Due to government efforts over the past two years, more than 58,000 transgender youth and young adults across 15 states are in jeopardy of losing access to gender-affirming care. In total, more than a third of the 150,000 transgender youth ages 13-17 in the U.S. live in the 15 states that have restricted access to gender-affirming care or are currently considering laws that would do so. More than 4,000 young adults ages 18 to 20 would also be at risk of losing access to gender-affirming care under the three proposed bills that would apply to young people over the age of 18.
In 2021, the Arkansas legislature enacted a ban on gender-affirming care for minors, aiming to restrict access to treatment for nearly 1,500 transgender youth in the state.
In February 2022, the governor of Texas issued an order restricting access to gender-affirming medical care for transgender youth—including the use of hormones to delay puberty and to promote physical development that is consistent with a child’s gender identity. The order classifies the provision of gender-affirming care as “child abuse” and directs the state’s Department of Family and Protective Services to investigate any reported instances of health care providers or parents who provide or seek out gender-affirming care for children. The order impacts as many as 13,800 transgender youth in the state. Both the Arkansas law and Texas order are currently being challenged in court.
As of March 2022, 13 other states are considering bills that would deny gender-affirming medical care to transgender youth. Access to gender-affirming care is in jeopardy for an additional estimated 42,950 transgender youth across these 13 states. State-specific estimates of the numbers of at-risk youth are provided in the table below.
The bills carry severe penalties for health care providers, and sometimes families, who provide or seek out gender-affirming care for minors. In each of these states, the bills would either criminalize health care providers who provide gender-affirming care to minors or subject them to discipline from state licensing boards. Bills in 10 states would also allow individuals to file civil suits for damages against medical providers who violate these laws. Bills in six states provide penalties for parents who facilitate minors’ access to gender-affirming medical care.
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.
Finally, a bill proposed in Missouri would attempt to limit access to gender-affirming care by classifying it as child abuse similar to the order recently issued in Texas.
Gender-affirming care, including the use of hormones to delay puberty and to promote the development of secondary sex characteristics that are consistent with a child’s gender identity, is recommended for transgender youth by the American Academy of Pediatricians and the Endocrine Society and is viewed by the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA) as evidence-based patient care. Moreover, the American Medical Association supports insurance coverage for gender-affirming care for transgender people.
Research shows that gender-affirming care improves mental health and overall well-being for transgender people, including youth. A 2020 study published in Pediatrics found that access to pubertal suppression treatment was associated with lower odds of lifetime suicidal ideation among transgender adults. Similarly, research conducted by the Williams Institute concluded that risk of past-year suicide attempts was lower among transgender people who wanted and received gender-affirming medical care. More generally, research indicates that efforts to support transgender youth in living according to their internal sense of gender is associated with better mental health and feelings of safety at school, while efforts to change the gender identity of transgender people (i.e., conversion therapy) are associated with suicidality.
