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An urgent call to protect gender-affirming care

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While efforts to ban or severely limit access to gender-affirming care are blunt and sweeping, gender-affirming care is anything but, writes Human Rights Watch's Yasemin Smallens.

Amid the ongoing strides in lesbian, gay, bisexual, and transgender (LGBT) rights, a disconcerting trend has surfaced: government bans on life-saving medical care for transgender people. Currently, 24 US states have enacted prohibitions on gender-affirming care for trans youth, leaving over 36 percent of such youth without access to treatment. Despite claims by conservative leaders that these bans protect vulnerable children, the reality is that these restrictions can put them in danger.

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Gender-affirming care encompasses a spectrum of practices, from changes in appearance (haircut, wardrobe change) to extensive mental health counseling, all emphasizing a personalized, multidisciplinary, and considerate approach. In the United States, trans youth undergo months or even years of evaluation by a team of doctors before any medical interventions are pursued.

While efforts to ban or severely limit access to gender-affirming care are blunt and sweeping, gender-affirming care is anything but. The American Medical Association, American Academy of Pediatrics, American Psychological Association, and the American Academy of Child and Adolescent Psychiatry, uniformly advocate for transgender youth to have access to the meticulously tailored, developmentally appropriate care.

When I speak with parents whose children have received gender-affirming care, the resounding sentiment is that the care their child received surpassed any previous healthcare experience. This is because gender-affirming care is highly individualized and prioritizes a holistic approach.

The life-saving nature of gender-affirming care is not mere rhetoric; it is grounded in evidence. Statistics reveal that transgender people are 67 times more likely to attempt suicide than the general population. However, studies consistently demonstrate that gender-affirming care significantly reduces this risk by up to 73 percent.

These statistics are not just numbers; they represent human lives, such as that of Sarah Johnson, a transgender teenager in Texas. Sarah’s family told me Sarah had enjoyed a healthy and happy childhood, thanks to the gender-affirming care she received. That was until 2022, when Texas officials criminalized gender-affirming care, causing her mental health to deteriorate. Fearing she would be forced to detransition, Sarah attempted suicide.

Sarah survived, but her experience is sadly not unique. Take Jay Clark, a 14-year-old transgender boy in another state who, despite undergoing counseling for two years to manage his gender dysphoria and other mental health concerns, has been denied access to gender-affirming medical care due to a recent ban. This callous measure not only disregards the desires of Jay's family and therapist but also denies Jay the right to health and non-discrimination. In my conversation with Jay, he expressed the unbearable weight of the continued denial of care, stating that if he cannot access gender-affirming medical care by 2025, he sees no option but to end his own life.

Sarah and Jay join a tragic list of young people ensnared by political agendas grossly masquerading to be protecting children and defending “family values.” Many of the families I speak with describe themselves as exiles in their own hometowns due to these legislative bans.

Being the parent of a trans child in a state with a ban in place means trying to locate providers for the care their children need in another state, and going through the difficulty and expense of travelling so their children can get the care they need. They have to navigate a complex web of insurance provisions, dodge potential legal penalties for seeking care, even if it’s out of state, and the need to testify at public hearings on trans rights, all while managing the unbearable mental toll of watching their child become the victim of cruel political chicanery. It’s like having another full-time job just to secure their child’s right to health. The claim that these parents are anything but loving, supportive, and devoted is insulting. The mandate for the state to investigate these families for child abuse, as the state has ordered in Texas, is egregious.

The parents who are able to commit the time, energy, and resources to helping their child access gender-affirming care are often those in some of the best-case scenarios with employment, resources, and mobility that allow them to support their child. For many other families, the costs, travel, and time required to access life-saving medical care are insurmountable, compounding the harm these bans cause for low-income families.

Let’s be clear: bans on gender-affirming care put youth in harm's way and rip communities at their seams, compelling loving families to abandon their hometowns Lawmakers have a responsibility to protect those at the margin and ensure their right to access life-saving medical treatment, not outlaw it. Officials at all levels of government should pass policies affirming the rights of trans youth to access expertly administered, evidence-based health care.

Yasemin Smallens is a senior coordinator with the LGBT rights program at Human Rights Watch.

Voices is dedicated to featuring a wide range of inspiring personal stories and impactful opinions from the LGBTQ+ and Allied community. Visit Advocate.com/submit to learn more about submission guidelines. We welcome your thoughts and feedback on any of our stories. Email us at voices@equalpride.com. Views expressed in Voices stories are those of the guest writers, columnists and editors, and do not directly represent the views of The Advocate or our parent company, equalpride.

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