The main takeaways

• This category of care may include such things as puberty blockers, gender-affirming hormone therapy, gender-affirming procedures, and socially transitioning by changing one's name, pronouns, or way of presenting; changing one's style of presenting, and changing one's name.
• At least 30 states have already passed legislation or are in the process of debating legislation that would restrict access to gender-affirming care.
   

In the most recent few months, gender-affirming care has been the focus of a lot of discussion in legislatures across the country. As a result of this, there have been a lot of misconceptions and myths spread about what exactly it involves and who exactly it is for.

According to a report that was published by The Williams Institute in March of 2023, thirty states had either passed legislation or were considering passing laws that would restrict access to gender-affirming care. As a direct consequence of this, there are currently 146,300 transgender children and adolescents who either do not have access to gender-affirming care or are at risk of losing such access. People up to the age of 26 would have more difficulty gaining access to medical treatment under several bans that have been suggested for 2023.

Even if there is a lot of false information floating around about the topic, it is essential that you get the facts straight: The American Medical Association, the American Academy of Pediatrics, and the Endocrine Society all agree that gender-affirming care is not only safe but also effective and required from a health perspective.

"Gender-affirming care is considered life-saving," said Rebecca Minor, MSW, LICSW, a gender specialist and therapist who delivers gender-affirming care. Minor is a provider of gender-affirming care. "It plays an extremely important role in improving the mental health, well-being, and overall quality of life for individuals who identify as transgender, non-binary, and gender diverse."

What Does It Mean to Provide Care That Is Gender-Accepting?

According to Minor, "gender-affirming care" is the term used to describe the provision of medical, psychological, and social assistance to those who identify as transgender, non-binary, or gender expansive. The purpose of gender-affirming care is to improve people's overall health while also assisting them in better harmonizing their sense of self with their external appearance.

Uri Belkind, MD, a pediatric medicine expert who works in adolescent medicine at the New York-based LGBTQ+ health clinic Callen-Lorde, told Verywell that "gender-affirming care" can mean different things to different people. Callen-Lorde is located in New York. "It is not a specific process, but rather a collection of tools from which we can select one that is better suited to better fit the individual's goals and needs."

One component of gender-affirming care is transitioning socially, which does not require any kind of medical intervention on the patient's part. According to Sean Arayasirikul, Ph.D., an associate professor in residence of health, society, and behavior at the University of California, Irvine, this may entail altering one's name and pronouns, clothing, or presenting in a way that validates their gender identification, and so on.
When it comes to gender-affirming care, in addition to socially transitioning, there are three broad medical alternatives accessible, according to Belkind. He added that some people may want or need all of them, while others may find satisfaction and well-being with only some of them. Puberty blockers, gender-affirming hormone therapy, and gender-affirming operations are examples of these types of treatments.

Puberty blockers are prescribed to younger patients who are beginning puberty and are finding the changes that their bodies are undergoing to be unsettling. These patients must have demonstrated an adamant, persistent, and consistent identification with a gender that is different than the one they were assigned at birth to be eligible for this form of care.

"This enables us to temporarily 'pause' these changes while the young person, with the support of their family, further explores their needs and gains a better understanding of what is possible from a medical standpoint and what it entails," said Belkind. "This allows us to temporarily 'pause' these changes while the young person further explores their needs and gains a better understanding of what it entails."

According to Belkind, the term "gender-affirming hormone therapy" refers to the practice of utilizing estrogen or testosterone to encourage certain physical changes and suppress others. In other words, it is a form of "gender-affirming" hormone therapy.

Certain physical attributes can be altered by the use of hormone medication, but other aspects of a person's appearance can be altered through gender-affirming operations, whether surgical or non-surgical. Belkind stated that some of these procedures may involve facial feminization, chest masculinization, permanent hair removal or hair grafting, and genital surgeries such as vaginoplasty or phalloplasty.
According to Arayasirikul, a prevalent misperception is that gender-affirming operations are only regulated for trans and gender-expanding persons and that these procedures are experimental and lack solid medical proof. Arayasirikul went on to say that this is a common misconception.

According to Arayasirikul, the reality is that cisgender people, often known as people who are not transgender, may opt to go through gender-affirming operations to verify their identity. This may involve procedures such as breast augmentation, a mastectomy for gynecomastia, a hair transplant, rhinoplasty, liposuction, facial fillers, or hormone therapy. Other possible procedures include hair transplantation, liposuction, and face fillers.

"These procedures, and so many more like them, are part of the health care that is provided to cisgender people," Arayasirikul added. "However, this same care is actively being criminalized for transgender and gender non-conforming people for no other reason than the fact that they are different."

Can Individuals of Any Age Receive Care That Is Affirming of Their Gender Identity?

Transgender children and adolescents have access to puberty blockers, which can postpone the onset of puberty, and cross-sex hormones, which can grow their bodies in ways that are congruent with their gender identification, in states where it is not illegal to provide gender-affirming care.

Arayasirikul stated that gender-affirming operations are typically reserved for adults and are not performed on minors.

Despite this, most of the controversy that has surrounded gender-affirming care in the United States has been on the topic of minors getting medical procedures.

According to Belkind, some patients decide to start using puberty-blocking medications as soon as puberty starts, while other patients may not seek medical assistance until after puberty or even later in life.

"It is important to note that, for children who strongly identify with a gender identity that is different from their sex assigned at birth, there are no medical interventions needed before puberty begins and only then do we consider the use of puberty blockers, if needed," Belkind said. "It is important to note that there are no medical interventions needed before puberty begins for children who strongly identify with a gender identity that is different from their sex assigned at birth."

According to Belkind, medical procedures are never undertaken without first doing an exhaustive assessment of the patient's requirements.

The Importance of Gender-Accepting Care and Why It Is Necessary

According to Minor, gender-affirming care can help minimize gender dysphoria, which is the discomfort a person may experience when their gender identity does not fit with the sex they were assigned at birth.

"Gender-affirming care, such as hormone therapy or gender-affirming surgeries, can help alleviate gender dysphoria by allowing individuals to align their physical appearance with their gender identity," she explained. "This can help alleviate some of the symptoms of gender dysphoria." "This reduction in distress and discomfort can have a significant positive impact on both mental health and overall well-being."

Transgender and gender-nonconforming people have been shown to have a much greater incidence of mental health issues, such as depression, anxiety, and thoughts of suicide.1 According to Minor, providing persons with the tools, resources, and interventions necessary to alleviate distress and develop a positive self-image through gender-affirming care paired with mental health assistance will help lessen these risks.

One recent study found that providing transgender and non-binary youths between the ages of 13 and 20 with gender-affirming care, such as puberty blockers and gender-affirming hormones, resulted in a reduction of suicidality by 73% and a reduction of the risk of developing moderate or severe depression by 60% throughout a 12-month follow-up period.2

When compared with transgender and gender-diverse people who had not had gender-affirming surgery but wanted it, people who had gender-affirming surgery were associated with a 42% reduction in psychological distress and a 44% drop in suicide ideation, according to the findings of another study that looked at the effects of gender-affirming procedures.3

"Gender-affirming care allows individuals to authentically express their gender identity, which promotes self-acceptance and improved self-esteem," said Minor. "Gender-affirming care is empowering." "Individuals can develop a stronger sense of identity and self-worth by aligning their physical appearance, social interactions, and personal identity," which leads to "improved mental health outcomes."

According to Minor, gender-affirming care frequently consists of support groups, peer networks, and counseling services that offer a secure and welcoming setting for persons to interact with one another, discuss their experiences, and receive emotional support. She emphasized the significance of having strong social support systems to counteract feelings of loneliness and foster the development of healthy connections.

Care of this kind can aid in the fight against the prejudice, stigma, and marginalization that transgender people and others who don't conform to binary gender norms frequently encounter in society. According to Minor, gender-affirming care can provide individuals the ability to advocate for themselves, defend their rights, and discriminatory challenge procedures.

"By affirming their gender identity, individuals can experience improved resilience, reduced psychological distress, and increased social acceptance," she added. “[T]hese are all outcomes that can result from embracing their gender identity.”