The LGBTQ+ Changemakers series features LGBTQ+ people all over the country who are making a difference through visibility and ingenuity.
Dr. Jesse Ehrenfeld has been practicing medicine and creating better health care opportunities for the LGBTQ+ community for over 20 years. A former combat veteran, Dr. Ehrenfeld has served as chair of the Massachusetts Committee on LGBT Health, co-founded the Vanderbilt Program for LGBTQ Health and is the newly inaugurated president of the American Medical Association. Also an award-winning photographer, Dr. Ehrenfeld lives in Milwaukee, Wisconsin with his husband Judd Taback and their two young children.
Dr. Ehrenfeld was kind enough to take time out of his busy schedule to talk with News is Out about improving health care access and treatment for the LGBTQ+ community, the challenges medical professionals are facing with providing gender-affirming care and how LGBTQ+ patients can advocate for themselves and their long-term health.
News is Out: In the early 2000s, you helped write and ultimately pass a resolution to form an LGBTQ+ committee at your state medical society in Boston. You were that with some pushback. How did you persevere?
Dr. Jesse Ehrenfeld: You know it was a moment where I knew it was the right thing to do. No state medical society at the time had a committee on LGBTQ+ health, either focused on patients or physicians. And yet, there are so many challenges that it was clear to me we needed a vehicle in a place to have some focused effort.
A lot of times in my career as a physician, as a leader, you get told that what you’re doing may not be popular, but it’s the right thing in your heart of hearts. And so, in spite of the sentiment that this was going to cause some challenges for me professionally, personally, and within the organization, I never hesitated for a minute. And here we are, all these years later. I’m glad that I ignored those voices or whatever it was at the time, but certainly, I always knew it was the right thing to do.
NIO: Well, speaking of time passing, how have you seen the medical community evolve or change in the last 20 years to be more welcoming to LGBTQ+ professionals and how doctors and medical professionals treat LGBTQ+ patients?
Within medicine, there’s a recognition that there are unique needs of LGBTQ people. Just the understanding of the science, of what it means to support people in the community, what are the appropriate prevention strategies and treatment needs and other considerations to support the whole person–that has grown tremendously.
That’s one of the reasons why the AMA, in partnership with the AMA Foundation, has launched a new national LGBTQ fellowship program–which has been very successful–as a way to acknowledge that there is this evolving scientific area that we need to make sure that we have practitioners who have the skill set, the training and the evidence, to keep people in the community healthy. I remember when I was in medical school, I was like, ‘Where’s the book on LGBTQ health?’
Well, there was one. There was one textbook that was written primarily around behavioral health by a Canadian physician and then there was the Fenway Guide. And that was it. Now there are probably a dozen. I think that’s just recognition that the needs of the community are unique and different and need to be handled appropriately. So, I think there’s that sort of scientific component that’s changed.
Then as a profession, we are a more diverse profession than we have ever been and AMA is a reflection of that both in our membership and our leadership. And certainly, when I look at the people on our board of trustees, leaders throughout the organization at every level, we are a much more inclusive, diverse organization than at any point in our history. And that’s a wonderful thing because it means that we’re meeting the needs of physicians across the nation and, ultimately the needs of our patients.
NIO: That’s wonderful to hear as a patient. I’m glad to know that this is happening. You recently spoke to one of our member publications, the Washington Blade, about the rise in gender-affirming health care bans and legislation. You told them, “We simply will not stand for anti-trans health care restrictions.” How can you expand on this? How is the medical community combating this legislation and these restrictions?
Dr. Ehrenfeld: Well, it’s frustrating that in spite of widespread support from every major medical association, that we’re having all of these attacks on gender-affirming care. It’s hard to actually keep track of the number of bills. It’s like 500-600 LGBTQ+ bills introduced since January. It’s a tidal wave.
NIO: And that’s more than doubled since 2020.
It’s unfathomable. The AMA strongly opposes any of those discriminatory actions that are simply a dangerous government intrusion into the practice of medicine. And we continue to be very clear that the decisions about gender-affirming care are properly made between a patient, their family and their physician. There should not be a politician inserting themselves into the exam room or second-guessing a health care decision that are being made by a patient. That is the framework that we view these unfortunate efforts across various states.
The other deeply disturbing aspect is we’re seeing evidence-based clinical interventions being criminalized. The fact that there are more and more states that have civil penalties, criminal penalties, and potential actions against one’s medical license for doing the right thing for a patient puts physicians in a terrible bind. How do you fulfill your ethical obligation and duty to a patient to do what you know is the evidence-based, appropriate, clinically-indicated thing to do? And yet you’ve got this law that is potentially criminalizing that care. That’s a challenge that’s real. We’re hearing about that. We’re seeing that take effect obviously in the gender-affirming care space, but also with reproductive health care.
“People are having to make hard choices. And people often don’t want to leave a community they’ve been a part of for years, that they are deeply integrated into.”
Dr. Jesse Ehrenfeld
NIO: Do you and the team at AMA see this becoming a mass exodus of medical professionals from these places?
Dr. Ehrenfeld: I was on the phone with the physician in Texas earlier this morning, and I spoke to a colleague in Tennessee yesterday. Physicians are having to make hard choices. And people often don’t want to leave a community they’ve been a part of for years, that they are deeply integrated into. But they also are facing some really, really hard choices about how they balance their need to do what’s right, what’s in the best of their patients, versus living in a place where they can’t actually execute that mission.
So, I don’t know where that’s going to end up. I think we’re seeing this struggle for a lot of physicians who provide LGBTQ+ care, but also physicians who are providing abortion and reproductive access. I ultimately don’t know what that looks like.
We are seeing, where there’s data on this in a couple of different publications, residency applications changing. You know, the places that medical students are willing to go to, that are willing to live in, that are willing to be trained at, is different this year than it was last year in the year before because of some of these laws that are popping up in dangerous ways.
We are seeing, where there’s data on this in a couple of different publications, residency applications changing. You know, the places that medical students are willing to go to, that are willing to live in, that are willing to be trained at, is different this year than it was last year in the year before because of some of these laws that are popping up in dangerous ways.
NIO: What are some of the biggest misconceptions about gender-affirming care, especially for trans and gender-nonconforming patients? Because there seems to be everything from misunderstandings to outright lies about how this is actually taken care of.
Dr. Ehrenfeld: Well, I don’t like to repeat falsehoods for obvious reasons, but one misconception is the majority of care for transgender people has nothing to do with gender-affirming care. It’s people who need health care. But because of the stigma around identity and being a part of the transgender community, it is now becoming increasingly difficult. I will tell you I spoke to a physician colleague, and they had a transgender patient who was turned away by seven other facilities in a major metropolitan region that you wouldn’t necessarily think of as a place that this would be a problem.
Maybe some of that was a lack of expertise. I doubt all of it was. Those experiences, unfortunately, are real, and that’s why, in many circumstances, LGBTQ+ patients have shorter lives and live sicker, because they have had negative experiences with the health care system. There may not be the level of trust with the health care system, with other individuals–and so that leads to delays in care and people not having the opportunity to stay healthy.We’ve got to change that. We’ve got to make sure that all facilities are welcoming and supportive of all patients, and that’s a big piece of our AMA larger health equity strategy, to make sure that the health care system is accessible to everyone
“We’ve got to make sure that all facilities are welcoming and supportive of all patients, and that’s a big piece of our AMA larger health equity strategy, to make sure that the health care system is accessible to everyone.”
Dr. Jesse Ehrenfeld
NIO: How can we, as LGBT patients be better advocates for ourselves in medical situations?
Dr. Ehrenfeld: I think it starts with being honest with your physician about your identity and orientation, who is in your family and who’s helping take care of you, and who can help keep you healthy.
I think that there, for understandable reasons, has often been a reluctance to be out in in a medical setting. But there are differences, right? If I know that you are a young gay man, then I ought to be offering you PrEP and that decision is a clinical decision, right? It’s a prevention strategy that based on CDC guidelines and evidence, is different, right? Based on those characteristics. So, people need to understand that health care is unique when you’re a part of the community, but those needs can only be fulfilled if patients are able and willing to be honest with their health care team about who they are.
NIO: You’re also a photographer. You’ve won the White House News Photographers Association Award. You’ve been nominated for an Emmy. How do you balance your love for photography with your advocacy, your medical career and raising two little ones?
Dr. Ehrenfeld: I don’t think there’s any magic tool solution. Every day is a gift and I try to treat it as such. The moments I have with my husband and our two amazing, beautiful, inquisitive children are a blessing. I just try to cherish every moment and do as much as we can to support each other as a family as we sort of go through this journey.
You know, it’s humbling to be in this role. I can’t even tell you the number of calls and emails, texts and tweets and all sorts of things I’ve gotten from all over the globe when I was elected and when I was inaugurated last week. That speaks to the significance of what it means for LGBTQ health equity globally to have the president of the oldest, most influential association be an out person.
We have real challenges. I’m not going to sugarcoat it.
I didn’t run as an LGBT candidate, but I know how important my visibility and representation is. And it is not just the LGBTQ people, but to so many physicians who are facing so many countless challenges today. When I gave my inauguration speech to a big audience in Chicago and a lot of people watching online, I know that somebody who was hearing my words was struggling because they’re gay or they identify as LGBTQ+. I can only hope that the visibility that I bring through my leadership of the most influential physician group in the nation can give that person who’s struggling some hope. Some sense of possibility. Because I want to make sure that all patients can get the health care that they need, regardless of who they are.
This conversation was edited for length and clarity.