With more than 220 bills circulating across the United States targeting transgender people, the controversy surrounding gender-affirming care is undeniably inescapable. If you’ve read, listened to, or watched the news at all over the last year, you’ve no doubt heard some of the buzzwords coming from politicians who are desperately trying to limit or restrict trans people—particularly trans youth—access to care and providers who will make them feel safe, seen, and heard. And more often than not, the politicians pushing for anti-trans laws say they’re doing so to “protect children.”
Except, banning access to gender-affirming care does the exact opposite of protecting children. Support, whether from their family, school, or medical providers, is essential to the mental health of transgender and non-binary youth. In 2022, out of the 300,000 youth identifying as trans or non-binary, less than 1 in 3 found their home to be gender-affirming—meaning these kids were living in homes where they did not feel supported. That same year, around 1 in 5 transgender and nonbinary youth attempted suicide, with even more reporting to have seriously considered it. However, there were significantly lower rates of suicide attempts in students who either attended LGBTQ+-affirming schools or lived in LGBTQ+-accepting communities. The patterns are clear, which is why the American Academy of Pediatrics (AAP), the American Medical Association (AMA), and the American Psychological Association (APA) have all come out in support of gender-affirming care for children and adolescents.
While this is a hot-button talking point for politicians, medical and mental health professionals agree that gender-affirming care is nonnegotiable. Despite their mission to “protect the children,” politicians pushing these laws are, in fact, causing immense harm to this vulnerable group, which is why here at Pregnancy & Newborn, we feel it is important to provide clarity on the topic and to assist our readers in understanding what gender-affirming care actually is, and why it’s so important. To help us do this, we spoke with experts JohnNeiska Williams, LPC, licensed therapist at Grow Therapy, MD Sitzes, communications manager at Equality Ohio, and Jennifer Covarrubias, MS, LMFT, APCC, clinical director of outpatient services at Mental Health Center San Diego, who shared their knowledge and thoughts on this urgent situation.
What is Gender Identity?
Before getting into the nitty gritty of gender-affirming care, it’s helpful first to have an understanding of gender identity. For centuries, gender and sex were (seemingly) straightforward and assigned at birth: man/male or woman/female. However, as civilization has developed and society has grown, so has our understanding of gender. Now we know that it’s not now, nor has it ever been as simple as man/male or woman/female.
For instance, just because someone is born with female anatomy and assigned female at birth (AFAB), doesn’t mean they feel like they belong in the gender role of a woman. In fact, maybe they tend to align more with traditionally masculine expectations—so they feel like who they are physically does not represent who they are at their core. In this case, this person may identify as a man.
Not identifying as the gender you were assigned at birth is called gender dysphoria. According to Boston Children’s Hospital, dysphoria means “significant uneasiness and dissatisfaction.” Symptoms of gender dysphoria can begin in early childhood (but can also appear later) and may include distress, anxiety, depression, negative self-image, a strong dislike of sexual anatomy, and (for children) a strong preference for the toys and activities associated with the other gender.
It’s important to note that gender dysphoria differs from gender non-conformity, which is when someone’s “gender identity, role, or expression are not typical for individuals in a given assigned sex category.”
Some common gender identity terms include:
- Cisgender: someone who identifies as the gender they were assigned at birth.
- Transgender woman (trans woman): someone who identifies as a woman but was assigned male at birth.
- Transgender man (trans man): someone who identifies as a man but was assigned female at birth.
- Non-binary (genderfluid, genderqueer, polygender, bigender): someone who does not identify solely as a man or a woman, regardless of what they were assigned at birth.
Finally, it is through gender identity that we get pronouns. For example, a trans woman will likely use “she/her” pronouns, even though that does not align with the sex/gender she was assigned at birth. Similarly, someone who is non-binary may use “they/them” pronouns; however, there are also several other alternative gender-neutral pronouns that they may use. When it comes to pronouns, if they haven’t explicitly told you what they use, the best thing to do is not assume and simply ask a person for their preferred pronouns.
What is Gender-Affirming Care?
For trans and non-binary people, the first step is identifying it from within, but they also need the people around them to support them by using preferred pronouns, calling them by their preferred name, and encouraging them to express themselves through the clothing they wear, their hairstyles, their behaviors, the activities they participate in, and however else they’d prefer. This applies to family, friends, teachers, and—perhaps most importantly—their health care providers.
“Gender-affirming care can expand across all health care fields, including mental health counseling and therapy,” says Williams. Covarrubias explains that it’s an “array of interventions or services within different settings that can support and affirm a person’s gender identity when it conflicts with the gender they were assigned at birth.”
According to Sitzes, gender-affirming care is tailored to the individual based on what they want and need. “It is important to note that gender-affirming care should be personalized, taking into account an individual’s age, unique circumstances, health considerations, and goals,” they say. “Collaboration between the individual and multidisciplinary health care team, including health care providers specializing in transgender health care, is crucial to ensure comprehensive and affirming care throughout the gender-affirming process.” They specify that for youth, “this team can [also] include their family, friends, and school.”
Some common elements Sitzes says fall under the gender-affirming care umbrella include:
- Mental Health Support: Therapy or counseling can address gender dysphoria, promote self-acceptance, and develop coping strategies. Mental health professionals play a vital role in the overall well-being of transgender individuals throughout their gender-affirming journey.
- Voice and Speech Therapy: This is particularly for individuals seeking to align their voice with their gender identity.
- Hormone Therapy: Hormone replacement therapy (HRT), which involves the administration of hormones (such as estrogen or testosterone) to align the individual’s physical characteristics with their gender identity.
- Surgical Intervention: Also known as gender confirmation or gender reassignment surgery, this may include chest reconstruction (mastectomy or breast augmentation), genital reconstruction (vaginoplasty or phalloplasty), or facial feminization/masculinization. Surgical options vary depending on an individual’s age, desired outcomes, and health considerations. It is important to note that, according to Human Rights Campaign, “gender-affirming surgeries are only performed after multiple discussions with both mental health providers and physicians (including endocrinologists and/or surgeons), to determine if surgery is the appropriate course of action.”
- Legal and Social Support: This may include assisting individuals with legal processes to update identification documents, such as gender markers or name changes, to align with their gender identity. To promote inclusivity, understanding, and respect, support may also be provided in navigating social contexts, including workplace or educational environments.
- Community and Support Networks: Connecting individuals with support groups, transgender community organizations, local and state nonprofits, and resources that foster a sense of belonging and provide avenues for sharing experiences, seeking guidance, and building supportive networks.
What Are Best Practices for Gender-Affirming Care in Kids and Teens?
Even though gender-affirming care is multi-faceted, politicians and media often mislead the public into thinking that any child receiving this kind of care is undergoing stages of gender transition that are irreversible—and that’s simply not true. In fact, “no medical interventions with permanent consequences happen until a transgender person is old enough to give truly informed consent,” according to Human Rights Campaign. Like most other medical treatments, gender-affirming care in children and youth often starts conservatively.
“Despite the emphasis on medical care in media reports on transgender adults, gender transition for children who have not reached puberty is entirely a social process,” explains Sitzes. “The steps a family and community take to affirm a child’s gender identity are called social transition,” they explain, “Social transition is completely reversible if the child determines it’s not right for them.”
Some examples of social transition Covarrubias provides include changing pronouns and/or names and wearing clothing or hairstyles that align with their gender identity. She further explains, “When medical intervention is present in the context of transitioning, it is important to involve all supportive parties in order to act according to what is age-appropriate and in the best interest of the person.”
Once a child reaches puberty, hormone therapy may become a topic of discussion—which is another treatment that is misrepresented by politicians. “Puberty blockers are often used as talking points in misinformation campaigns, but really they are completely reversible, stoppable, and are simply a way to give children and their parents more time to think deeply about their choices,” says Sitzes.
While Williams supports and advocates for gender-affirming care for kids and teens, she notes that it’s also important for providers to dig deeper into gender dysphoria to ensure there isn’t another underlying condition. “Nothing is wrong with exploring [gender identity], but the idea of the exploration may be due to other issues such as abuse, bullying, trauma, or other mental health issues that go ignored,” she explains. “It’s significant to make sure that access [to mental health care] is available while [also] supporting them. Exploring their gender won’t change trauma. Being too positive can often invalidate and ignore more significant issues.”
What Are the Benefits of Gender-Affirming Care?
The argument for gender-affirming care is strong: it saves lives.
“The risk associated with losing gender-affirming care extends far beyond medical aspects—it encompasses the potential loss of loved ones,” says Sitzes. “Transgender individuals face significantly higher risks of suicide compared to the general population [and] research has consistently shown that the presence of at least one supportive person in the life of an LGBTQ+ individual can be instrumental in preventing these tragedies.”
Ideally, a child or teen exploring their gender identity would have several people offering them support, but if their health care provider is the only person, that can still make a powerful difference.
“Imagine being treated in a way that aligns with you are at your core,” explains Covarrubias, “Feeling supported and heard has a positive effect on your mental health and overall health. It allows individuals to be more likely to be honest with providers about their symptoms and needs. Individuals are also more likely to involve their loved ones in the treatment process in any form. Being truly understood and heard has many benefits.”
Williams notes that gender-affirming care “decreases anxiety and depression” in kids and teens, and when they don’t have access to this care, they are more at risk of “suicidal ideations, in most cases from lack of feelings of belongingness.” She also explains, “The alleviation of discrimination and assumptions [gender-affirming care provides] allow a person to feel more comfortable and open to receiving all care and is said to reduce the feelings of hopelessness that oftentimes lead to suicidal ideations for those in this community.”
In 2022, around 1.6 million people aged 13 years and up in the United States identified as transgender—and studies show that this number will continue to climb as more and more young people feel safe exploring their gender identity. By fighting to ensure access to gender-affirming care, we are telling trans and non-binary youth that their lives are valuable, and we will do whatever we can to protect them.
“As parents, the most important thing we can do is love our children unconditionally, accepting them for who they are,” says Sitzes. “Will we choose to raise our children in an environment of conflict and division, or will we foster an atmosphere that embraces authenticity, honors differences, celebrates diversity, and promotes love and acceptance,” they ask. “The responsibility to shape the future lies with us. By educating ourselves and supporting our children, we can create a society that embraces and respects all individuals, regardless of their gender identity or expression.”
To learn more about gender-affirming care, gender identity, and trans and non-binary youth, check out The Trevor Project, American Civil Liberties Union (ACLU), and Human Rights Campaign.