Boston Children's Hospital faces threats over gender-affirming care

Far-right activists have unleashed a torrent of threatening calls and emails against Boston Children's Hospital over its health care services for transgender youth — the latest in a broad effort against those who offer gender-affirming care.

Driving the news: The hospital is boosting security and working with law enforcement after receiving a barrage of online complaints and threats about its program for treating trans and nonbinary youth.

• The program also offers genital surgeries for patients ages 18 and up. Far-right influencers and their followers are falsely claiming doctors are performing these surgeries on minors, particularly young children.
• U.S. Attorney for Massachusetts Rachael Rollins issued a statement saying the Department of Justice will ensure "equal protection of transgender people under the law," and urged people to report potential hate crimes to the office's new hotline, 1-83-END-H8-NOW.

What's happening: Attacks on the hospital crescendoed after Libs of TikTok, a popular far-right social media account, posted a video last week to its 1.3 million followers falsely claiming the hospital "is now offering 'gender-affirming hysterectomies' for young girls."

• The hospital refuted those claims, and said in an email to Axios that the attention has sparked "hostile" online messages, "including threats of violence toward our clinicians and staff."
• Libs of TikTok has made similar claims about a Nebraska children's hospital, and has since targeted Phoenix Children's Hospital.

Why it matters: Massachusetts' strong protections for transgender youth have made the state a target for people who oppose gender-affirming care at a time when other states have passed laws restricting such treatment.

• Moira Szilagyi, president of the American Academy of Pediatrics, wrote in a blog post last week that laws restricting gender-affirming care and criminalizing pediatricians who provide it have a "chilling effect" for those seeking and providing care.
• "The people who suffer the most from this discrimination are of course the children and teens just trying to live their lives as their true selves," she wrote.

What they're saying: "If there's any place you would think is sacred in political or social life, it would be a children's hospital that treats children with cancer and severe illnesses," Alejandra Caraballo, an instructor at Harvard Law School's Cyberlaw Clinic, told Axios.

• She added that the tactic is "exactly a page out of the anti-abortion playbook," which she noted has led to abortion providers being murdered.

The other side: Libs of TikTok declined to comment.

Zoom in: The American Medical Association and other major medical groups have endorsed gender-affirming care.

• The AMA asked governors last year to oppose legislation in their states limiting transgender health care for youth, calling it "medically-necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people."
• At least 16 studies through January 2022 suggest that gender-affirming medical care results in positive mental health outcomes.

Be smart: Doctors do not perform genital surgeries on young children; patients seeking those surgeries must be at least 18 in nearly all cases.

• Children approaching puberty might seek medicines (known as puberty blockers) that block testosterone and estrogen to delay their bodies from developing, but this is reversible.
• Older teens who meet certain requirements can obtain cross-gender hormones (some have permanent effects, while others are reversible), an option that doctors typically turn to before considering gender-affirming surgeries.

Opponents of gender-affirming care have falsely said children are getting genital surgeries, which has snowballed into the far right claiming that "genital mutilation" and "grooming" are happening, said Jack Turban, incoming assistant professor of child and adolescent psychiatry at the University of California San Francisco.

• "One political strategy has been to conflate what medical or surgical interventions are considered for different age groups or stages of development," Turban told Axios.

Between the lines: Far-right accounts online falsely accused Boston Children's Hospital of giving children vaginoplasties, a surgery used to construct a vagina for transgender women, and shared a factsheet about the procedure.

• The factsheet stated patients between ages 17 and 35 are eligible, but Boston Children's Hospital told Axios the document was outdated and unclear.
• "For surgical consultation, you must be 17 years of age and between 18 and 35 years of age at the time of surgery," the hospital said. It has since updated its website to reflect those protocols.