Alabama doctor: ‘Panicked energy’ at clinic in last days before transgender youth treatment ban

University of Alabama at Birmingham Hospital and Children's of Alabama buildings are seen Friday, May 6, in Birmingham, Alabama. The hospitals serve a number of transgender children and young people around the state. File. Ruth Serven Smith/AL.com

University of Alabama at Birmingham Hospital and Children's of Alabama buildings are seen Friday, May 6, in Birmingham, Alabama. The hospitals serve a number of transgender children and young people around the state. File. Ruth Serven Smith/AL.com

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Dr. Hussein Abdul-Latif now regularly clocks 14-hour days as he tries to squeeze in appointments with patients during the last days Alabama allows gender-affirmimg care for transgender children.

He and his colleagues at the University of Alabama at Birmingham’s Gender Clinic see children and adults who have gender dysphoria. They provide counseling and courses of treatment, which can include medication. Over the last two weeks, they have contacted about 100 recent patients to make sure they have prescriptions they need to maintain treatment in the next year.

Beginning May 8, unless a federal judge takes action, under a new law Alabama health care providers could face criminal penalties if they continue to prescribe or administer hormone treatments or puberty blockers to minors. Even if the judge pauses enforcement, though, the law has impacted his clinics’ ability to provide care, Abdul-Latif said.

“The law has really intimidated the clinic even before it goes into effect,” he said. “Nurses came into my office crying when the law first was signed, saying I don’t want to go to jail. Am I liable by triaging patients for you to see?”

There is a “panicked energy” among parents and an urgency to get appointments before Sunday. Parents are asking for prescriptions to be transferred to other states, and for help mapping out the future of their child’s treatment should the judge decide not to issue an injunction in the coming days, he said.

He saw eight patients this week and 14 patients last week where it is typical to see only one. Patients administer their treatments at home and don’t need to come into the clinic unless it’s for an evaluation or counseling with a psychiatrist.

But many families needed assurance, one mother saying she hadn’t slept in three nights because she worried her daughter, who is six months from turning 19, would have to go without estrogen until her birthday.

“Usually the first question during an appointment is how are you doing? Or how can I make your life better? Now, the first question is, where do we go from here?” he said.

A ticking clock

On April 8, Governor Kay Ivey signed the Alabama Vulnerable Child Compassion and Protection Act into law, along with a bill to restrict transgender students from using school bathrooms and locker rooms that align with their gender identity.

“There are very real challenges facing our young people, especially with today’s societal pressures and modern culture. I believe very strongly that if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl,” Ivey said when signing the law. “We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life.”

U.S. District Judge Liles Burke is hearing from witnesses in Montgomery this week in the case of Eknes-Tucker v. Ivey, where families of transgender minors, a doctor, psychologist and pastor are seeking an injunction on the ban before it takes effect on Sunday. Abdul-Latif is not a plaintiff in the lawsuit.

Puberty blockers and hormone therapy are considered safe and effective “evidence-based care” for children and adults, in appropriate situations, according to the American Academy of Pediatrics. Gender-affirming surgeries for minors are not performed in Alabama.

Many of Abdul-Latif’s patients were initially referred to him by the psychiatric unit at UAB hospital, where they were admitted after suicide attempts. According to the Trevor Project, a national LGBTQ youth advocacy and suicide prevention organization, their suicide crisis line in Alabama supported more than 2,600 crisis contacts from LGBTQ young people who reached out over the last year, though not all related to the laws.

“Recent political attacks aimed at transgender and nonbinary youth have not only threatened their access to health care, support systems and affirming spaces at school, they’ve also negatively impacted their mental health,” said Jonah DeChants, research scientist at The Trevor Project, in a recent report.

Some patients were referred to Abdul-Latif’s clinic because they’d discovered that eating disorders stop menstruation.

“Some kids will go to very dangerous lengths to control their dysphoria,” he said.

In the 48 hours after the legislation was passed, Abdul-Latif said there was a “big uptick” of visits to the Emergency Room at Children’s of patients who were presenting suicidal ideations.

“There is high anxiety among patients,” he said of the mental health impacts of recent legislation.

One 16-year-old came to Abdul-Latif this week to try to start treatment before the law goes into effect.

“I had the painful task of writing to him that if the law takes effect, I cannot prescribe you medications but I’d love to see you and help in any way,” he said. “That teenager was gracious and patient, saying they still really want to see me even if you don’t give me the prescriptions until I turn 19. It was a tremendous degree of maturity, which is different from the picture that the writers of the law are painting of these patients.”

For now, he can only predict a shift to counseling services and tell existing patients their refills have been called in.

Calling in prescriptions is usually part of the nurses’ jobs, but many of them have expressed fear of going to jail if they do so, so Abdul-Latif has taken on the task himself.

He said he tried to assure nurses that these treatments were still legal, but one employee left the unit altogether.

His new task of calling in prescriptions has been made harder by the pharmacies that will not fill them, erroneously saying it’s illegal to do so.

One father who tried to pick up his son’s testosterone on the Friday morning before the ban went into effect, was refused by his pharmacist.

“Please can you call a pharmacy in Georgia or Mississippi and I will drive there,” he told Abdul-Latif.

It was not clear what pharmacy made the error, but a CVS spokeswoman said the company has not told Alabama pharmacists to stop providing medications yet. Walgreens did not respond to a request for comment.

“We do not have a policy that prohibits our pharmacists from dispensing gender-affirming medications for minors in Alabama,” said Amy Thibault, of CVS.

The last few days have taken a toll on Abdul-Latif. When he’s not seeing patients or dealing with pharmacies, he is watching the news to see if there are any updates on the court hearing.

He said he is trying to focus on his current patients instead of thinking about potential consequences of continuing treatments past Sunday.

“My worry is that I will hit a Post Traumatic Stress Disorder in a few weeks,” he said. “It’s very painful to think that if I withhold care, I am harming my patients.”

The Trevor Project’s crisis line can be accessed 24/7 at 1-866-488-7386 or by texting ‘start’ to 678-678.

Savannah Tryens-Fernandes is a child health and wellness reporter for The Alabama Education Lab at AL.com. Her position is supported through a partnership with Report for America. Contribute here.

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