Twenty states have passed a law or policy to ban gender-affirming healthcare for transgender people under 18, and an additional seven states are considering passing these laws. More than 44% of the country’s transgender youth live in these 27 states.

Some states, such as Texas, Oklahoma and South Carolina, have considered banning gender-affirming care for transgender people up to age 26, according to the Human Rights Campaign (HRC), which is the largest LGBTQ lobbying organization in the country.

Gender-affirming care encompasses a range of medical, psychological and behavioral interventions designed to support a person’s gender identity when it does not align with the gender they were assigned at birth. This type of care could include things like therapy, hormone replacement medications and gender confirmation surgery. 

While some may consider the laws discriminating against transgender children to be just another part of the country’s injurious and enduring culture war, this issue poses a major threat to the health and wellbeing of LGBTQ youth across the nation. LGBTQ advocacy groups and clinicians argue that healthcare providers have a responsibility to treat this problem like the public health crisis that it is. 

To do this, providers must educate themselves about the laws in their state and nearby states, fight misinformation about gender-affirming care, and try to collaborate with nonprofits to deliver care to kids in states where their access is under attack, experts agreed.

Understanding the laws

It’s imperative that clinicians who treat children get familiar with the types of transgender health laws that have been passed or introduced in their state, Sarah Warbelow, HRC’s legal director, said in an interview. The specifics vary significantly state-by-state, she pointed out.  

For example, some states have banned doctors from providing gender-affirming care but have not necessarily prohibited them from making referrals to doctors in other states that can provide this type of care, Warbelow explained. Other states, such as Alabama, have passed laws making it illegal to facilitate gender-affirming care for trans children in any way — this includes doctors making referrals and parents taking their children to an appointment, she said.

However, in some states, laws related to transgender youth’s healthcare have already been temporarily or permanently enjoined — including Arkansas, Florida and Indiana. The laws were enjoined after being found unconstitutional on equal protection and due process grounds, Warbelow noted.

This means that there is “no reason” providers in these states can’t continue to provide gender-affirming care to minors, she declared — even though they may be under social and political pressure to discontinue this type of care while the courts work things out.

“Providers should be fully educated and keep up to date on any changes to the law because they should provide the care as long as they’re able to do so. We’re hopeful that more of these laws will be found unconstitutional, which should increase the ability of folks to be able to continue their care,” Warbelow said.

Organizations like HRC, the American Civil Liberties Union and the Transgender Legal Defense & Education Fund are actively litigating against the passage of discriminatory laws by filing lawsuits on behalf of transgender youth and their parents in federal court. These groups are also conducting public education initiatives for doctors and parents to help them understand the limitations of the laws in their area, as well as providing direct support to families who are affected, Warbelow pointed out. Some examples of direct aid include helping families relocate to different states or coordinating travel to healthcare appointments in different states.

Dr. Michael Morse, a clinical psychiatrist at Medstar Georgetown University Hospital, agreed that providers must keep abreast of the laws in their area. He added that doctors in states without discriminatory laws “have an obligation” to look for ways to help families from other states that are seeking new places to receive care. Some states are in alignment with Dr. Morse’s view — for example, New York recently became the latest state to designate itself as a safe haven for transgender youth and families who are fleeing legal persecution.

How these laws affect transgender children and their families

Dr. Morse treats young patients, some of whom are transgender, so he knows first-hand about the mental health toll that the passage of anti-transgender laws can take.

“I think there are few domains of medical practice where the science is more clear that these sorts of discriminatory laws and bigoted personal statements that are being made around the country by people in a lot of power are hurting trans kids — and the queer community more broadly,” he declared.

The fact that transgender children are facing negative mental health consequences as a result of these laws is especially concerning given that this population already suffers from depression and suicidal thinking at higher rate than their cisgender peers. The Trevor Project’s 2022 national survey on LGBTQ youth’s mental health showed that more than half of transgender and nonbinary youth seriously considered attempting suicide in the past year.

Additionally, transgender youth face barriers blocking them from receiving gender-affirming care even without discriminatory laws — such as financial and social pressures — Dr. Morse pointed out.

“When kids really feel a strong sense of a need to affirm their gender and their gender dysphoria is very intense, they’re much more likely to have suicidal thoughts. They wonder not necessarily if life is worth living, but is it worth living in this body in which they feel so alien, dissociated and depressed?” he explained.

Dr. Matthew Biel — a pediatric psychiatrist and chief medical officer of pediatric mental health startup Fort Health — echoed Dr. Morse’s comments and added that he doesn’t believe that the laws in question were written from a clinical perspective.

“The relationship between a patient, their family and their providers should be protected, private and highly individualized. It should be responsive to the healthcare needs and priorities of the patient and family, as well as the expertise and knowledge of the provider. Having something interrupt that because of politics and a culture war just seems really, really bad for patients and really bad for care,” he declared.

The fact that a child’s access to care can be stripped from them based on where they live is “super concerning,” Dr. Biel added. If a child is experiencing severe gender dysphoria, their doctor will know that they need gender-affirming care regardless of whether they live in Massachusetts or Texas, he said.

When a child is no longer allowed to receive gender-affirming care in their state, it can also cause immense distress for the entire family, Warbelow pointed out.

She said her organization has heard stories from families who have moved out of a state they previously cherished due to gender-affirming care bans. This can be massively disruptive — families must say goodbye to their support systems, communities and friends. In some cases, families had to shutter small businesses, and in others, families moved away from grandparents who needed assistance, Warbelow said. There are also some cases where families are divided, meaning one parent remains at home with some of the kids in their home state, and another parent relocates with their transgender child to seek care for them elsewhere, she added.

“Even if these bills don’t pass or trans kids don’t reside in states where these bills are passing, they’re aware of these conversations. They read the news just like everybody else, and there is a real mental health toll that comes from being told that you don’t deserve to live as yourself,” Warbelow said.

How providers can fight misinformation

Many supporters of laws that strip transgender youth of their access to care lack an accurate understanding of what gender-affirming care is and how it’s delivered, Warbelow declared. She said that advocacy organizations like HRC are encouraging healthcare providers to speak up and educate the public about the fact that gender-affirming care is age-appropriate and medically necessary.

Warbelow added that the medical necessity of gender-affirming care has been backed by decades of research and is supported by every major medical association.

For example, the American Medical Association’s letter to the National Governors Association said that banning gender-affirming care for minors is a “dangerous governmental intrusion into the practice of medicine and will be detrimental to the health of transgender children across the country.”

Dr. Morse agreed, saying that gender-affirming care is “just as much a medical issue as high blood pressure or diabetes or anything else that doctors treat.” When transgender youth cannot access that care and experience feelings of intense sadness and depersonalization, those are “symptoms in the domain of psychiatric medicine” and must be addressed by medical professionals, he explained. 

“Doctors sacrificed a lot in order to have the privilege of caring for people who need it. I think that we have an obligation to impart what we know from scientific and medical literature — which is that gender- affirming care improves lives and saves lives. We have to support our patients,” Dr. Morse declared.

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