this post was submitted on 02 Nov 2025
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Me over here with actually somewhat radical positions.
All HRT should be available OTC. (Yes, including T.)
A parent denying a child access to puberty blockers should be required to pay reparations if the child continues to identify as trans into adulthood.
Require unisex bathrooms for any business larger than a bananna stand.
I'm going to push back on OTC HRT because of the health risks. Supraphysiologic estrogen and testosterone can both have lethal side effects, so correct dosing and monitoring for health complications are essential components of trans healthcare.
You can get lethal effects from nicotine, alcohol, bleach, ammonia, and many, many combinations of chemicals that are available with, at most, age verification.
I'm all for people educating themselves as much as they want, from whatever sources they trust, but bodily autonomy DEMANDS someone be able to direct their own medication, including gender affirming medication. Doctor-as-gatekeeper is, IMO, not as good a model as Doctor-as-confidant-and-educator.
As a soon-to-be physician that has sought training in trans healthcare, I do not see my role as gatekeeper, but the role of educator includes teaching about and monitoring for the risks and complications that can come from HRT. Estrogen and Testosterone are both powerful and potentially dangerous hormones and I do not want to see my trans patients dying from strokes or heart attacks that could have been prevented with more careful dosing of their HRT.
No one imagines they are the bad guy. But, if a patient asks for a drug and you deny it to them, you are being a gatekeeper. I imagine you are only doing this for "good reasons", but you are still violating their bodily autonomy.
To be clear: I am not saying this about HRT specifically because, most of the time, HRT is safe when dosed appropriately.
That being said, if I think a medication is going to be dangerous, harmful, or lethal to a patient and I prescribe it anyways, I am legally and morally liable for any harm that comes to them from that medication. I have had conversations with patients about weight loss drugs that they really want, but that would be extremely dangerous based on other comorbid conditions like heart problems or pancreas issues. If a patient asks me for something that I think is unsafe, I engage them in a discussion about why they want that medication, the risks and benefits of it, and possible alternatives that could be safer. If a patient is dead-set on getting a medication that is very likely to harm them, I'm not going to write that prescription because if the worst happened, their blood is on my hands.
It is very uncommon that physicians refuse to prescribe something that a patient is asking for specifically. The much more common situation ends up being that the physician can write the prescription, but insurance won't pay for it. There are obviously some physicians out there that refuse to prescribe things like birth control based on their personal beliefs, but they are obligated to refer that patient to a provider that will give them the prescription.
Then, you don't value bodily autonomy as much as I do, and will deny it to some of your patients, gatekeeping -- no matter what you "think" you are doing.
Does my ethical autonomy count for nothing? Am I really obligated under your worldview to harm my patients by acquiescing to their demands carte blanche?
Even as a medical student, I have had patients die in my care from things I couldn't do anything about. I had no way to save them because the medicine to fix the problem simply does not exist. As an ER tech, I have had multiple times where the physician running the code called the time of death while I was the one doing compressions on the patient. Most of those were children. I am already haunted by the patients I have lost through no malpractice, negligence, incompetence, or malice of my own. I refuse to intentionally add to my nightmares by doing something that I truly believe would harm my patient, even if it is what they are asking for.
In my worldview, the drugs would not have a gatekeeper. They would in available OTC. You should not have your "ethical autonomy" compromised at all. (And yes, it does count for nothing compared to bodily autonomy.)
If your reason (for not providing the drugs) was only protecting yourself or others from State-backed violence, it could be justified. But, you claimed you would do it because you know better how to manage a patient's body than themselves.