Respect Equality

Gender-affirming care is being debated in more than a dozen states. Providers say it isn’t up for discussion

Medical professionals rally in Texas in 2021 to speak out against legislation that would ban gender-affirming care. (Erich Schlegel/AP Images for Human Rights Campaign)

Story at a glance

  • More than 30 bills in state legislatures would restrict access to gender-affirming care for minors, with some carrying punishments as harsh as a life sentence in prison.
  • Doctors who provide gender-affirming care to minors told Changing America that it can be life-saving, and research has already shown that treatments like gender-affirming hormones can significantly improve the mental health of transgender and nonbinary people.
  • Importantly, gender-affirming care will look different for everyone.

More than 30 bills have been filed in state legislatures across the country aiming to restrict access to gender-affirming care for minors. Some, like proposed legislation in Alabama, would make it a felony to prescribe puberty blockers or hormones or perform gender-affirming surgeries on patients younger than 19 years old.

Lawmakers in Idaho last week also advanced legislation to criminalize gender-affirming care, which would be punishable by up to life in prison. But the Idaho bill differs from others in that a parent or guardian under the bill would also be guilty of a felony if they took their child to another state to receive gender-affirming care.

In the neighboring state of Washington, Gina Sequeira, co-director of the gender clinic at Seattle Children’s Hospital, told Changing America that her young patients and their families — several of which come from Idaho — are afraid.

“Should this bill pass, I can’t think of any way that a young person would be able to continue to live in Idaho and continue to access care before they turn 18,” she said.


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And as a provider, Sequeira, whose clinic typically works with patients between the ages of 8 and 18, also has to worry about herself. It may mean making a devastating decision.

“Should I desire to continue providing care for my patients in Idaho, that would put me at risk for receiving a felony charge,” she said.

“Our team is really fearful of the impact of this bill, should it pass,” she added. “It already is having a negative impact on many of our patients and families, but should it pass, it would have a profoundly negative impact on youth in Idaho, on their families, forcing them to move out of state to be able to continue ongoing care.”

But moving isn’t an option for everyone because of the financial burden that typically comes with an out-of-state move. And gender-affirming care is far from cheap. The puberty blocker implant used by Sequeira’s clinic can cost upward of $50,000 without insurance, and has to be replaced every one to two years.

Moving to another state can also mean disconnecting from an established support system, which is critical for both transgender and nonbinary children and their families.

The mental health of trans and nonbinary youth can already be fragile, and doctors have warned that the nation is teetering on the edge of a LGBTQ+ youth mental health crisis as states like Idaho work to restrict access to gender-affirming care.

Some studies suggest that the very introduction of such legislation can affect LGBTQ+ youth, and two-thirds of LGBTQ+ 13- to 24-year-olds in a January report by The Trevor Project said their psychological well-being had taken a hit because of recent state-led efforts to restrict the rights of trans and nonbinary people.

In the absence of legislation, lawmakers have taken creative approaches to limit access to gender-affirming care.

Texas Gov. Greg Abbott (R) late last month ordered state agencies to investigate gender-affirming care as child abuse, responding to an opinion by state Attorney General Ken Paxton (R) in which he wrote that some types of gender-affirming care amounted to “abuse” under his interpretation of Texas law.

Notably, gender-affirming care — even for minors — has been backed by the nation’s largest medical groups, including the American Medical Association, the American Psychological Association and the American Academy of Pediatrics, as best practice for trans and nonbinary individuals.

In fact, gender-affirming care can have a particularly salient effect on the mental health of trans and nonbinary people when it is administered in adolescence, research suggests.

In a recent study of more than 100 transgender and nonbinary youth during their first year of gender-affirming care at Sequeira’s clinic, treatment including puberty blockers and gender-affirming hormones was associated with 60 percent lower odds of depression and 73 percent lower odds of suicidality.

In December, researchers at The Trevor Project found that hormone therapy was associated with nearly 40 percent lower odds of recent depression or a suicide attempt in the last year among young people under the age of 18.

“It is so critically important that we acknowledge that the medical evidence and the current guidelines of care for youth strongly suggest and recommend the provision of gender-affirming care for youth who desire that care,” Sequeira said.

Still, there is no one-size-fits-all option for gender-affirming care, and gender-affirming care for one person may look drastically different from that of another. It doesn’t always involve medical intervention, either.

“Many folks do choose to have medical or surgical intervention, if that is what’s best for them, but otherwise, gender-affirming health care is providing support and expertise and assisting someone as they navigate a society that may not always support them,” Kristin Rager, an adolescent medicine physician in Tennessee, told Changing America.

At least four bills in Tennessee aim to restrict access to gender-affirming services for minors, threatening Rager’s ability to prescribe puberty blockers and hormones to her patients, who she described as “incredibly fearful.”

“Gender-affirming care is life-saving care, first and foremost,” Rager said, “and to threaten to take that away from folks — you can imagine the dire consequences. I don’t think that I am using a hyperbole when I say lives will be lost.”


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