As of the writing of this article, 18 U.S. states have passed laws banning forms of gender-affirming care in 2023, with Texas expected to join them (Forbes). Hundreds of anti-trans bills have been introduced throughout 49 states, with 71 becoming law (Trans Legislation Tracker). Across the nation, conservative legislators are defying the medical community to attack transgender youth through restrictions to healthcare access. To understand why fighting these attacks is so important, we’re breaking down what gender-affirming care is, why it’s especially but not exclusively important for transgender youth, and why the right-wing attacks on gender-affirming care are so wrong.
• Support The Knights & Orchids Society, the Transgender Education Network of Texas, and the Phoenix Transition Program.
• Learn how to be an ally to transgender and nonbinary youth and understand gender identity terms.
• Research and attend a local protest to support trans rights.
What is gender-affirming care?
Gender-affirming care is a broad term for practices “designed to support or affirm an individual’s gender identity” (AAMC). When we’re born, a doctor looks at us and decides whether we’re male or female based on physical characteristics. That status follows us through life, reinforced by social norms and institutional records. But that sex assigned at birth is different from your gender identity, your internal sense of your own gender, which might be male, female, neither, or a mix of both. Many cisgender (non-transgender) people never have to think about this because their own sense of their gender identity is affirmed by government documents, medical institutions, and society. Transgender people are those whose gender identity doesn’t match the sex they were assigned at birth (NPR).
The mismatch between your gender identity and the sex you were assigned at birth can cause psychological distress called gender dysphoria. Many, but not all, transgender people experience this. Non-transgender people can experience gender dysphoria, as well (see below). Gender-affirming care is an umbrella term for “a range of social, psychological, behavioral, and medical interventions” to help “people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity” (AAMC). Different state laws ban different forms of gender-affirming care.
What are examples of gender-affirming care?
Gender-affirming care includes:
- Social affirmation: aligning clothing, names, and the gender pronouns people use to refer to them (e.g., he/him, she/her, they/them) with a person’s gender identity
- Hormone therapy with estrogen or testosterone
- Surgery: top surgery on the chest area, bottom surgery on the genitals or reproductive organs, and surgery on the facial area
- Non-surgical options like chest binding, breast padding, and speech therapy
- Gender-affirming therapy (Healthline)
Gender-affirming care goes far beyond medication and surgery, which is rarely provided to pre-teens. Many interventions are reversible, such as puberty blockers, which “slow things down” to “allow a young person time to fully determine their gender identity and how far they wish to transition before the onset of permanent sex characteristics” (AAMC). Adolescents denied access to gender-affirming care are forced to develop these characteristics despite the mismatch with their identity. Transgender people who receive hormone therapy in puberty experience “far less” psychological distress than those who start it as adults (Scientific American).
Is gender-affirming care only for transgender people?
No. Cisgender men who receive testosterone therapy and cisgender women who receive breast augmentation are getting gender-affirming care. So are cisgender teen boys who develop breast tissue—gynecomastia—and get it surgically removed. There are also many other more common forms of gender-affirming care that have been normalized for cisgender people, like when balding men get hair transplants, men take testosterone to bulk up, or women get laser treatment to remove unwanted facial hair often associated with men.
“As a teen boy who identified as a boy — randomly sprouting breasts really, really sucked,” says Justin Brown. “A quick procedure and a few weeks of wearing an ace bandage later, I was flat-chested and finally had a body that looked like mine. Trans children deserve the same consideration” (NBC News).
What are the impacts of gender-affirming care?
Repeated studies looking at more than 30,000 subjects “consistently show that access to gender-affirming care is associated with better mental health outcomes—and that lack of access to such care is associated with higher rates of suicidality, depression and self-harming behavior.” It’s so clear that gender-affirming care saves lives that the American Medical Association, American Academy of Pediatrics, and American Psychiatric Association are unanimous in their support (Scientific American).
Aren’t many children being forced into irreversible surgeries?
No. “Typical gender-affirming care consists of listening carefully to children and families to create safe spaces to talk about gender identity and explore this and other aspects of adolescent development,” says Dr. Michelle Forcier of Open Door Health. “There is no massive rush to surgeries and there are no ‘experiments’ being done on children” (SPLC).
“Gender-affirming surgeries are very, very rare” and almost never are given to minors, says Dr. Meredithe McNamara from Yale School of Medicine. “In these politicized and misinformed debates on gender-affirming care, surgery is being overly represented to stoke fear in the public and to convince people that politicians should be intervening in healthcare decisions between parents and physicians and patients themselves” (PBS).
What can we do?
We can’t wait until a future election cycle to address the permanent damage caused by anti-transgender state laws and anti-transgender policies, practices, and norms in every community.
We also need to fight to make sure that every space we’re in is trans-inclusive. We should ask instead of assuming other people’s gender pronouns, starting by introducing ourselves with our own gender pronouns as a general rule (NPR). We should fight to change spaces that are unnecessarily gendered, like single-occupancy restrooms or social spaces.
• Dozens of anti-trans laws have been passed recently, with many banning gender-affirming care for youth.
• Gender-affirming care is a broad term that includes therapy, social interventions, hormone treatment, and surgery.
• Gender-affirming care is supported by major medical associations and gender-affirming surgery is often provided to non-transgender people without controversy.