MUSC to stop providing gender transition treatments to adults

Chase Glenn, executive director of Charleston-based nonprofit Alliance for Full Acceptance, speaks on the Statehouse steps on Wednesday, Feb. 14, 2024. Glenn, a transgender man, spoke against a bill that would ban hormones and puberty blockers for transgender youth. (Skylar Laird/SC Daily Gazette)

COLUMBIA — The Medical University of South Carolina’s health system will stop providing gender transition procedures and hormones for adults due to a new law signed in May, the hospital confirmed to the SC Daily Gazette on Wednesday.

The public medical university, which has not provided transitioning hormones for youth under 16 since 2022 , pointed to a single sentence in the law to explain its decision.

While the law focused on prohibiting gender transition surgeries and hormones for anyone under the age of 18 statewide, it included one line barring the use of public funds “directly or indirectly for gender transition procedures.”

“MUSC Health funds are public funds. We are prohibited from providing gender transition services to all patients,” Dr. Patrick Cawley, MUSC’s chief executive officer, said in a statement Wednesday.

Only a small portion of MUSC’s funding comes from state coffers. Of the hospital’s $5.9 billion budget in the 2023-2024 fiscal year, $176.4 million came from the state, according to the university’s annual financial report .

The hospital will stop accepting new patients for the treatments Aug. 1 and phase existing patients off the hormones or other drugs they’re already taking by Jan. 31, 2025, according to a list of frequently asked questions and answers sent to MUSC doctors and obtained by the SC Daily Gazette.

MUSC did not answer the outlet’s questions on when it would cease providing these services, exactly what services it will stop providing, how it will notify patients, how many patients are affected or when officials made this decision.

The law defines what’s banned as any treatments involving drugs that block children from starting puberty, hormones of the other sex used to change someone’s presentation in order to better match the gender with which they identify, and gender reassignment surgeries.

Ban on hormone therapy for minors could soon be SC law. Transgender advocates vow to keep fighting.

MUSC does not do gender reassignment surgeries for anyone of any age, officials have previously said. The hospital stopped providing cross-sex hormones and puberty blockers to youth younger than 16 years due a law that applied only to its health care system.

In 2022, legislators inserted a clause in the state budget specifically barring MUSC — as a public research university getting state dollars — from providing any treatments that “further the gender transition” of anyone 15 and under. It’s remained in the budget since.

The law passed in May was touted by GOP legislators as barring the same for all health care providers statewide for anyone under 18.

The single line barring public funds received little-to-no mention during debates. That line sets no age. Advocates for transgender people say MUSC is overly interpreting the law.

The law will not impact other treatments, such as hormone therapy to help ease pain from endometriosis, a painful condition affecting the tissue in the uterus, Cawley said in the statement.

Nor will it affect mental health therapy for transgender people, since that is not a gender transition procedure, according to answers from the internal list of questions.

“While MUSC Health can no longer offer this specific service, we provide a vast array of other complex care, primary and behavioral health services that are accessible to all patients, including transgender patients,” Cawley said in the statement.

Most of the debate around the law centered around whether children should have access to gender transition hormones and surgeries.

Supporters of the law said they were protecting impressionable children from life-altering procedures and potentially irreversible hormone treatments. Opponents argued that taking these treatments from transgender children would increase their risk of mental health problems, including suicide.

Even the law’s author said MUSC’s interpretation went beyond what was intended, though he agrees with it.

House Majority Leader Davey Hiott, the main sponsor, said legislators “went as far as we could with the law,” in banning treatments for children and the use of taxpayer-funded health care to pay for transgender treatments for all ages.

A separate line in the law specifies Medicaid can’t “reimburse or provide coverage for practices prohibited.”

The line on public funds was meant to apply to the state health plan for public employees, Hiott said.

MUSC “made the further decision on their own” to completely end services for adults, the Pickens Republican said.

He praised the health care system for taking that step. While his biggest concern was ensuring children didn’t make life-altering decisions, he said he supported restricting gender transition procedures across the board.

“I think (MUSC) made the right choice,” Hiott said. “I applaud them for doing it.”

No interpretation is necessary at state-run health clinics. They don’t offer gender-transition hormonal treatments, so a ban on public funds doesn’t affect them, said Department of Public Health spokesperson Casey White.

LGBTQ advocates decry change

Jace Woodrum, director of the American Civil Liberties Union of South Carolina, said he wasn’t surprised to hear about MUSC’s decision. The ACLU has been warning that the law would affect transgender adults since it was first introduced, he said.

“The inclusion of the public funding provision in the bill shows this isn’t about protecting kids,” said Woodrum, a transgender man. “It’s about inserting politics into health care decisions and making life-saving health care harder.”

After the 2022 scrutiny from legislators over MUSC’s services for teens, Woodrum added that he understands MUSC’s caution.

Already, doctors who prescribe hormonal treatments have been calling the ACLU to ask whether their treatments are legal, and health care providers who stop prescribing hormones over the fear of losing their license might further restrict access to treatment for transgender adults, he said.

“We have a network of providers that is being flooded and is nervous about legally what they are allowed to do,” Woodrum said.

Chase Glenn, director of LGBTQ nonprofit Alliance For Full Acceptance Action and a transgender man, goes to an endocrinologist at MUSC for his hormone replacement therapy.

No one has officially notified him of the change yet. After finding out about the change through friends, he had to reach out to his doctors to figure out how he would move to another practice.

“I love my providers at MUSC,” Glenn said. “There are incredible providers at MUSC. I don’t want to stop going there, but I’m going to have to leave.”

He already called the endocrinologist he saw when he first started hormone therapy in 2015, who later moved from MUSC to a private practice. But her appointments are booked, so it’s unlikely he’ll be able to get a spot, he said.

How an already overloaded health care system will handle an influx of what Glenn expects is several hundred patients remains to be seen, he said.

“They’re going to have an influx of trans adults looking for places to continue this care,” Glenn said. “Hopefully the system can absorb the number of people seeking care elsewhere.”

Glenn said he’s not worried about his own treatment as much as he’s worried about other transgender people who will lose care. He can take the time to find another doctor or travel to another city for treatment. Other people don’t have that option, he said.

“It’s not realistic for trans folks to have to work that hard to get care,” Glenn said. “Having to fight this fight is not what they should be spending their time doing.”

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