Pgh Lesbian Correspondents

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As the American Psychiatric Association notes, it is not being LGBTQI+ that increases your risk of having mental health issues such as depression, anxiety, PTSD, suicidal ideation. It is the bullying, harassment, and overt discrimination that LGBTQI+ youth face that lead to those mental health outcomes whether from home or at school.  

After the brutal murder of 14-year-old trans girl Pauly Likens in Mercer County this summer, I was struggling mightily with how to move forward with my work. The story of how this interview came to be is convoluted, but I put on my blogger hat and asked Admiral Rachel Levine, Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS), to complete an email Q&A. As a trans woman, a pediatrician, and a Pennsylvania native, it felt right to ask her to help describe a path forward.

It was a long shot, but it worked. I’ve never interviewed someone at her level of government before so it was definitely eye-opening. I’m immensely grateful to Admiral Levine and the other folx who made this happen. Publishing this during the month of the Trans Day of Remembrance seems fitting given the nature of our questions.

Please note that we did not discuss specific situations, including the killing of Pauly Likens, but I think the conversation shines a light on many situations involving trans youth and the very real violence they experience every day in this world. My work memorializing trans victims of violence has exposed me to an array of concerns around youth, especially those in state care.

It is an honor to publish this Q&A.

Name: Admiral Rachel Levine, M.D.

Pronouns: she/her

Position: Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS)

We are documenting an uptick in fatal violence targeting trans youth. Since 2020, I’ve identified 36 youth, 21 and under, many involved with child welfare agencies.  What can HHS do to ensure each state agency is trans and queer competent?   

All children deserve safe, loving homes with the supports systems they need to be successful. However, we know that transgender youth are over-represented in foster care and are more likely to experience higher levels of bully and harassment in care.  

·       The Administration for Children and Families (ACF) is making great strides to protect LGBTQI+ youth across the United States.  

·       In April 2024 the U.S. Department of Health and Human Services (HHS), through ACF, finalized a policy that strengthens protections for youth in foster care by clarifying how states must meet their statutory requirements to appropriately serve LGBTQI+ children in foster care. 

·       This final rule makes clear that all children in the child welfare system, including LGBTQI+ children, are entitled to protections against harassment, abuse, and mistreatment, regardless of their placement. Additionally, this final rule safeguards youth from the harms of conversion therapy and specifies that as part of meeting the existing statutory requirement to provide safe and proper care for all children in foster care, state child welfare agencies must ensure that LGBTQI+ children have access to specially designated foster care placements. 

Here in Western Pennsylvania, we’ve lost three young trans people since 2021. One shooting death remains unsolved. What impact do these trends, including the lack of closure, have on public health?  

Fear of violence is a threat to the health and well-being of transgender Americans.  

·       A recent CDC Mortality and Morbidity Report supplement found that transgender and questioning high school students experiences higher rates of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing than cisgender students. Transgender students also experienced less school connectedness than their cisgender peers.  

·       As the American Psychiatric Association notes, it is not being LGBTQI+ that increases your risk of having mental health issues such as depression, anxiety, PTSD, suicidal ideation. It is the bullying, harassment, and overt discrimination that LGBTQI+ youth face that lead to those mental health outcomes whether from home or at school.  

·       It is critically important that everyone become familiar with SAMHSA’s 988 program, which launched in 2022. Simply dialing 988 will connect a person in need with a suicide and crisis lifeline. Suicide prevention for LGBTQI+ youth is a national priority. The lifeline provides a “click 3” program that allows people to click 3 to be directed specifically to LGBTQI+ trained counselors. 

The amount of disinformation about trans kids and trans teens is daunting. How do we help the skeptical public to believe in health science over the science of politics?  

· HHS exists to provide scientifically supported information to those who can use it to save lives and improve public health. In my estimation, this part of our mission has never been more in demand or more under attack. 

·       We need to be able to have conversations that question the assumptions underlying today’s attacks. We can help create the social atmosphere, the academic atmosphere, and the professional atmosphere we all seek by building it one step and one interaction at a time. In order to make that possible, not just for ourselves but for those who come after us, we need to advocate not just for our legal rights but for our dignity. Quite simply, we need to educate the public in as many forums as possible. 

·        Being an ally to the transgender community involves listening, learning, and taking action to build relationships based on trust and respect.  

·       First, educate yourself. Learn about the history and terminology, as well as the social issues the community faces.  

·       Second, be aware of your biases. Question stereotypes and negative assumptions and acknowledge your own prejudices. 

·       Third, listen. Give people your full attention and respect their perspectives. When someone says they are experiencing discrimination, listen to them and take what they say seriously. 

·       Fourth, be respectful. Do not assume you know best, and don’t take credit for the work of marginalized people. Center people who are impacted by asking them how they are doing and listening to their responses. Apologize if you unintentionally cause harm.  

·       Last, take action. Speak out against discrimination, and try to change oppressive systems. For example, if you’re leading a meeting and notice that some people are getting more than their fair share of the talking time, you can ask questions and to give everyone an equal opportunity to speak. 

There’s a notable explosion in anti-trans activity on the state level targeting youth. How can the federal government respond to protect these children?  

At HHS, Secretary Becerra and I are committed to doing everything we can to help vulnerable patients and their families get the medical care they need, no matter where they live and no matter their life circumstances. 

·       We believe medical and political discrimination against LGBTQI+ people have to end.  

·       President Biden signed a historic Executive Order on Advancing Equality LGBTQI+ Individuals, establishing that it is the Administration’s policy to defend the rights and safety of LGBTQI+ individuals. In the Executive Order, the President directs relevant agencies to: address the dangerous and discredited practice of so-called “conversion therapy;” end disparities that LGBTQI+ children and parents face in the child welfare and foster care system; ensure that federal benefits programs are equitably accessible to LGBTQI+ households; address the overrepresentation of LGBTQI+ youth and households among those experiencing homelessness; and increase federal support for programs that offer family counseling and support to reduce the risk of family rejection of LGBTQI+ youth. 

·       Also, in keeping with our multi-disciplinary approach to public health, HHS has been part of an interagency team, alongside the Department of Homeland Security and the Department of Justice, to ensure safety for LGBTQI+ communities in light of increased violence and threats. 

·       The President delegated bold deliverables to HHS, and we have been working hard to meet the challenge and to advance access to care for LGBTQI+ people. 

There are reports of families of trans people fleeing ‘unsafe’ states (most prominent examples are TX and FL) largely due to limits on healthcare access. What is HHS doing about this? 

This has been a hard time for transgender people and trans youth in particular, as well as their families and medical providers. These ideological attacks in numerous states are not grounded in science or evidence. Gender affirming care is essential health care. Gender affirming care is mental health care. Gender affirming care is quite literally suicide prevention care. It is based on decades of study. It is an evidence-based standard of care practice. 

·       We have medical refugees in the United States who have to leave their state to get the care they need and deserve. 

·       The decisions made by their state, their city, and their municipality determine peoples’ health and their quality of life. This impacts both their physical and mental health.  

·       At HHS, Secretary Becerra and I are committed to doing everything we can to help vulnerable patients and their families get the medical care they need, no matter where they live and no matter their life circumstances.. 

·       It is absolutely wrong to stand in the way of any person and their family’s access to medical care, including gender-affirming medical care, that can improve their health and their quality of life. 

·       HHS’ Office of Civil rights is tracking complaints and providing technical assistance arising the LGBTQI+ individual regarding accessing to affirming health care. 

o   Our new Grants Non-discrimination Rule ensures that HHS grantees do not discriminate against people based on their sexual orientation or gender identity. 

o   OCR has also updated its compliant portal by expanding to include 15 languages,

Your career trajectory is notable and important to share with all trans youth. What do you say to trans and queer children who don’t have as many visible representations of life and career opportunities such as yours in pediatric medicine?   

Do not live your life with fear. By embracing my true self, I have been able to accomplish so much more than living my life in fear. To sum it all up, my recommendation is to plan big.  Have big goals for your career. And know that life may take many different turns and send you on many unexpected paths. 

·       When I transitioned, I was fortunate enough to work at Penn State College of Medicine and the Hershey Medical Center. I was not just accepted there. I was welcomed. The diversity I brought to the school of medicine and the medical center was seen not as a problem to be solved, but as an occasion for celebration. I am a strong supporter of diversity, equity, inclusion, and accessibility even though it has been criticized lately. It creates a rich tapestry that weaves together to enhance any organization.  

·       I am in my fourth year as your Assistant Secretary for Health. I was honored to be the first transgender person to receive Senate confirmation, and the first transgender person to become a four-star admiral. I said at the time that I hoped my appointment would pave the way for others to follow in my footsteps so that we will have a future where our leadership is more reflective of the people that we serve. I am proud to say that it has. We are seeing a more diverse workforce, where diversity, equity, inclusion and accessibility are celebrated, and we are seeing a future where diverse ways of thinking and overcoming challenges are making our world a better place.  

All of these topics – allyship, data management, investigations, unsolved cases, even hope – are tied to our individual and collective health. Why are we so reckless with our health? 

Working to advance health equity means we recognize that our health outcomes are greatly impacted by the social conditions of our lives, in public health we call that the social determinants of health. We do want to promote healthy behaviors, but we also want to address the structural inequities that are a significant driver of health inequities.

We can help create the social atmosphere, the academic atmosphere, and the professional atmosphere we all seek by building it one step and one interaction at a time. In order to make that possible, not just for ourselves but for those who come after us, we need to advocate not just for our legal rights but for our dignity. Quite simply, we need to educate the public in as many forums as possible. 

Thank you, Admiral Levine.

Learn more about local Trans Day of Remembrance events throughout the region.