Practicing Health Care for Transgender Youth

“In medicine,” Adam Briggle writes in “The Heart is Not Neutral” (Issues, Winter 2025), “the view is always from within someone’s body—the view from nowhere cannot be found.” Trained as an environmental scientist, he might seem an unlikely messenger on trans health—but he’s a remarkable one. He’s a science-minded, reality-grounded philosopher drawn to this space because he loves someone who needs this view. I am a physician and the care of trans people is within my scope of practice. I wish that finding the view from within someone’s body was fully realized throughout medicine, but we’re further from that paradise than we’ve ever been.

Over the years, while adapting my practice to political hostility, I’ve come to think of the care I provide as a liquid that I must transfer. Each patient brings their own container to a clinical encounter, a container shaped by their values, goals, experiences, culture, identity, and physical health needs. Those containers have different shapes and spouts. Some are made of a pliable substance that changes over time. Some patients want their containers filled quickly, completely, and some want just a little at a time. Some have wide spouts that are easy to fill, while others have spouts with a tight lid that takes a little work to loosen. It is only by finding the view from within someone’s body that these containers can be comfortably and safely filled.

Just as liquid is a space occupier, it also is a reflector—but it does this well only when its surface molecules are aligned and there are no disruptive outside forces. Thus, the task is to block intrusive forces enough to reflect the non-neutrality of our patients’ lives, bodily and spiritual experiences, suffering and joy, skills and strengths, back to them. If we do not source a liquid that reflects an image that clinicians and patients can both see, and that patients can accept into their container, then care proceeds from nowhere.

When I reflect my gender-diverse patients’ selves and fill their containers, I sit with them in a wondrous space. Everyone deserves this experience, and I’ve never met a patient who feels they don’t. Many are afraid to ask for it. And while I am part of an international community of clinicians who practice exactly this way, medicine’s legacy is prescriptive and standardized.

Briggle talks of how the Cass Review, commissioned by the United Kingdom’s National Health Service, was a vehicle for a health care ban. A ban functions as a type of medical practice, but fills no container and reflects no patient. Have leaders in medicine, with non-malevolent but misplaced intentions, cleared a path for politics to enter health care? I wish it were that simple, but no clinician had a seat at the table when health care became decided by ban. Bans informed by the view from nowhere.

There is dark irony in that people crave the populist mores of trans health in their own care. People who oppose access to gender-affirming medical care want their providers to assume the view from within their own bodies. For their trans neighbors, they want an approach to health care that they do not want for themselves. But no one gets their containers filled or their selves reflected if some expressly cannot.

Meredithe McNamara