggesting things change for the better for trans health care?

SABRINA IMBLER: Definitely. There are some immediate suggestions, just like making care a more inclusive experience in a health care clinic. You can ask people their pronouns and their name before they’re seen by a doctor. Once you’re inside the examination room, you can use gender-neutral terminology, such as instead of saying ovaries, you can say reproductive organs. And there are larger issues, like making this health care more accessible for all trans youth, especially youth of color and people living in rural places.

And I guess the last thing that a lot of the young trans people I interviewed expressed a desire for is just more trans doctors, being able to share a life experience with your provider. It takes some of the burden off of you in terms of explaining your body.

IRA FLATOW: Mm-hmm. Interesting story. Let’s move on to a COVID story. Schools have been back in session for a few weeks now. COVID tests are proving to be an issue for some districts. What’s the story here?

SABRINA IMBLER: So Emily Anthes and I wrote a story for The Times about how across the nation, every school district is basically doing it differently. It’s a big policy patchwork. Some districts have robust large-scale testing programs. For example, the San Antonio Independent School District is offering free weekly tests to students and staff, which is a great way of catching spikes before they happen. But other districts, even in the same area, are doing almost no testing.

Some are only testing students who are symptomatic. Some are actually not referring symptomatic students to testing at all. And the government is offering some programs to make this process easier. But districts need to opt in. And many are not opting in or have opted in too late to have the program in place by the time school started.

IRA FLATOW: If every district were to opt in, you’re testing every single person once a week or even more. That’s a huge number of tests you need to process.

SABRINA IMBLER: Absolutely. And even the schools that have these ambitious testing programs, they’re struggling to keep up. A lot of schools are understaffed due to a labor shortage. And at one school that I spoke with, they’re posting positions for school nurses, but no one is filling them.

There are also shortages of testing supplies. And some districts have had to cut down on testing just because they can’t buy enough rapid tests for their needs. And sometimes a curveball just comes. Like, we spoke with a district in New Orleans that was just about to get their testing program off the ground, and then Hurricane Ida hit and closed everything.

IRA FLATOW: Wow. Do we know if testing at schools is working to keep COVID out of classrooms?

SABRINA IMBLER: Well, with some of the districts that we spoke with that are using this robust testing, cases appear to be low. But these situations change weekly. And protocols that work when transmission rates are low become unsustainable when COVID cases rise.

IRA FLATOW: Mm-hmm. Let’s move on to something we’ve talked about on this show a few times, ivermectin. We know that it’s not an effective way to combat COVID-19. And yet many people think it does. And this has led to a shortage for industries that actually need it. Who’s affected most by this shortage?

SABRINA IMBLER: So Erin Wu has this great story for The New York Times about how animal hospitals and veterinary centers are just strapped for ivermectin. And vets use this drug to de-worm animals like chickens, dogs, horses, and snakes. It’s really a staple for people who work with livestock to keep the animals healthy and parasite free.

But these hospitals are running out of ivermectin. In one hospital in Mississippi, there just isn’t enough ivermectin for all the animals. So the vets are only giving it to the exotics, like snakes, and asking dog owners to buy a replacement that just costs so much more.

IRA FLATOW: Wow. Are there alternatives that vets and farmers are using in replacement of ivermectin? You mentioned these alternatives. Is that what you’re talking about? They’re just so expensive?

SABRINA IMBLER: Yeah. There are some alternatives that are approved for dogs, say, but not approved for snakes. But they are more expensive. And they’re also just selling out. So there just isn’t really a reliable supply.

IRA FLATOW: Hmm. Staying in our wormy-like spectrum, let’s talk about solar-powered sea slugs. This is a mind blower. What is a solar-powered sea slug? Does it actually get energy from the sun?

SABRINA IMBLER: Yeah. So Katie Wu has this great story for The Atlantic about how some sea slugs are solar powered, which means that they can actually photosynthesize and convert light energy into chemical energy. And Katie has this great line about how that’s just about the plantiest thing on Earth, which is true. And the slugs are able to do this because they steal the chloroplasts from the algae they eat. And then they store those chloroplasts in their body for long periods of time. And one species she talks about can go without eating its entire life, as long as it just binges on algae just once in its youth.

IRA FLATOW: This is a pretty incredible. Do we know if this skill set could translate to other creatures?

SABRINA IMBLER: Yes, there are some other creatures that are known to steal chloroplasts. They’re single-celled creatures called dinoflagellates. But their chloroplast stealing might represent a different intermediate step towards keeping the chloroplasts more permanently in their cells.

IRA FLATOW: You know what’s interesting is that we had a science fiction writer on a few weeks ago who was writing about colonizing Mars and talking about changing our genes. And one of the genes he wanted to change or add to humans was to put in a chlorophyll gene so that our skin would turn green, and we could use solar energy–

SABRINA IMBLER: I would love that gene.

IRA FLATOW: –on Mars. Would you like– would you volunteer for that?

SABRINA IMBLER: I would definitely volunteer for that clinical trial.

IRA FLATOW: All right. We’ll let you know when it happens. [LAUGHS] Let’s wrap it up with a story about ancient domestication of a creature we wouldn’t dare try this on now. Tell us about the story about a cassowary.

SABRINA IMBLER: Yeah, so I hope I won’t offend bird people. But the southern cassowary is truly just a bird of nightmares. It has this really bright-blue neck and very muscular legs, which I find suspicious in birds. And they’re normally shy and secretive in their native forests in New Guinea and Northern Australia. But they can be very aggressive in captivity, which has led some to nickname them “the murder bird,” as one did technically wound, mortally wound, a Florida man in 2019.

IRA FLATOW: Do they have special skills that they can hurt people?

SABRINA IMBLER: So adults can grow as tall as a person–

IRA FLATOW: No kidding?

SABRINA IMBLER: –which just means they can do a lot of damage. And they have these really powerful feet, which they can use as weapons.

IRA FLATOW: Wow. Do we know how these ancient people pulled this off, this domestication of them?

SABRINA IMBLER: So Asher Elbein has a great story about this for The Times, where he writes that as early as 18,000 years ago, people in New Guinea might have somewhat domesticated these birds by collecting the eggs, hatching them, and then rearing the chicks into adulthood.

IRA FLATOW: And did they farm them, or did they keep them around for what reason?

SABRINA IMBLER: I don’t know for what particular reason. I know that they did eat their meat, and they also did eat their eggs. And young cassowary hatchlings actually imprint on people. So they’re just like little murder bird friends. But once they become adults, they can be trouble. So I don’t know if they would live alongside the adults for too long.

IRA FLATOW: So were cassowaries proto chickens, then, an ancient human society?

SABRINA IMBLER: Probably not. Chickens were domesticated 8,000 years ago, much later than the cassowary. But I feel like there’s a reason we never fully domesticated the cassowary and probably should never try to.

IRA FLATOW: You think? [LAUGHS]

SABRINA IMBLER: [LAUGHS] If you like living.

IRA FLATOW: Yeah. I think I’ll vote for that. I’ll vote for a living instead of cassowaries. Thank you very much, Sabrina.

SABRINA IMBLER: Thank you so much, Ira.

IRA FLATOW: Sabrina Imbler’s Science Reporting Fellow at The New York Times based in New York City. We have to take a break. And when we come back, we’re revisiting the invasive spotted lanternfly. We talked about it a while back. And well, it may be in your neighborhood, so we’ll see. Stay with us. We’ll be right back after this short break. This is Science Friday from WNYC Studios.

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