According to the Williams Institute — the leading research center on sexual orientation and gender identity law and public policy — over 90% of transgender youth live in a state where anti-LGBTQ+ lawmakers have proposed or passed laws restricting their rights.
For these youth as well as transgender adults, one such focal point has been gender-affirming care. As of this publication, over half of the country’s states have enacted laws or policies targeting access to these essential services, despite the U.S. Department of Health & Human Services calling it “a supportive form of healthcare” for those in need.
“For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system,” HHS explains. “Research demonstrates that gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents.”
Florida is among the states to deny access. Senate Bill 254 went into effect in 2023, banning gender-affirming care for transgender youth and restricting it for adults. For the latter, the law requires care be provided exclusively by physicians, excluding nurse practitioners, and bars forms of treatment like telehealth.
According to GLAD Law, which has been instrumental in protecting LGBTQ+ civil rights since 1978, it marked “the first time any state passed such an extreme law.” The group was among those to challenge it in court, resulting in a temporary hold in its enforcement that ended when a federal court of appeals let it advance in August 2024.
“This is deeply disappointing and puts the lives of transgender Floridians at risk,” Equality Florida responded to the news. The state’s largest LGBTQ+ civil rights organization was also among SB 254’s challengers.
“To every transgender Floridian, the fight is not over,” the group promised. “We won’t stop until you have the medical freedom you deserve and a Florida that treats you with dignity and respect.”
In the interim, misinformation surrounding gender-affirming care continues to grow. Here, we detail what it is.
WHAT IS GENDER-AFFIRMING CARE?
“Gender-affirming care, sometimes referred to as transition-related care, is life-saving healthcare for transgender people of all ages,” says the Human Rights Campaign, the nation’s largest LGBTQ+ civil rights group. They also challenged Florida’s law.
“It is not a single category of services but instead is a range of services, including mental health care, medical care and social services,” HRC continues. “At all ages, clear, well-established, evidence-based standards of care exist.”
This care can be needed because many transgender and nonbinary individuals experience gender dysphoria. Understanding that sex is determined by biological characteristics while gender relates to a sense of self, HHS defines this as “clinically significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity.”
“Just like any other form of healthcare, it also helps transgender and nonbinary people live safe and healthy lives … [and] is always delivered in age-appropriate, evidence-based ways, and decisions to provide care are made in consultation with doctors and parents,” HRC says.
WHO SUPPORTS IT?
Every major medical and mental health organization recognizes gender-affirming care as medically necessary to support those who need it. These groups collectively represent over 1.3 million doctors nationwide
Among many others, this includes the American Academy of Child and Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Nursing, American Psychological Association, National Association of Social Workers and the World Medical Association.
TYPES OF CARE
Social affirmation is one type of gender-affirming care and can be used at any age. Social transitioning is simply when someone takes non-medical and fully reversible steps to live and present publicly as their gender.
It consists of wearing hairstyles or clothing that affirms one’s sense of self, utilizing pronouns or restrooms that align with one’s gender identity and more.
HRC notes that “for many transgender and nonbinary people, social transition is the first step in their gender transition journey, regardless of the age they begin transitioning. This is because it offers the opportunity to easily and quickly take small steps to begin living authentically, before involving medical interventions.”
Puberty blockers, which are reversible and utilized during puberty, can be a next step. This practice utilizes medications to temporarily pause the effects of puberty.
“For transgender and non-binary youth who are aware of their gender at a young age, going through puberty can cause intense distress and dysphoria, as it leads their body to develop into a gender that is not theirs —including in ways that are irreversible, or only reversible with surgery,” HRC explains. “For example, teenage transgender boys who do not have access to blockers will have to go through a puberty that includes growing breasts and later in life will require surgery.”
Puberty blockers may be prescribed to counter this. These decisions are made by doctors early in one’s puberty in consultation with the child, their parents and therapists. It gives the youth “time to continue exploring their gender identity before potentially moving on to more permanent transition-related care when they are older.”
Puberty blockers also have decades of safe use. The FDA first approved them in 1993 to treat precocious puberty — when a child’s development begins before a typical age — for those who are cisgender.
Hormone therapy is utilized in early adolescence and after. Synthetic versions of testosterone or estrogen, which develop naturally at different levels in both cisgender men and women, are used with provider supervision and management for this type of gender-affirming care.
“These same medications are used safely every day by millions of cisgender men and women worldwide,” HRC says. Hormones are typically not prescribed until someone is at least 18.
“Though adolescents may receive gender-affirming hormones starting in their late teens, this is only done with physician approval, parental consent and informed consent from the adolescent in question,” they advise. The effects can also be partially or fully reversible, depending on how long the hormones have been administered.
Gender-affirming surgeries, which are only performed after significant discussions with mental health providers and physicians like endocrinologists and surgeons, are an irreversible form of gender-affirming care used in adulthood. They are rarely used in adolescence.
Procedures include “top surgery,” which makes changes to one’s chest or torso, or “bottom surgery,” which makes changes to one’s genitals. Plastic surgery can also be utilized to change features deemed masculine or feminine on one’s face.
Of note, HRC stresses that “there is no single gender-affirming surgery — nor does a person have to have any surgery, or a specific surgery, to be transgender.” Also of note, gender-affirming surgery is not unique to those who are transgender. These “are the same procedures that have safely and effectively been given to cisgender and intersex people for decades, for a host of cosmetic and medical reasons,” HRC says.
WHY IT MATTERS
“Gender-affirming care is patient-centered and treats individuals holistically, aligning their outward, physical traits with their gender identity,” HHS says. “Medical and psychosocial gender-affirming healthcare practices have been demonstrated to yield lower rates of adverse mental health outcomes, build self-esteem, and improve overall quality of life.” HHS notes.
As for legislation restricting this care, HRC says legislators are “inserting political battles into private and personal conversations between parents and their children, and patients and their doctors.”\
“These laws are not about safety — as the safety, efficacy and life-saving nature of gender-affirming care for transgender and nonbinary youth and adults is clear,” they advise. “Instead, in ignoring a wealth of scientific evidence and overwhelming support from the medical community, these legislators are attempting to enshrine discrimination into law.”
Learn more about gender-affirming care here.
This feature was originally published in Watermark’s 2024 Q-Health Guide. View the digital edition here.
