Here's What Gender Affirming Medical Care Involves and Why It Can Be Lifesaving

Bills prohibiting and criminalizing gender affirming medical care are popping up across the nation, but research shows that the care is critical for the health and wellbeing of transgender youth.

Vintage brown leather Doctor's bag with a stethoscope around the handles, and a LGBTQ+ transgender pin on the outside
Photo: Getty / Design by Jo Imperio

In Texas, a record number of anti-LGBTQ+ bills are under review and a majority of them target the health of transgender adolescents. Some of the latest directives include banning gender affirming therapy for transgender youth, even classifying such therapy as child abuse. Parents and other adults with knowledge and assistance of the gender-affirming medical treatments can face criminal charges.

Similar anti-transgender bills have been put forth in other states such as Idaho (where the measure passed successfully) and Arkansas, where an effort to prohibit health care professionals from providing—or even referring— transgender young people for medically necessary health care, was blocked by a federal court.

Time and time again, research has shown that gender affirming medical care is incredibly important for the health and wellbeing of young transgender kids. A December 2021 study from The Trevor Project, for instance, says gender-affirming hormone therapy was linked to a 40% lower risk of depression and suicide attempts in the past year. Another recent study conducted jointly by Seattle Children's and University of Washington also found a 60% reduction in depression and a 73% reduction in suicidality in transgender and nonbinary adolescents in their first year of gender-affirming hormone care.

Gender-affirming care has become a buzzword tossed around by politicians with anti-transgender agendas who say they want to protect children. But gender affirming care does not always involve hormone therapy or surgery. Here's a closer look at what gender-affirming care actually involves, why it is important, and how to access it.

What Exactly Is Gender Affirming Medical Care?

Gender affirming care is any treatment that helps a transgender, nonbinary, or gender non-confirming person in their transition process. Professionals specializing in gender-affirming care provide a judgment-free environment to help patients explore their gender identity.

There are a lot of misconceptions involving gender affirming care that may in large part be due to a narrative that's been woven by anti-transgender care activists, say experts. This narrative often involves a variety of false assumptions regarding the process of gender-affirming care. The main goal of gender affirming care is to help patients be comfortable with their gender identity and not try to "fix" it.

Rapid Onset Gender Dysphoria (ROGD)

Rebecca Minor, MSW, LICSW, a gender specialist, clinician, and part-time faculty at Boston University who is focused on the intersection of trauma, gender, and sexuality, said some people may be against gender affirming care because they think it is just a phase. "Some parents will often cite a concept called rapid onset gender dysphoria as a reason they don't want to take their kid to gender affirming care, but I would like to publicly point out that it's not a real thing," Minor told Health.

The term 'rapid-onset gender dysphoria' or ROGD, dates back to about 2016, according to an article published by The Sociological Review. The name was used to describe an alleged epidemic of youth coming out as trans 'out of the blue' due to social contagion and mental illness. "The term reflects a deliberate attempt to weaponize scientific-sounding language to dismiss mounting empirical evidence of the benefits of transition," according to the publication.

Hormone Therapy and Surgery

Another popular misconception is that gender affirming care only involves hormone therapy or surgery. But not everyone with a gender different from the one assigned to them at birth wants to undergo surgery in their transition. Gender affirming care is tailored to each individual's wants and needs. It can also include a safe space through therapy with patients and their families to process and understand the transition. Patients may also opt for psychoeducation of gender and sexuality.

Because gender affirming care is an individualized process, people can start off with a social worker or a psychologist and later make a decision to include an endocrinologist on their team for medical treatment. For those who do decide to medically transition, there are options such as gender-affirming hormone therapy and genital reconstruction.

Hormone treatment can begin once a young person experiences changes to the body related to puberty, such as breast development for a patient who's assigned female at birth or testicular enlargement on a patient who is assigned male at birth. Gina Marie Sequeira, MD, MS, co-director of Seattle Children's Gender Clinic said puberty blockers serve as a pause button on puberty and can help a younger person who is having a lot of distress related to the way their body is changing. "These medications have been studied for many years in patients with early puberty and have been shown to be very safe," Dr. Sequeira told Health.

If a patient receives hormone therapy in later adolescence or as an adult the medications would accompany other medications such as testosterone (male sex hormone) or estradiol (female sex hormone), Dr. Sequeira said. Another type of gender affirming medical care is gender affirming top surgery — a medical procedure where doctors remove breast or chest tissue (masculizining chest surgery) or increasing and shaping breasts (feminimizing mammoplasty). Top surgery is available to adults and people in later adolescence.

"As someone who prescribes puberty blockers and gender-affirming hormones, it is a part of my responsibility as a medical provider that both a young person and their family are fully aware of the decision that they're making and what these medications do, and whether they're able to make the right decision for themselves," Dr. Sequeira told Health. Making the decision to medically transition requires ongoing conversations that can take months, if not years, about a patient's goals around care, added Dr. Sequeira. And when a patient starts gender affirming medications, it is important to have conversations about how they're feeling regarding the changes they're seeing, in order to determine how best to move forward with care.

These decisions are not taken lightly. Less than 1% of people who decide to medically transition decide to detransition, said Minor. She explains a common misconception that people fear about gender affirming therapy is that it's irreversible. But that's not true. Many of the changes are reversible once you stop taking hormone medication.

Is Gender Affirming Care Available Throughout the Country?

Gender-affirming hormone therapy is difficult to access for many patients and families because few clinics and medical providers offer this type of care. Gender identity clinics are available in the United States, but not in all states. According to the Human Rights Campaign, there are more clinical care programs for transgender and gender-expansive youth along the northeastern region than the central and southern regions of the United States.

Transgender youth living in rural areas are one of the most affected, as there are little options for gender-affirming hormone therapy. To put it into context, there is only one clinic in Idaho that provides gender affirming care, Dr. Sequeira said. Patients in Northern Idaho would have to travel at least eight hours from any pediatric gender center. With the passage of anti-LGBTQ+ bills and measures, such as the one in Texas which equates gender-affirming care withchild abuse, the number of providers who offer this type of service will likely decrease, Minor said.

Telehealth has helped somewhat in bridging the gap in rural areas but the benefits are limited by the number of licensed professionals within a state who can prescribe treatment.

Is a Prescription Required for Gender Affirming Care?

If you do have access to gender affirming care, you do not need a prescription for nonmedical services such as therapy. However, all gender affirming medical treatments require a prescription.

"If a young person is interested in receiving puberty blockers or gender affirming hormones, like testosterone or estrogen, all of those are medications that are prescribed by physicians," Dr. Sequeira explained, adding that hormone therapy is always provided in an outpatient setting such as a clinic that cares for adolescents and has a pediatric endocrinologist on staff to provide the services.

Gender affirming care is only accessible when a child is in puberty. There are no medical interventions for a young person before they start to have changes to their body from puberty. Additionally, some clinics have different approaches surrounding the type of treatment a person is eligible to receive.

Additional Resources

Multiple organizations such as the American Academy of Family Physicians, American Academy of Pediatrics, and the American College of Obstetricians stand in support of access to gender affirming care. Here are some of the websites and organizations that can provide more information about gender affirming care:

The key message that experts want to convey is that there is scientifically-backed evidence supporting the physical and mental health benefits of gender affirming care. Both Minor and Dr. Sequeira equated gender affirming care to critical, life-saving treatment.

"One thing that's really important for parents to hear is that young people who are interested in gender affirming medications—whether it's puberty blockers, testosterone, or estrogen—those medications can significantly improve mental health outcomes for trans youth," Dr. Sequeira said. And it's incredibly important for parents to create supportive environments for young people, but a part of that is helping facilitate access to gender affirming care for kids."

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