GOP Attacks Threaten Gender-Affirming Care for a Third of Trans Youth in the US

More than one-third of the estimated 150,000 transgender youth and young adults in the United States are at risk of being denied gender-affirming health care as politicians push a deluge of anti-LGBTQ bills through multiple state legislatures, and authorities in Texas threaten to tear apart families over transphobic allegations of “child abuse.”

Fifteen states have restricted access to gender-affirming care or are considering laws to do so, putting an estimated 54,000 transgender youth ages 13 to 17 at risk of losing access to health care that is shown to be essential for improving mental health and saving lives, according to a new report from the Williams Institute at the UCLA School of Law. Another 4,000 young adults are also at risk of losing access to care under proposals in Alabama, North Carolina and Oklahoma that target people between the ages of 18 and 20.

The report comes as Republican politicians across the country attack the rights of LGBTQ youth and their families in an attempt to capture media attention and rally their base to the polls in 2022 and 2024. More than 100 bills attacking trans and gender-nonconforming people have been introduced in state legislatures since 2020, and 2021 was the “worst year for anti-LGBTQ legislation in recent history,” according to civil and human rights groups. The bills in 15 states currently targeting trans youth would punish and, in some cases, criminalize parents and medical providers.

Right-wing lawmakers across the country have already pushed to bar trans athletes from school sports, and now they demand that the government interrupt or even criminalize health decisions that advocates say should be left up to youth, parents, counselors and doctors. All major health organizations, including the American Academy of Pediatricians (APA) and the American Medical Association, oppose legislation that would ban gender-affirming care for adolescents.

While gender-affirming medical care may include the use of hormones to delay puberty and to promote physical development that is consistent with a child’s identity — which is recommended by the APA for trans youth when they reach an appropriate age but exploited by the right to spark outrage — these treatments are only one part of a much broader model of care for trans, nonbinary and gender-nonconforming people.

Many hospitals will only offer hormone treatment to patients ages 16 and older, and some patients may choose other services instead. The gender-affirming care model includes counseling and psychological evaluations, as well as support during and after social and legal transitions, with an emphasis on affirming a patient’s identity in health care settings. Some patients receive speech therapy or laser hair removal, for example. Research has shown that rates of attempted suicide are lower among transgender people who want and receive gender-affirming health care.

Victoria Kirby York, deputy executive director of the National Black Justice Coalition, an LGBTQ+ and racial justice group, said Black youth are facing a suicide crisis, and bills peddled by lawmakers that could “take a child’s life” are a “disgrace.”

“Gender-affirming care is a model with a range of treatments, not just hormones or surgery, which is getting lost in the national conversation about these bills,” York said in an email. “For instance, gender-affirming care treatment from a mental health therapist could include the recommendation of social transition for transgender youth (name, clothing, pronouns shift, use of a binder, etc).”

While many of the anti-trans bills target hormonal treatments for transgender youth, advocates say the legislation threatens an entire medical model that has become standard treatment for trans people. Right-wing politicians cling to false claims that minors are undergoing gender-reassignment surgery, but these procedures are typically only available to adults.

Last year, lawmakers in Arkansas succeeded in passing a law to ban gender-affirming care for transgender and gender-nonconforming minors. In Texas, Attorney General Ken Paxton and Gov. Greg Abbott, both Republicans, have been widely condemned for declaring gender-affirming care “child abuse” and ordering the state’s child protective services to investigate parents of trans kids. The policy is terrorizing families and putting youth at risk of being removed from their homes, forced into a broken foster care system and made to suffer serious emotional harm. Health officials in the Biden administration call Abbott’s order “discriminatory and unconscionable” and vowed to extend federal protections to Texas families.

The anti-trans efforts in Texas and Arkansas face lawsuits and are currently blocked by courts, at least for now. However, an anti-trans bill introduced in Missouri would rip a page from Abbott’s playbook and enshrine gender-affirming care as “child abuse” in state law. Anti-trans bills in 10 states would allow private citizens to file civil lawsuits against medical providers who violate proposed bans on gender-affirming care for youth, a tactic that mirrors the Texas “bounty hunter” anti-abortion law that has devastated reproductive health care services in the state.

The anti-trans bills across 15 states carry severe penalties for health care providers and, in some cases, family members and parents of trans youth, according to the Williams Institute. In each of these states, the bills would either criminalize providers of gender-affirming care or subject them to discipline from state licensing boards. Thousands of frontline doctors already oppose any legislation that criminalizes patient care for trans and gender-nonconforming patients.

Additionally, bills in six states would penalize parents who facilitate gender-affirming care for their children. The report continues:

About half of these bills would further limit access to gender-affirming care for transgender youth by barring certain insurance providers from offering coverage for gender-affirming care, by placing restrictions on the use of state funds or state facilities to provide this care, or by excluding gender-affirming care as a tax-deductible health care expense. Bills in seven states would prohibit certain health insurance plans from offering coverage for gender-affirming care. In eight states, bills would prohibit the use of state funds for gender-affirming care or more broadly prohibit distribution of state funds to any organization or individual that provides gender-affirming care to minors, seemingly regardless of what the funding is used for. In five states, bills would prohibit gender-affirming care by or in government-owned or operated facilities, and by individual providers employed by government entities. In four states, bills would exclude gender-affirming care as a tax-deductible health care expense.

The right’s onslaught of anti-trans policies is already taking a heavy toll on the mental health of trans youth and their families, and research shows that anti-trans messages in the media are associated with adverse mental health outcomes in adults. Advocates and researchers say trans and other LGBTQ youth are particularly vulnerable due to discrimination, the harms of negative media messaging and bullying by their peers, especially if they are also youth of color.

York said our youth must be protected at the ballot box during the midterm elections in November, which requires a serious commitment to voting at all levels of government.

“We need elected officials who will value ALL children over campaign dollars generated by wedge issues,” York said.