Transgender Youth Face Hurdles Getting Gender-Affirming Care Even When It's Legal

Amid a wave of legislation in Republican-led states targeting gender-affirming care for minors, families with transgender children face a growing challenge: accessing essential medical treatment.

While some states have banned gender-affirming care altogether, others have allowed existing patients to continue treatment. However, the Associated Press reports that access is becoming increasingly difficult even in those states where it remains legal for those to continue on treatments. That difficulty is due to legal battles and provider concerns.

Becky Hormuth, a mother whose 16-year-old son was receiving care from the Washington University Gender Center at St. Louis Children’s Hospital, described the abrupt halt in care as “a completely crushing blow.”

Like many parents, she is frustrated with these laws’ impact on her child’s well-being.

“These politicians don’t see our children. They say the health care is harmful. They don’t know how much it helps my child,” Hormuth lamented to the AP.

“Should we have to leave?” Hormuth asked. “No one should have to have a plan to move out of state just because their kid needs to get the health care they need.”

Republicans have attacked gender-affirming care under the guise of wanting to protect children. More than 20 states have restricted trans health care for minors in some way. Many of those restrictions are being taken to court.

These laws primarily ban gender-affirming surgery for minors, which is already very rarely done for some transgender boys seeking chest surgery in their late teens. However, the landscape varies regarding puberty blockers and hormone treatments.

Some states, like Georgia, permit these treatments for minors, while others, including North Carolina and Utah, allow existing patients to continue. Meanwhile, some states mandate a gradual phase-out of medical therapies over time.

The medical community widely accepts puberty blockers and hormone treatments as evidence-based care that transgender individuals should have access to. These treatments often positively impact mental health and well-being, as observed in the case of James Thurow’s stepson, who experienced improved academic performance and reduced anxiety after receiving gender-affirming care, the AP reports.

Earlier this week, a poll was released indicating the American public’s divided stance on gender-affirming care. The “State of Our Nation” poll, conducted by The 19th and SurveyMonkey, showed that while more than 57 percent of the respondents support transgender adults’ right to gender-affirming care, the support drops to 39 percent regarding minors.

Dr. Angela Kade Goepferd, the medical director of the Children’s Minnesota Gender Health Program, spoke to The Advocate about common misconceptions surrounding transgender medical care for youth. Goepferd explained that gender-affirming care has been part of medical education and treatment for decades and is based on established standards with positive mental health and well-being outcomes. They further clarified that contrary to extremist claims, surgeries are not a standard part of gender-affirming care for minors and that procedures like chest surgery for transgender boys only account for less than 0.5 percent of all transgender adolescents after extensive consultation and parental consent.

However, recent legal changes have forced some medical providers to stop offering medical treatment. For example, the Washington University Gender Center in Missouri had to discontinue care due to a new law that increased liability for providers. Patients can now sue for treatment-related injuries until they turn 36, or longer if the harm persists, with a minimum damages award of $500,000, the AP notes.

In North Dakota, while the law allows treatment to continue for minors receiving care before its enactment, doctors cannot switch patients to different gender dysphoria-related medications. This vague law has led providers to cease gender-affirming care to avoid criminal liability.

Executive director of the Campaign for Southern Equality Jasmine Beach-Ferrara told the AP that it’s not just the prospect of liability causing providers to halt treatment.

In many states with bans on gender-affirming care, confusion, and misinformation have led psychologists and pharmacists to believe the restrictions apply to them, even in areas where court orders have temporarily blocked enforcement.

“It’s hard to overstate the level of kind of chaos and stress and confusion it’s causing on the ground,” Beach-Ferrara told the AP, “particularly ... for people who live in more rural communities or places where even before a law went into effect, it still took quite a bit of effort to get this care.”

Beach-Ferrara’s organization now offers grants and navigation services to help children access treatment in states where it’s both legal and available. However, the ongoing nature of gender-affirming care complicates this process.

Families like Hormuth’s are left with limited options, including long drives to clinics or considering moving to another state where care is accessible. This situation has prompted some families to hoard medication, like leftover testosterone vials, as a temporary solution while they seek alternatives.

As these legal battles continue, transgender youth and their families are caught in the crossfire, struggling to access vital care amidst changing regulations and provider concerns.

Recent survey highlights public opinion on gender-affirming care

The 19th survey sheds light on public opinion regarding transgender issues and gender-affirming care. The survey, conducted among more than 20,000 adults in late August, revealed that most Americans are not deeply concerned with transgender-related legislation.

Transgender issues ranked low among political priorities, with only 17 percent of respondents believing politicians should focus on restricting gender-affirming care, while 33 percent thought they should protect transgender individuals.

While Republicans were more likely to support limiting transgender rights, they opposed politicians focusing on transgender issues, with 58 percent opposing such a focus. Independents and Democrats showed lower opposition, at 49 percent and 32 percent, respectively.

The survey also drew parallels between public opinion on gender-affirming care and abortion. Approximately 72 percent of respondents believed politicians lacked sufficient knowledge about gender-affirming care for minors to create fair policies. Similarly, over 70 percent of Americans doubted politicians’ ability to craft appropriate abortion policies due to their perceived lack of expertise.

Despite these challenges and divides in public opinion, there is hope for progress. A significant number of Americans, 47 percent, believed that gender-affirming care would become more accessible in their lifetime, showing optimism on both sides of the political spectrum.