I know a lot of you don't see me personally. Either you see one of my providers or someone else entirely elsewhere in the country.

Doing this job is difficult and I've been talking to a lot of colleagues that have trans treating clinics in other states who are really struggling with a lot of different things. Many of them are having extreme financial difficulties right now due to falling reimbursement and the poverty of this community. Hopes and prayers unfortunately do not pay salaries for my providers or my staff, and my clinic is probably one of the most successful there is. Smaller ones in other states that are more conservative are struggling to remain open.

We get a lot of abuse from people outside of the transgender community. It's a regular thing. This clinic gets death threats. That's why we carry here (to protect you). There's nothing you guys can do about that, because you can't stop people who hate trans people from being assholes.

But be nice to your provider. Tell them thank you. Tell them you appreciate them putting a target on their back in places where they likely receive constant harassment that they never tell you about.

A lot of my colleagues, they are ready to quit. They are talking to me about shutting down their practices or stopping seeing transgender patients entirely. Just completely no longer doing the thing. All of those people would just be adrift then. But they feel like they have no other choice. They're literally afraid that they're going to be hurt.

This is just one of today's nastigrams, but this stuff happens all the time. Everyday there's usually at least something that I get. Mostly digital, occasionally in the mail, very rarely in person at the clinic (only a handful of times we got protestors or actual threats of bodily harm/death).

These past few years have been hard for transgender people as people with political aspirations try and legislate transgender people out of existence. Trust me, I don't know what it's like to be transgender, but to be the provider of these people is in many ways very difficult right now too.

My own patients take pretty good care of me and they're very good about letting me know that I'm appreciated. It really does help a lot when I'm having a rough day. One of my transgender patients recently got a dream job working at Yellowstone. They sent me a patch from the park along with a note of how we have impacted their life. It literally made my day. Such a simple thing, but it reminded me why I do this job despite the hate.

But if you see a different provider, especially somebody who doesn't see a lot of transgender people, thank them for having the bravery to do what they do. Because this sort of stuff, it starts to grind you down after a while. If things don't change, I'm genuinely concerned that most of the colleagues that I know well that treat trans people are simply going to stop doing it. They are actively discussing it in clinician groups online. This will be disastrous for the community, and so I'm asking, be nice to your providers. Tell them thank you. I don't think you guys realize how tenuous the situation is right now (unless you live in Florida, then, I think you probably know).

These people will really appreciate your appreciation. They're having a hard time. It may not be visible on the surface, but what I see behind closed doors, I'm genuinely concerned that a large proportion of the treatment options for transgender people are going to evaporate over the next year or two.

Thanks for listening

-Dr. P