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Gender-affirming care is banned for transgender youth when it's mainly cisgender people who use it, and when it has a significantly lower regret rate than all other major surgeries, tattoos, and children.
It's banned for transgender youth when it's mostly cisgender people who use it. It's feared as a life-altering decision when most of it is reversible, and the rest has lower regret rates than most major surgeries, tattoos, and children. President Donald Trump lied and said it's being freely offered in schools when in reality its patients struggle to access it. That's right — it's time to talk about gender-affirming care.
Here's everything you need to know about the life-saving treatment.
Gender-affirming care encompasses several forms of therapies that are meant to validate a person's gender identity, including talk therapy, hormone therapy, or surgical procedures.
While not every transgender person will choose the same combination of therapies, physical treatments such as hormones or surgery may be required to legally update one's gender. As the World Health Organization adds, "Some transgender people seek medical or surgical transition, others do not."
There are several barriers to receiving gender-affirming care, as transgender people are usually required to receive a gender dysphoria diagnosis through a therapist or other medical professional before they can receive prescriptions for hormones or be referred to specialists for surgeries.
This typically involves months-long physical and mental examinations to ensure there are no health risks, as outlined by the Association of American Medical Colleges, and the patient must give their informed consent — meaning they must demonstrate that they are aware of and understand the potential side effects. For youth, the patient must give informed consent, and their guardians must also consent.
Gender dysphoria is a specific type of stress that arises when one’s gender identity does not match their sex as assigned at birth, often manifesting as discomfort about one's body or their physical appearance.
Not every transgender person experiences dysphoria. The diagnosis exists to allow trans people to get the care they need without stigmatizing their identities, as Mayo Clinic explains, "A diagnosis of gender dysphoria focuses on the feeling of distress as the issue, not gender identity."
Gender-affirming care for prepubescent youth primarily focuses on socially transitioning — changing their hair, clothing, or potentially going by a new name and pronouns. Only after many months being evaluated in talk therapy could a pubescent child demonstrating gender dysphoria be prescribed puberty blockers. When the patient is old enough, usually ages 16 to 17 per Planned Parenthood, they can then be prescribed hormones to replace those produced by their body.
Gender-affirming surgeries among minors are incredibly rare. There is no evidence of surgeries being performed on trans youth under the age of 12, according to a recent study in JAMA, and only 2.1 out of every 100,000 trans youth ages 15 to 17 received surgery — the vast majority being chest surgeries.
Puberty blockers, as the name suggests, delay the effects of puberty until a patient is old enough to begin hormone therapy. They are largely used among cisgender children to treat precocious puberty — the early onset of puberty that can lead to adverse health effects.
Puberty blockers are completely reversible, meaning that their effects disappear once a patient stops taking them. There are no known permanent side effects, and they do not cause damage to the ovaries nor uterus, as a study from the American Physiological Society found last year.
Hormone replacement therapy (HRT) involves a patient taking either feminizing (estrogen) or masculinizing (testosterone) hormones for the purpose of altering their appearance to better reflect their gender identity, typically in the form of an injection.
Hormone therapy is described as having the effect of "going through puberty," according to Planned Parenthood. It takes about 18 to 24 months for patients to notice changes, including to voice, fat distribution, and hair growth. However, HRT can not alter skeletal shape or height.
Some changes from HRT are reversible, and others are not. In transfeminine people, changes like slowed body hair growth and softened skin texture are completely reversible, whereas breast growth is irreversible. In transmasculine people, changes to acne and muscle mass are reversible, but hair loss and a lowered voice can be potentially permanent.
While transgender people are often portrayed to be the primary recipients of HRT or gender-affirming surgery, cisgender people receive the care far more frequently. Hormone therapy is most commonly used among cis women experiencing menopause, and significantly more teenage girls get breast implants than trans teens get chest surgeries. Out of 151 breast reductions performed on American minors in 2019, 146 (97 percent) were performed on cisgender males, according to the JAMA study.
Most insurance providers offer coverage for gender-affirming care, as it is deemed medically necessary by all major medical organizations. However, 10 states prevent Medicaid from covering the care for all ages, according to the Movement Advancement Project, and two additional states ban coverage for minors.
Some surgeries, such as breast augmentations or reductions, may not be covered by insurance and instead considered cosmetic regardless of gender dysphoria diagnosis. Thus, many transgender people pay out of pocket for their procedures.
The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, the World Medical Association, and the World Health Organization all agree that gender-affirming care is evidence-based and medically necessary not just for adults, but minors as well.
Several studies demonstrate that depression and anxiety is alleviated in youth when they socially transition and receive treatment for gender dysphoria. Many other longitudinal studies show that gender-affirming care vastly improve quality of life for people who identify as transgender. Out of 55 peer-reviewed studies, not a single one which found that gender transition has negative outcomes.
Gender-affirming surgeries have one of the lowest regret rates of any major surgery. Only 0.3 percent of transgender men and 0.6 percent of transgender women said they regret their gender-affirming surgery, according to a 2023 study from the National Library of Medicine.
In contrast, a report from the American Journal of Surgery found that regret ranged from 0 to 47.1 percent for breast reconstructions, 5.1 to 9.1 percent for breast augmentations, and 10.82 to 33.3 percent for body contouring. Over 30 percent of patients experience regret following prostatectomy, and up to 19.5 percent following bariatric surgery.
Major life events also have significantly higher regret rates than gender-affirming surgery, as 7 percent of people regret having children and 16.2 percent regret getting tattoos.
