Paula Neira still lives by a motto she learned in the navy: semper porro, ever forward.
That’s why Neira, the clinical director of the new Johns Hopkins Center for Transgender Health and a transgender woman herself, isn’t letting herself get bogged down by the institution’s rocky past around transgender issues.“It’s real easy to change course on a little patrol boat; it’s real difficult to change course on a dime on an aircraft carrier,” she told The Daily Beast. “These institutions are big institutions. But when you have the commitment from the leadership on down to change course, you’ll change course.”
Once the first medical institution in the U.S. to offer sex reassignment surgery in the 1960s, it has taken nearly forty years for Johns Hopkins Medicine to return to the field of transgender health care after the original clinic was shut down in 1979 at the urging of Dr. Paul McHugh, then chair of the psychiatry department.
McHugh, now 85, has remained vocally opposed to transgender medical care ever since. And his continuing affiliation with the university has left some in the LGBT community concerned that the new center—scheduled to open in the summer of 2017, offering hormone therapy, surgeries, and other services to transgender patients—won’t do enough to repair Hopkins’ reputation.
For instance, after the Washington Post published a front-page feature last week focusing largely on McHugh’s reaction to the opening of the Center for Transgender Health, Human Rights Campaign national press secretary and transgender advocate Sarah McBride responded with an opinion piece saying that “Hopkins has a long way to go before transgender people feel safe.”
“While the opening of the clinic is important, that alone cannot heal the wounds inflicted by Hopkins against transgender people nor alleviate the ongoing harm caused by the continued invocation of its credibility to support Mr. McHugh’s essays attacking LGBTQ people,” McBride concluded. “The only path toward inclusive care requires Hopkins to clearly speak out.”
McHugh’s name, as The Daily Beast has previously reported, has become a staple in anti-LGBT circles. His 2014 Wall Street Journal op-ed “Transgender Surgery Isn’t the Solution,” in particular, has been widely-cited. But his views on transgender health care are dramatically out of step with major medical associations, which support and affirm transgender medical care.
According to the American Medical Association, for example, there is an “established body of medical research” that shows “the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment” for many transgender people.
And as the disjuncture between McHugh’s views and medical consensus has become more pronounced, Johns Hopkins Medicine has taken public steps to reassure the LGBT community that no single individual represents the institution as a whole.
Last October, two months after McHugh co-authored a paper questioning the concepts of sexual orientation and gender identity, Johns Hopkins Medicine leadership published a “Dear colleagues” letter stating that the institution’s “commitment to the LGBT community is strong and unambiguous,” acknowledging that “some have questioned our position … because of the varied individual opinions expressed publicly by members of the Johns Hopkins Medicine community.”And in a new statement to The Daily Beast issued in response to questions about concerns like McBride’s that exist in the transgender community, a Johns Hopkins Medicine spokesperson stated: “Johns Hopkins Medicine has and is taking steps toward becoming an employer and provider of choice for all, including transgender individuals. And statements or actions to the contrary by current or former affiliates of Johns Hopkins do not reflect our institution’s current views. We are committed to being a caring, inclusive place for all patients, families and employees.”
Despite the October 2016 statement, the Human Rights Campaign this March deducted 25 points from Johns Hopkins Hospital’s Healthcare Equality Index score, attributing it to “Johns Hopkins Medicine’s failure to address HRC’s concerns regarding deeply disturbing anti-LGBTQ misinformation” written by McHugh.
Neira—who transitioned after leaving the navy, going on to become a registered nurse and an attorney advocating for the repeal of “Don’t Ask, Don’t Tell”—fully realizes that McHugh’s presence will have some impact on the transgender community’s perception of the new center.
“We’re aware that there’s going to be skepticism in some quarters because of the history, because of McHugh’s writings,” she told The Daily Beast. “But his writings don’t reflect the institution’s values and where we’re going.”
Neira believes that transgender people are “smart” consumers who “tend to be much more informed about their care” than average—often out of necessity, given how frequently they have to educate their own physicians—and she hopes that the new center will be judged by its actions rather than the words of one doctor.
“The folks in the community will make up their mind about what we do,” she said. “And as the clinical program director for the center, I wouldn’t be in this role if [Hopkins] wasn’t committed to doing this right.”
The World Professional Association of Transgender Health, the leading organization for transgender health care professionals, is cautiously optimistic about the new Hopkins clinic. In written statements to The Daily Beast, treasurer Dr. Walter Bouman said that “WPATH welcomes new transgender healthcare services to increase access of care for trans people” and immediate past president Dr. Jamison Green said that it was a “positive move.”
“We will have to see what policies the clinic uses, and what principles inform their procedures,” added Green. “I think it is a positive sign, though, that Johns Hopkins is willing to add to the knowledge base concerning gender—and I expect the new crop of clinicians will have benefited from all the good work that has been done in the field since their original clinic was closed nearly 40 years ago.” (Neira indicated to The Daily Beast that the new center would indeed use WPATH’s Standards of Care.)
In a follow-up interview with The Daily Beast, Green disagreed with the idea that Hopkins Medicine should specifically call out McHugh’s writings: “If they give him that much attention, that is simply going to elevate his profile.”
Green called it a “big deal” that a health care leader like Hopkins would open a transgender health center as it “reinforces the idea that this is meaningful.”
As for McHugh himself, he reiterated in a phone interview with The Daily Beast that he disagrees with the idea that his writings pose any threat to transgender people.
“I certainly am not wounding anybody,” he said. “I am saying that the treatments that are being offered do not help them.”
McHugh has known for months that Hopkins would re-enter the field of transgender medicine. As the Washington Post reported in last week’s feature, McHugh received a visit from the head of plastic and reconstructive surgery last fall, who informed him that Johns Hopkins Hospital would once again start offering sex reassignment surgery. The Post reported, paraphrasing McHugh, that he “bears no animus” for transgender health providers at Hopkins.
He told The Daily Beast that although he has no hard feelings for his colleagues at Hopkins who made the call, he has voiced his disagreement.
When asked by The Daily Beast if he thought it was a mistake for Johns Hopkins Medicine to open the new transgender health center, he said, “Yes and I think they will regret it and I’ve told them so.”
Asked what “they” said back to him, McHugh laughed gently.
“They ignore me.”