Gender-affirming care helps transgender and nonbinary individuals transition to the gender with which they identify. These range from surgical intervention to courses in speech or behaviour and are aimed at allowing these individuals to make their outward presentation match their internal sense of self as a very personal journey for each person.

Although major medical associations have recommended that gender-affirming care saves lives, more than a dozen states have enacted laws or are considering enacting laws to ban this medically necessary, evidence-based, multidisciplinary treatment for transgender people. This care aids in an individual’s transition from the gender they were assigned to one that they identify with and wish to be identified as.

Understanding Gender-Affirming Care

Gender affirming care refers to a wide spectrum of societal factors, as well as psychological patterns of behavioral intervention and medical measures to confirm an individual’s gender identity if and when it differs from their sex at birth. This care encourages individual transgender people to align their emotional, interpersonal, and biological attributes with their internal experience of gender. The American Psychiatric Association, also known as APA, states that gender identity is a spectrum.

Interventions can include counseling, social expression alterations, and medications. In children, these interventions are based on intellectual development and physical development but require parental consent. Surgeries like those that lower the Adam’s apple, also known as the laryngeal prominence, or align chest or genital characteristics with gender identity, are scarce, for individuals under the age of 18. It’s not about “treating” a condition, but listening to the child; building understanding and a safe space where the child can explore their feelings, inquiries, and worries.

Certain Facts on Gender-Affirming Care

Extreme politicians are targeting the LGBTQ+ community, particularly transgender and non-binary youth, using critical issues to push anti-LGBTQ+ legislation. Major medical associations support age-appropriate and safe gender-affirming healthcare, but state governments have removed access to medically necessary care. These bans will affect everyone’s access to this crucial care that can also serve cisgender and intersex people.

A challenge to some of these bans is before the Supreme Court, which may issue a ruling by Spring 2025. Advocates incorrectly assert that transgender people are an “ideology” against which they should be free to dissent. This falsehood is driving a campaign of disinformation that has prompted anti-trans laws and threats to people who offer gender-affirming care.

As anti-LGBTQ+ attacks persist, we must know the facts about this life-saving care. Denying access to gender-affirming care is not only unethical, it can lead to devastating consequences for the physical and mental health of transgender and non-binary Americans.

Problems Faced by Youths in the USA

More than 58,000 transgender youth aged 13 and older are barred from gender-affirming care across 15 U.S. states. These states, together home to about a third of the nation’s population of transgender youth, have passed or are working to pass laws that will limit such services, and could punish health providers and family members who try to access this care. In Texas, the governor ordered an investigation into some gender-affirming procedures, which the state attorney general classified as child abuse. But the American Civil Liberties Union (ACLU) made a request before a judge, who temporarily barred the state from imposing this order. And although there have been legislative efforts to end gender-affirming care, it continues to be a recommended form of care for transgender and gender-diverse individuals.

Reasons For Youths Seek This Care

Many children sense that there is a mismatch between the gender they were assigned at birth and their actual gender identity at a very early age. This incongruence can cause gender dysphoria, a traumatic psychological state identified in the “DSM”, of the American Psychological Association. Gender dysphoria involves a profound desire to have the primary or secondary sex aspects of a different gender and to be socially accepted as that gender.

Trans youth, particularly those with gender identity disorder, are especially vulnerable to emotional distress, depression, bullying, violence, self-harm and suicidal ideation. In fact, according to a University in Minnesota, the study determined that among transgender youth, 61% reported suicidal thoughts than the rate of their cisgender counterparts.

Gender dysphoric youth tend to have poor social and academic adjustment at school. They feel pressured to wear clothes that match their sex, which was assigned at their birth, or they’re concerned about being bullied. Stigma and the lack of experienced providers can also make it challenging for you to access appropriate health and services for mental health.

The Standard Role

Largely supported by the leading medical associations, such as the American Medical Association, American Psychiatric Association, American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry, gender-affirming care is clinically indicated for individuals of all ages.

The only global standard for that is the 2012 guidelines set by the World Professional Association for Transgender Health, and they provide a framework for offering effective, affirming pathways to lasting personal comfort with one’s identity for transgender and gender-diverse people. Evidence shows access to such care can have a profound impact on mental health and well-being, addressing the marginalization and disparities that this population often faces in healthcare services.

Social Care

Gender-affirming care is a treatment that affirms a person’s actual gender. It is developmentally appropriate, non-judgmental care, delivered in a safe setting, according to the American Academy of Pediatrics. This method collaborates with counselors and families as well as schools and communities to best cater to the individual. Some children realize their true gender as soon as they are 3 years old, others in puberty or later. Gender-affirming care is now available in clinics across the country, where experts use a team-based approach to tailor care to each patient.

The first step at Columbia’s Gender Identity Program is a phone call, screening, and meetings with mental health professionals. They evaluate the family and understanding of gender identity and expression, and any other mental health needs. This includes therapy or parent support. The process of social transition, including using a chosen name/pronouns, changing clothes, and presenting as one’s true self. The care is patient-specific and is based on decisions made by the parents, guardians, and others.

Treatments

Nonsurgical Treatments

Gender affirmation treatments vary for each individual. This can include laser hair removal,  hormone therapy to masculinize or feminize the body, and voice/communication therapy.

Later on, depending on the target tissues, we have low-energy laser hair removal used for permanent removal of unwanted hair. Masculinizing hormone therapy uses medications to suppress female characteristics and develop male ones, resulting in increased muscle mass, added body hair, and a lower voice. Feminizing hormone therapy uses medications to decrease physical traits characteristic of men and increase those more typical of women, such as breast development and decreased body hair.

Speech therapy may help individuals adapt their voice, speech and nonverbal communication to align with their gender identity. Mental health support is important for emotional/social preparation,  too. Reproductive counseling is also important because gender affirming treatments can have an effect on fertility.

Surgical Treatments

There are two major types of gender affirming surgeries, male to female surgeries and female to male surgeries. These include facial reconstruction, to give the individual a better cosmetic appearance, chest/breast surgery, to create a flatter, more masculine-looking chest, and sex reassignment surgery, to change the genitals to match the person’s identity. Procedures can vary, as can recovery time, based on a given patient’s health and the procedure performed, so doctors can advise the patient on what to expect. In general, the recovery phase will be different for each patient and will vary with the specific procedure being performed.

Hormonal Therapies

Puberty Blockers

Puberty blockers are medications that prevent sex hormones, such as estrogen and testosterone, from being released in transgender youth who have yet to go through puberty. These blockers assist young individuals in exploring gender identity and determining their desire to have a transformation before undergoing irreversible physical changes. Doctors usually administer puberty blockers at the start of puberty to temporarily halt unnecessary hormonal changes that can hinder healthy adult development.

Hormone Therapy

Hormone therapy is also available for older transgender youth and adults. This raises their testosterone and estrogen levels to develop sex characteristics that better match their gender identity. For trans guys, this can lead to more facial/body hair and muscle growth. For trans women, this results in the development of their breast and testicle atrophy.

But those changes happen gradually, and many people discontinue hormonal therapy before achieving maximal secondary sex trait development. Some changes may go away part way, not completely, depending on when they stop, such as broadened shoulders from male hormones or early breast growth from female sex hormones.

How Is It Decided If Someone Qualifies and Is in Need Of The Procedures?

WPATH, the AAP, and the Endocrine Society all have guidelines on therapies for gender-affirming care. They set out the criteria for offering hormone treatments to young people.

According to the WPATH, it is important to conduct a careful exploration of the person’s mental health, family background and social situation before considering any physical treatments.

Many young people have a questioning period where they are exploring their gender identity disorder, and if hormones are a way forward.

Impact of These Therapies

Care for Gender-affirming has been proven to alleviate depression, suicidal thinking, and harmful behavior in children. Research suggests that starting hormonal therapy in their teen years is associated with lower rates of mental health issues and abuse of substances than when treatment begins later on. But some groups say there isn’t enough evidence for chronic mental well-being benefits or reduced suicide rates.
Even so, health care providers say that patients who get care for gender-affirming show positive changes, including greater happiness, lower rates of depression and anxiety, better grades, and feeling safer. Despite some state governments’ attempts to proscribe specific treatments, doctors should emphasize that all forms of gender-affirming care are essential healthcare.

Gender-Affirming Care Helps in Anxiety, Depression, And Suicidal Thoughts

Gender-affirming care allows people to explore and redefine their gender identity without judgment. It is tailored to each person’s needs, including learning about gender and sexuality, getting family support, and having social and medical changes. Transgender and non-binary (TGNB) youth experience increased anxiety, depression, and suicidal thoughts relative to their cisgender peers. But gender-affirming care is mental health care, and helps TGNB youth.

The first step is usually a social transition, which might involve experimenting with new names/pronouns (which some of us will suggest); trying out new activities and environments. This can also reduce depression and anxiety in TGNB children. Blocking puberty with medication buys more time to decide on gender identity, and this is associated with better mental health and life satisfaction. Gender-affirming hormones also materially lessen gender identity disorder.

Older teens with stable gender identity, good mental health and family support can get chest surgery. Transmasculine teens say they find this surgery alleviates dysphoria with very little regret. Genital surgery is typically performed only on people 18 and older.

Conclusion

Gender-affirming care saves the lives of trans and non-binary people. It’s not just a medical service, it’s foundational to living truthfully and safely. Decades of research support this, and major medical groups endorse it. This care decreases depression, anxiety, and suicide, particularly among young people. Denying access based on misinformation or politics does more than compromise public health, and it is jeopardizing lives.

With the fight for equal rights, and healthcare, ongoing, we must all stand in solidarity with the trans community. Promote evidence-based care and imagine a world where all can flourish as their own true self. Protecting gender-affirming care is protecting human dignity, health, and life.