Gender-Affirming Care Bans Harm More Than Just the Trans Community

Fact checked by Nick Blackmer

Key Takeaways

• A record number of bills banning or restricting access to gender-affirming care for young people were passed in 2023.

• As health providers depart from states with bans, they leave a dearth of care options for trans youth.

• Cisgender adolescents, including teens with diabetes and cancer patients who need reconstructive surgery, often suffer from health care restrictions, too.

A wave of legislation prohibiting certain gender-affirming care procedures swept the United States this year, and several states are considering new restrictions. Some states created criminal penalties for health professionals who give hormone therapy or parents who enable their transgender child to get health care.

Gender-affirming care includes psychological, social, behavioral, or medical interventions to support and affirm an individual’s gender identity. Major medical groups, including the American Psychiatric Association and the American Medical Association, consider these treatments to be safe, effective, and medically necessary.

There are about 300,000 transgender people ages 13 to 17 in the U.S. and more than 44% of those adolescents across 30 states have lost, or are at risk of losing, access to gender-affirming care, according to a recent report.

Gender-affirming care involves a variety of health providers, from mental health professionals to primary care pediatricians to endocrinologists. When those providers are forced out of their practices or confused about what type of care they're allowed to provide, cisgender patients suffer, too.

“Many providers have reached out to me in some of these states—in Texas and Florida in particular—and they're terrified,” Marci Bowers, MD, a gynecologist and surgeon who specializes in gender confirmation surgeries. “There are ripple effects throughout the medical community, and in particular, those who treat adolescents are the most frightened.”

Related: How Can We Improve Access to Gender-Affirming Health Care?

The Status of Gender-Affirming Care Bans in the U.S.

Nineteen states now ban best-practice medication and surgical care for trans youth. Some states limit access to care for people as old as 26 years.

All but three of those states enacted bans this year, leaving nearly 78,000 transgender youth without local access to care. As of June, seven more states are considering gender-affirming care bans, according to the Human Rights Campaign.

It’s a felony crime to provide gender-affirming care to minors in five states. In other places, state licensing boards can discipline providers and rescind their medical licenses. Those policies most directly impact pediatric endocrinologists, reconstructive surgeons, and other providers who may prescribe hormonal medications or give gender-affirming surgeries. But often vague laws can also cause confusion among health professionals providing routine care.

Lauren Wilson, MD, is a pediatric hospitalist and President of the Montana Chapter of the American Academy of Pediatrics. Montana lawmakers signed a gender-affirming care ban in April that will go into effect in October.

“I take care of a lot of trans youth if they happen to need to be hospitalized. If I were to reorder medications that they're currently on so that they can continue to receive them in the hospital, this ban would make me subject to having my license removed,” Wilson said.

Gender-affirming care teams often involve multiple health professionals, including psychiatrists, endocrinologists, pediatricians, and more. Wilson said that even among providers who don’t specialize in trans care, gender-affirming care bans can cause confusion and fear among health providers.

“If I were to prescribe [hormone blockers] for a child with precocious puberty, is the burden on me to make sure that that child is not trans and will not become trans?” Wilson said. “There’s a lot of fear because no one wants to be criminalized or have their medical license removed for something that's ultimately in the hands of a nonmedical jury and is at best vague.”

Bowers

We're not looking for new members. We're just looking for better conditions to live in.

Ripple Effects of Gender-Affirming Care Bans on Cisgender Adolescents

When providers move out-of-state or cease to provide gender-affirming care, “they take with them not just the gender services or the abortion services, but they also take away the obstetrical services and the primary care services that they were providing,” Bowers said. “That has an effect on the cisgender population as well.”

For instance, pediatric endocrinologists help patients with medical concerns ranging from metabolic disorders to height issues to thyroid conditions. Since the 1970s, endocrinologists have been using hormones to slow the development of some children who develop puberty years before their peers. Those same puberty blockers are sometimes used to provide care to trans youth.

In addition to trans and nonbinary youth, minors who need support from endocrinologists, and especially those living in rural areas with few existing providers, suffer the most from gender-affirming care bans.

“These laws affect not only rural youth, but Native youth and those who have more difficulty accessing medical systems in general, which are often those kids who are living in poverty and might have transportation issues, or kids who are affected by health disparities to begin with, like people of color,” Wilson said.

Surgical bans could also make it difficult to get certain reconstructive surgery unrelated to gender dysphoria. That includes breast reductions for young men with gynecomastia, or overgrowth of breast tissue.

While many of the bills target the most invasive gender-affirming care interventions, surgical procedures make up only a small portion of the gender-affirming care typically provided to trans youth.

“The talk is so much about surgical care. But really, the bigger discussion for us is about medical care and the things that really allow parents and patients to make decisions, and take the time and space to deal with dysphoria,” Wilson said.

In the three years between 2019 and 2021, about 780 trans people age 13 to 17 years old received top surgery nationwide, while fewer than 60 got genital surgery, according to an analysis of insurance claims by Reuters.

Limiting Providers Means Longer Waitlists for Care

In some cases, clinic staff are quitting out of fear for their safety and the safety of their families. Pediatric trans care providers in states including Texas and Florida departed from their health clinics before bans were instated, leaving patients scrambling for care.

In states with trans health bans, some clinics are seeing such a loss in patient volume that they’re being forced to lay off staff. That can be particularly troubling when those providers are themselves LGBTQ+ or gender diverse and are forced out of a job where they may have felt safe and accepted, Bowers said.

Besides, losing health providers makes access to care more challenging for everyone. The U.S. is already seeing a shortage of healthcare providers, a trend exacerbated in recent years by the toll of the COVID-19 pandemic.

Even before the new spate of anti-trans legislation, there was a shortage of gender-affirming care providers, leaving patients to wait weeks or months for evaluations and care.

Anti-trans legislation is also chilling some of the enthusiasm Bowers had previously seen in health students interested in pursuing trans care. Now, she said, “they don't want to go into a field whether their family is potentially at risk.”

"One rule doesn't fit every situation, so that's why we continue to stress individualized care, and this is why we need expertise in this area of medicine," Bowers said. "The last people that we should be asking to make these decisions are people that aren't even doctors—they don't even see these patients, they don't even know who they are, they don't know their families—and yet they're passing legislation to keep them from receiving health care."

Bowers said she remains hopeful that the political tides will turn in favor of protecting the right to full health care options for all people.

“Gender diversity—diversity period—adds brightness to this world,” Bowers said. “Don't put out the flame.”

What This Means For You

If you are a young person undergoing gender-affirming care, Wilson recommends speaking with a pediatrician to make a plan in case your health care is interrupted.