Few hospital websites post about LGBTQ+ services or policies

When children’s hospitals across the country faced threats and harassment in 2022 over misconceptions about gender-affirming care services, many of them responded by removing information about the care from their websites. Two years later, new research shows that few adult and pediatric hospital websites share information about LGBTQ+ services and policies.

This finding was part of a broader study by a group of Harvard Medical School students who analyzed the websites of 300 adult hospitals and 46 children’s hospitals to get a full picture of the information hospitals provide online to sexual minority patients and gender minorities. Overall, the results were “very concerning,” said Sahil Sandhu, a fourth-year medical student and first author of the study, which was published Monday in JAMA.

About 25% of adult hospitals posted resources such as tips, explanatory articles, or links to national or local organizations serving LGBTQ+ people; 25% included a directory (such as a “find a doctor” page) specifically designed to help users search or filter for physicians who provide LGBTQ+ services or inclusive care; 26% included information about medical services, clinics or centers for homosexuals.

Children’s 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 simple intervention that can have a big impact,” said José Bauermeister, director of the Eidos LGBTQ+ Health Initiative at the University of Pennsylvania, who was not involved in the study.

Queer people already avoid or delay medical care at high rates due to discrimination or abuse. Showing that LGBTQ+ care is a priority can create a friendly, safe environment, Bauermeister said. These sites can be the first place a patient goes to learn about gender-affirming care, such as hormones, surgery, voice therapy or even HIV treatment, preventive medications, LGBTQ+ fertility options and more.

“Adult hospitals can learn a lot from children’s hospitals,” Bauermeister said. The study looked at independent children’s hospitals, which the authors noted are often in large cities with more progressive policies. That, along with increased attention and demand for LGBTQ+ services for youth in general, could play a role in increased representation.

The study authors were more encouraged by the fact that 77% of adult hospitals and 78% of pediatric sites published nondiscrimination policies that included sexual and gender minorities.

“That was the only result that we thought was relatively good,” Sandhu said. The Affordable Care Act requires hospitals to have non-discrimination policies, but whether that includes protections based on sexual identity or gender expression often changes as presidents move in and out of the White House.

The study is modeled after an article published last year in the Annals of Internal Medicine that analyzed abortion information available on hospital sites. As with reproductive care, the availability of gender-affirming care and other LGBTQ+ health services varies widely depending on the state in which a patient lives.

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 guides or information about available services than those in states with highly protective policies.

It is unclear how often hospitals receive explicit threats related to gender-affirming care programs, but politicians and commentators continue to discredit the care. Former President Donald Trump has called gender-affirming care “child abuse” and vowed to end all federal programs that promote the health of transgender people if he is re-elected this year.

“The invisibility is a big part of the point of these threats,” said Alex Keuroghlian, a psychiatrist and professor at Harvard Medical School who worked with the students on the JAMA study. Keuroghlian also heads 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, the MGH program became much more cautious about the information it shared online after the threats in 2022 started.

A new online project called “Stop the Harm” shows the risk hospitals have taken in advertising LGBTQ+ health care, especially transgender health care. The project tracked hospitals across the country that provide gender-affirming care to young people, and identified a “Dirty Dozen” list of “the worst children’s hospitals that promote gender reassignment treatments for minors.” Part of the criteria used to create the rankings was each hospital’s level of “activism and public support for gender ideology,” according to the group’s site.

“It goes without saying that any attempt to continue to provide this care or advertise this care will be met with more adverse consequences, hostility and even legal consequences,” Keuroghlian said. “The threat is very real.”

The stakes are high as institutions seek the balance between protecting staff and patients from threats and providing enough information so people can access care. To do this well, future research should examine 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-world health care experiences, Bauermeister said.

“I think this (paper) sets the stage for perhaps a larger study to look at the actual national representation and prevalence of all hospitals and health care systems,” he said.

In the meantime, he hopes the research will prompt health care systems to reassess their own websites and ensure information about LGBTQ+ health care is available to those who need it.