When children’s hospitals around the country were subject to threats and harassment in 2022 over misconceptions about gender-affirming care services, many of them responded by stripping information about the care from their websites. Two years later, new research shows that few adult and children’s hospital websites share information about LGBTQ+ services and policies.
That finding was part of a broader study by a group of students at Harvard Medical School who analyzed the websites of 300 adult hospitals and 46 pediatric hospitals to get a full picture of what information hospitals provide online for sexual and gender minority patients. Overall the results were “very concerning,” said Sahil Sandhu, a fourth-year medical student and first author on the study, published Monday in JAMA.
About 25% of the adult hospitals posted resources such as tips, explanatory articles, or links to national or local organizations for LGBTQ+ people; 25% included a directory (like a “find a doctor” page) specifically designed to help users search or filter for clinicians providing LGBTQ+ services or inclusive care; 26% included information about medical services, clinics, or centers for queer people.
Pediatric hospital websites provided more information: 59% posted resources, 35% had inclusive directories, and 61% had information about services.
Sharing information on hospital websites is “a low-touch intervention that can have high impact,” said José Bauermeister, director of the Eidos LGBTQ+ Health Initiative at the University of Pennsylvania, who wasn’t involved in the study.
Queer people already avoid or postpone medical care at high rates due to discrimination or mistreatment. Showing that LGBTQ+ care is a priority can help signal a friendly, safe environment, Bauermeister said. These sites could be the first place a patient goes to learn about gender-affirming care like hormones, surgery, voice therapy, or even HIV treatment, preventative medications, LGBTQ+ fertility options, and more.
“Adult hospitals could learn a lot from pediatric hospitals,” Bauermeister said. The study looked at standalone children’s hospitals, which the authors noted are often in major cities with more progressive policies. That, along with greater attention on and demand around LGBTQ+ services for youth generally, could play a role in the increased representation.
The study authors were more encouraged by the fact that 77% of adult hospital sites and 78% of children’s sites posted nondiscrimination policies that were inclusive of sexual and gender minorities.
“That was the only outcome that we thought was relatively good,” Sandhu said. The Affordable Care Act requires that hospitals have nondiscrimination policies, but whether that includes protection based on sexual identity or gender expression often changes as presidents move in and out of the White House.
The research was modeled after a paper published last year in the Annals of Internal Medicine analyzing the information about abortion available on hospital sites. As with reproductive care, the availability of gender-affirming care and other LGBTQ+ health services varies widely depending on what state a patient lives in.
The study found that websites for hospitals in states with negative policy environments for sexual and gender minorities (according to the Movement Advancement Project) were less likely to have friendly provider directories or information about services available as compared to those in states with highly protective policies.
It’s unclear how often hospitals receive explicit threats in connection with gender-affirming care programs, but politicians and commentators continue to disparage the care. Former president Donald Trump has called gender-affirming care “child abuse,” and pledged to cease all federal programs that promote transgender health if he is re-elected this year.
“The invisibility is the point, to a great extent, of these threats,” said Alex Keuroghlian, a psychiatrist and associate professor at Harvard Medical School who worked with the students on the JAMA study. Keuroghlian also directs the Psychiatry Gender Identity Program at Massachusetts General Hospital, and said that even in a state like Massachusetts with several laws protecting gender-affirming care, MGH’s program became much more cautious about what information it shared online after threats began in 2022.
A new project online called “Stop the Harm” demonstrates the risk hospitals have taken when advertising LGBTQ+ health care, specifically transgender health services. The project tracked hospitals nationwide that provide gender-affirming care to youth, identifying a “Dirty Dozen” list of “worst-offending children’s hospitals promoting sex change treatments for minors.” Part of the criteria used to make the ranking was each hospital’s level of “activism and public support for gender ideology,” according to the group’s site.
“It stands to reason that any efforts to continue to provide this care or to advertise this care, will encounter more adverse repercussions, hostility, and even legal consequences,” Keuroghlian said. “The threat is very real.”
The stakes are high as institutions search for the balance between keeping staff and patients safe from threats while also providing enough information so that people can access care. To get it right, future research should explore the motivations and barriers for hospital administrators who decide what to share online, as well as how patients actually navigate hospital websites and how that translates to their real experiences with health care, Bauermeister said.
“I think this [paper] sets the stage for perhaps a larger study to look at the true national representation and prevalence of all hospitals and healthcare systems,” he said.
In the meantime, he hopes the research will spur health systems to reassess their own websites and make sure there’s information available on LGBTQ+ health care for those who need it.