As a society, we are responsible for ensuring that young people have the resources they need to thrive physically, psychologically, and developmentally. Part of promoting young people’s future happiness, health, and dignity is providing health care that recognizes all aspects of their evolving identities, including their gender identity and gender expression, and supporting them as they make choices about their own well-being. Yet we are failing to live up to those obligations for transgender, non-binary, and gender-diverse (TNGD) youth who face discrimination when navigating the health care system and who experience daily and constant attacks on who they are. In a 2022 survey of transgender and non-binary young people, 32 percent of respondents reported being refused medical care by a health care provider in the past year. Twenty-one percent of respondents reported that a health care provider refused to provide reproductive or sexual health services due to their gender identity. These health care gaps were even starker for transgender and non-binary youth of color. Research also suggests that transgender people are more likely to delay care and report negative effects of disclosing their gender identity to their provider compared with cisgender people.
We owe young people so much better. They deserve supports like gender-affirming care and a broad array of medical, non-medical, and mental health services that promote healthy gender identity development. Put simply, gender-affirming care is health care that is responsive, affirming, and appropriate – the sort of dignified health care that every person deserves. This care is essential for the physical and mental health of young people and is a crucial support as they pursue their goals and dreams. Gender-affirming care has been around for decades and has been recognized as medically necessary by major medical organizations including the American Medical Association, the American Academy of Pediatrics, and the World Health Organization. Though it is most commonly associated with TNGD youth and adults, it is accessed by people of all gender identities. For example, for cisgender people, gender-affirming care includes reconstructive mastectomy, hair removal, hormone replacement therapy, and breast reduction surgery to alleviate the social and mental health challenges of unwanted breasts in cisgender men and boys. These services, which help cisgender people align their gender identity with their physical gender expression, are gender affirming, even though they are not always commonly recognized as such. While respectful and affirming health care is important for all people, it is particularly beneficial for transgender, non-binary, and gender-diverse youth, whose emerging identities are regularly undermined and who are otherwise often ill-served by the health care system. Gender-affirming care is a bright spot that decreases the risk of depression and suicide for youth and can help them grow into healthy adults who are loved and respected for all that they are.
Unfortunately, as of November 2024 26 states have enacted laws and policies infringing on young people’s dignity and bodily autonomy by limiting access to gender-affirming care for youth who identify as transgender, non-binary, and gender-diverse. These restrictions affect more than three-quarters of youth who identify as transgender. These states include Tennessee, which argued before the Supreme Court on December 4th in defense of its own ban, which classifies providing affirming care to TNGD youth as a misdemeanor, even if that care is offered via telehealth by an out-of-state provider. In front of the same court that overturned Roe v. Wade in a blow for people’s rights to make their own health care decisions, Tennessee asserted that it should be allowed to wage an outright assault on young people’s ability to make decisions about their bodies, health, and gender identity without policing or coercion. Tennessee’s law, like similar bans in other states, is intrusive and politicizes the routine, intimate decisions about health and well-being that young people should be free to make with the guidance of their families and providers.
Ultimately, these bans are fueled by a rising tide of transphobia and anti-LGBTQ+ sentiment across the country. This is evident in the open hostility marking the legislative process leading to these bans. For example, Tennessee’s legislators used inflammatory and disdainful language against TNGD youth when debating the law. The discriminatory intent is also obvious from the way these bans specifically target affirming care for transgender, non-binary, and gender-diverse youth while preserving it for cisgender youth. Despite proponents’ claims that the bans are intended to protect young people from potential regret and danger, each of the 26 states banning gender-affirming care targets interventions for TNGD youth that they allow for cisgender young people. If these legislators were truly concerned that affirming services were dangerous, they would ban access to these services for all young people. Indeed, as, despite the political rhetoric, the vast majority of gender-affirming surgeries (97%) are actually for cisgender youth and not transgender youth, it makes even less sense that the laws carve out exceptions for cisgender youth. Clearly, the concern is not that these interventions are unsafe or harmful, but rather that they are used to support gender identities that state policymakers oppose and wish to control. Moreover, despite their insistence that they are promoting youth well-being, these legislators also ignore both the documented benefits of affirming care and the clear harm their policies have on young people who identify as transgender, non-binary, and gender-diverse. Across the country, these bans and other discriminatory efforts have led to a spike in anxiety, depression, and suicidal ideation.
States’ efforts to ban gender-affirming care are actively harming our young people. These bans make it impossible for transgender, non-binary, and gender diverse young people to be themselves, and not only deny young people basic health care, but signal to them that they are not safe, accepted, or loved for who they are. These laws will result in a patchwork of care that is damaging to young people and their families, whose only options are now to either live in a state that bans access to this critical care or be forced to move to another state in order to access it. For youth in foster care who reside in a state that has banned affirming care, relocating to a friendlier state will not even be an option. They are subject to state authority, which means they already experience a glaring lack of control over their lives and decision-making about their bodies. For foster youth, bans on essential health care represent another area of their lives that is dictated by the state. We owe it to young people to show them the support and care they need as they are growing up. We need to let them know that their well-being and access to care should never depend on who they are, where they live, or if their family has resources to uproot themselves to another state. We need to eliminate and prohibit bans on gender-affirming care, as well as other discriminatory policies that marginalize or diminish any aspect of a young person’s identity. We also need to go beyond undoing harmful policies by actively showing up for young people and making our communities safe havens where all young people can live safely and freely with the resources they need to affirm their rights and promote their health and well-being.