Dr. Morissa Ladinsky
By Richard Friedman
Passover, celebrated last month, challenges Jews not only to remember the story of the Exodus from Egypt but also to interpret and integrate it into their own lives. Few have done that more intensely and publicly than Birmingham Jewish community member Dr. Morissa Ladinsky.
Ladinsky is associate professor of pediatrics at the University of Alabama at Birmingham, and co-leader of UAB’s Youth Multidisciplinary Gender Health Team. She has emerged as a high-profile plaintiff in a recent lawsuit challenging the constitutionality of a new Alabama law.
That recently-enacted measure makes it a crime for physicians such as Ladinsky to provide certain gender-related medical care to anyone under age 19 who is transitioning from the gender assigned them at birth to a new gender identity.
Thus far, two other states have passed similar laws, though Alabama is the first one to impose criminal penalties.
The U.S. Department of Justice had asked for an injunction stopping Alabama’s new law from going into effect until the case is decided. On May 13 a federal judge Issued an injunction putting on hold the provision barring transitioning medications to minors, adding that he believes it is likely unconstitutional. Other provisions were allowed to remain intact, such as a ban on surgical procedures on minors, which do not occur anyway,
The Alabama law is part of a wave of bills and laws being enacted in more conservative states, including measures restricting the use of bathrooms and participation in sports by transgender people.
As the measure started gaining legislative traction, Ladinsky wrote a piece that was published on al.com, talking about a recent consultation she had with a patient battling gender dysphoria, a condition where one is at odds with the gender assigned at birth. “My patient — a well-built teen clad in oversized maroon scrubs — was pacing tensely in a small room in my hospital’s psychiatric ward,” Ladinsky wrote.
The patient was admitted as a male to the hospital after a third suicide attempt and unrelenting depression. “Earlier that day, the patient told the care team an inescapable secret: The patient had always known herself to be a girl,” Ladinsky explained. “With puberty closing in and a visceral dissonance deep inside her, amplified by the trepidation of angering her family, she was left entirely hopeless. Her dark eyes, windows to a kind but troubled soul, conveyed her long journey, a forever search to be heard and understood.”
The piece ran under the headine “I’m a doctor and Alabama could arrest me for doing my job.”
For medical professionals such as Ladinsky who are involved in gender care, the matter goes beyond a young person’s decision to transition.
“Internalized guilt, confusion, shame and a sense of defeat lead almost half of transgender youth to embark on suicide during their journeys. Our clinic patients have made large right turns away from that darkness, daily reminders of the healing power released by affirmation and hope,” she wrote.
As a specialist in pediatric gender issues, Ladinsky is part of a small, multi-disciplinary UAB team that counsels and comforts families and provides medical and psychological care to young people trapped in a world few on the outside understand. There are about 55 such teams in the U.S.
The UAB team begins with a comprehensive, integrated approach that includes psychological evaluation, counseling with patients and their families, and reviewing available resources to help patients and their families during this often perplexing and stressful time.
Then, there is an extended, ongoing analysis of each situation on a case-by-case basis, often lasting 1 to 3 years before medical options are considered. Even then, the team’s mantra is to go slow, especially with patients in their early teenage years, said Ladinsky.
For younger teens, puberty blockers are prescribed if the team thinks they are necessary. “These medications, introduced in early puberty, provide a short term pause button on further pubertal changes and are instrumental in preserving the mental health of younger teens who are beginning to struggle with gender dysphoria,” Ladinsky explained.
As the teen patient gets older, hormone therapy becomes an option.
In cases of females transitioning to male, hormone injections can stimulate the growth of body hair, deepen the voice and create a more masculine appearance. For males transitioning to female, treatments can lead to breasts, softer skin, rounder hips and other changes.
For those new to the transgender conversation, especially if they have never met a person who has transitioned, it can be confusing, complex and unsettling.
Yet, there is nothing new about gender transitioning. What is new is that public awareness has become much greater and transgender people have become more open about their gender journeys.
This pediatrician knows the transgender issue is emotionally charged in heavily conservative Alabama. It’s also one that she believes politicians are using to score points with voters. She remains determined as she fights for those she calls “my kids,” driven in large part by her Jewish faith.
Chatting over Zoom during Passover, Ladinsky saw a parallel between the Jews enslaved in ancient Egypt and the oppression, bullying and burdens that plague transgender youth.
The 58-year-old doctor grew up in what she calls a “culturally Jewish home” in Madison, Wisc. Her parents were University of Wisconsin professors and social activists.
Inherent in her family’s Judaism was a commitment to social action and a belief that Jews, because of their difficult history, are obliged to stand up for those who are oppressed — such as the transgender community.
“I was the kid who brought home the kid other kids were picking on.”
Being at the forefront of the transgender issue and practicing gender pediatrics, especially in Alabama, reflects Ladinsky’s commitment to Tikkun Olam, the Jewish concept of repairing the world.
Blending Midwestern amiability with steely determination, she speaks out whenever she can.
“By signing SB 184 (the new law) Gov. Kay Ivey has told kind, loving and loyal Alabama families they cannot stay here without denying their children the basic medical care they need,” Ladinsky said in a public statement after Ivey signed the bill into law.
“The governor has undermined the health and well-being of Alabama children and put doctors like me in the horrifying position of choosing between ignoring the medical needs of our patients or risking being sent to prison.”
Ivey said she signed the bill because she believes that “if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl.”
The governor also said, “We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life.”
No gender affirming surgery is performed on minors in Alabama, Ladinsky noted.
State Rep. Wes Allen, the sponsor of the House version of the bill., was quoted on NBC as saying “We regulate all kinds of things that are harmful for minors — alcohol, cigarette smoke, vaping, tattoos — because their minds aren’t ready to make those decisions about things that can affect them long term,” said Allen. “With these powerful medications that have detrimental effects on their body long term, we just want to put a pause on it… (to) give them a chance to develop and grow out of that.”
Ladinsky offered her own historical perspective. “For a long time, the gay community was the target for politicians in culturally conservative states. Now that same-sex marriage is law, they have moved on to a new group — transgender people. And they’ve weaponized the lives of these people who they perceive of as not following the so-called natural order.”
Several studies suggest there are from 1.4 million to 1.7 million transgender people in the U.S.
Additional thoughts on the challenges transgender people and their families face come from a mom involved in Jewish life, who has spent nearly her entire life in the Deep South, and whose child transitioned from female to male.
This mom loves her now-son deeply and sees in retrospect that this was her child’s destiny. She asked that her family’s name not be used only to protect her son’s privacy. (See companion story.)
“I’m not the least bit embarrassed. In fact, after years of frustration, I’m so grateful that we found the answer to what was plaguing our child. All the signs were there but my husband and I had no ability to read them. It’s a complex, confusing issue, and until you understand it, a scary issue,” she said.
She has little patience for what she sees as “politicians trampling on peoples’ lives for votes.” However, she also has compassion for those who are sincerely uncomfortable with the idea of people, especially young people, transitioning to new gender identities.
And, she admitted, for some, experimenting with different gender identities has become “trendy,” which, she worries, gives fodder to those pushing restrictive gender identity measures.
“Like other things, people fear what they don’t know. Yet, I have seen from our own family’s experience that once someone gets to know someone who has transitioned, they tend to become more enlightened.”
At UAB, Ladinsky sits in her small office handling an array of university duties while staying focused, with the support of her team and others, on fighting the new Alabama law. The legal challenge she and others have initiated continues to unfold.
This UAB pediatrics professor did not start out in gender care. “When I was growing up, people weren’t talking about transgender people. It wasn’t something I learned about in medical school and residency either,” said Ladinsky, who was born in 1964.
She was a practicing pediatrician with a typical practice doing both clinical and academic work. Her turning point came about 10 years ago while she was working in Cincinnati. Based on what she was seeing in her practice, Ladinsky’s interest in transgender youth began to grow.
A few years later, in 2015, Olympian Bruce Jenner’s much-publicized transition to Caitlin Jenner sparked an explosion of interest in transgender issues, catapulting the gender identity conversation onto the front pages. Social media has magnified it even further.
Ladinsky recalled the story of a 16-year-old Ohio teen, feeling female but trapped in a male’s body, who committed suicide in December 2014 because of bullying and harassment. It’s hard for her to talk about it even today.
That’s because the teen was Leelah Alcorn, who went to school with hundreds of Ladinsky’s patients and whose suicide drew wide attention. “Almost every day, I would drive by the place where she killed herself and think about her.” Alcorn’s legacy included Cincinnati being one of the first cities to ban “conversion therapy,” which her parents had forced her to attend. Conversion therapy insists one can pray away transgender notions, but studies have found it to be not only ineffective but harmful.
There are other stories, scores of them.
“I also remember one girl, who I had taken care of since she was little, freezing up at her annual physical at the start of her teenage years, as her parents, with tears in their eyes, asked me why she was starting to wear boys’ underwear.”
The pediatrician’s chance to do more in the gender area came when her husband, Dr. Mitch Cohen, a prominent pediatrician at Cincinnati’s Children’s Hospital Medical Center, was recruited in 2014 to be chair of the UAB Department of Pediatrics and physician-in-chief of Children’s of Alabama.
UAB also provided Ladinsky with an opportunity to teach and practice, opening the door to her and a UAB pediatric endocrinologist, also interested in gender care, co-establishing a transgender care program. Their team, which also includes a chaplain and psychologist, was established in 2015.
“We are the only group providing this level of care in Alabama and Mississippi. Families from the Florida panhandle, southern Tennessee and western Georgia also come to see us. Since we began, we’ve touched the lives of 400 to 500 kids and families. We also have helped pediatricians better understand gender dysphoria and the toll it can take on a young person’s physical and mental health.”
Being in the limelight hasn’t been easy.
“I’ve gotten some crazy emails from really bizarre humans.” Though visibly Jewish, none of it has been antisemitic. The emails don’t faze her. It’s the political attacks directed toward “my kids” that deepen her determination, along with her commitment to her Jewish faith.
And she remains firm.
“This law doesn’t help people. It can actually harm them. It could have devastating downstream consequences for these kids, especially loss of life. Plus, it’s an unprecedented overreach into medical decision-making.”
Ladinsky knows not all Jews agree with her views. For her, though, her interpretation of Judaism not only validates her position but also empowers her.
“We as Jews are taught to elevate voices, to hear those whose voices others are attempting to silence; to see, hear and elevate the voices of people who are oppressed.”
She augmented her point by referring to a conversation she had during Passover with the UAB chaplain who is part of her team.
“God will always hear — and listen to — the voices of the marginalized, oppressed and disadvantaged, just as God heard the voices of the Jewish people who were enslaved and oppressed in Egypt,” he told her.
Serene and confident, Ladinsky draws strength from her colleague’s words. “His comment explains exactly why as a Jewish person I must step forward and be heard loudly — in word and deed.”
(Updated May 14 with information on the May 13 ruling)