“Gender-affirming care” (often abbreviated “GAC”) is a catch-all term for medical and psychiatric care with the aim of supporting and affirming transgender patients. It is multifaceted. It is individual. It saves lives. And it’s a practice that the American public – and their government – know next to nothing about.
In December of last year, the US Supreme Court heard arguments in an ongoing federal suit against the state of Tennessee regarding a law restricting gender-affirming medical care for trans minors. With this law, Tennessee joins the 25 states that prohibit all gender-affirming medical care for transgender youth. These restrictions are at odds with modern science and spawned from a fundamental ignorance of the subject.
There are a myriad of approaches to gender-affirming healthcare, but a painfully common misconception is the conflation of the various practices and procedures that fall in this category. This misunderstanding sparks moral panic at the idea of “transitioning minors.” Pop culture and shoddy news reporting mean that when cisgender Americans hear about medical care for transgender people, many think of the final, most invasive tools in the practice’s arsenal: the permanent alteration of biological sex through hormone replacement therapy (HRT) and sex reassignment surgeries. Political fearmongers obfuscate the manifold nature of gender-affirming care, duping voters into believing their children are being subjected to irreversible medical procedures on a whim and without their parents’ knowledge. This pervasive trend of disinformation is exemplified by President Donald Trump’s campaign-trail fabrication about elementary-aged students receiving genital surgeries in public schools.
In reality, these irreversible medical steps are never taken by children and uncommon even among older teenagers. HRT is afforded on a case-by-case basis to trans people over the age of sixteen. Hormone treatments affect sweeping changes in the body and are difficult to reverse – which is why they are only prescribed to trans people who are mature enough to understand the long-term consequences of medical intervention. Transition surgeries, which are only available following sustained HRT, are vanishingly rare. A Harvard study in 2019 found a rate of 2.1 per 100,000 for surgeries in minors with diagnosed gender dysphoria. When they do occur, gender-affirming surgeries aren’t just for trans people. Particularly in minors, they’re usually to reverse the effects hormonal conditions like gynecomastia have on cisgender patients. In fact, the aforementioned Harvard report found that 97% of gender-affirming operations for minors were for cis male teens. Banning GAC for youth, counterintuitively, disproportionately affects cis children. Banning it for trans youth alone, as Tennessee has tried, creates an absurd double standard in an attempt to solve a nonexistent problem.
So what does gender-affirming care for minors look like in the real world? First off, contrary to the president’s apparent belief, every step in the process is subject to parental approval, as is all pediatric medical and psychiatric care. In fact, the first step isn’t even medical in nature. Young transgender people are encouraged to socially transition, working with their families and communities to change gender signifiers like name, pronouns, wardrobe, and so on. This obviously requires no medical intervention and can be easily walked back at any time if the need arises.
Medical intervention begins for trans tweens at a minimum Tanner stage 2 of puberty, when the child is 10 or 11 years old. Patients must have a standing history of gender dysphoria and have already begun socially transitioning. They may be prescribed gonadotropin-releasing hormone (GNrH) analogues, colloquially known as puberty blockers, which suppress the production of sex hormones as long as they’re taken regularly. These GNrH analogues are demonstrably safe: they have been used for over forty years for precocious puberty in cisgender children. They are also fully reversible. When regular blocker treatment stops, the production of sex hormones starts again and AGAB (assigned gender at birth) puberty resumes as normal.
When misinformation about gender-affirming care leads to its heavy-handed overregulation, the stakes are high. Every form of gender-affirming care has been demonstrably, positively associated with reduced rates of depression and suicidality. In teens, both temporary puberty blockers and permanent HRT are linked to improved mental health outcomes. The available scientific evidence on the topic overwhelmingly supports the availability of age-appropriate gender-affirming care: social support for trans children, GNrH analogues and possible HRT for dysphoric teens, and the same freedom to seek out elective medical procedures for both cis and trans adults.
Right now, safe, reliable, scientific transgender healthcare faces an uncertain future in our country. On January 28, Trump signed an executive order that smears gender-affirming care as “chemical and surgical mutilation” from which American children (bizarrely defined as those under the age of nineteen) must be “protected” and discredits best-practices medical care based on abundant scientific evidence. Right here in Virginia, Governor Glenn Youngkin’s announcement that he will be enforcing that order and pulling funding from institutions that provide age-appropriate, scientifically-backed GAC to minors sparked protests at major providers like UVA. Now more than ever, all Americans must understand the truth about gender-affirming care rather than blindly accepting voodoo science from willfully ignorant politicians punching down at their most vulnerable constituents. Gender-affirming care saves lives. Ignorance kills.
