Gender-affirming care bans across the country are having negative impacts on the mental health of trans youth and their caregivers and causing tensions amongst medical and mental health providers who are responsible for the health care of trans individuals.
These findings come from a literature review led by University of Washington School of Public Health (UW SPH) researchers, published in Current Pediatrics Reports in June 2024. The review analyzes research published from 2021-2024 on the growing number of gender-affirming care bans and their impacts on trans youth, their caregivers and health care providers. The review also provides recommendations for future research and advocacy in this area.
Approximately 39% of transgender youth ages 13-17 live in one of the 26 states that have passed bans on gender-affirming care. These bans go against major medical association’s support of gender-affirming care for trans youth, including from the American Medical Association, American Academy of Pediatrics and the American Psychological Association. Research has found gender-affirming care can lead to reductions in suicidality, depression and anxiety and improvements in mental well-being for trans youth.
The authors of the literature review found that over 1,400 bills have been proposed since 2021 that target gender affirmation more broadly, including gender-affirming care, using pronouns that align with one’s gender identity, or access to sports teams and bathrooms that match one’s gender identity.
“Laws that ban gender-affirming care greatly undermine evidence-based practice that is developed and backed up by years of research and by the lived experiences of trans individuals and the professionals working with them throughout their gender transition process,” said Jessie Melina Garcia Gutiérrez, lead author of the literature review, and Health Services doctoral student at the UW SPH. “In more ways than one, it is irresponsible and unethical, and shows a complete lack of empathy and awareness of the impacts gender-affirming care has throughout trans individuals' lives.”
Garcia Gutiérrez notes these bans often show ignorance toward gender-affirming care medical interventions and procedures. For instance, many gender-affirming care bans prohibit the prescription of puberty blockers, yet this is a treatment that has long been supported for cisgender children who experience precocious puberty. While bans also prevent surgeries, the researchers point out that surgeries are already not recommended for adolescents under 18 by the World Professional Association for Transgender Health, except under rare circumstances and careful consideration from a team of health care professionals.
Several states have laws that remove medical providers’ licenses, allow legal action to be taken against them, or charge them with a felony if they provide gender-affirming care to trans youths. Researchers found that while many medical providers in these states support gender-affirming care for their patients, the bans have made them concerned about how to be compliant with state regulations and how to provide the standard of care necessary for their trans patients. While research on this topic is still limited, anecdotal evidence suggests that some providers have decided to leave the state or alter their future medical practice plans due to these state regulations.
Mental health providers also face new legal and ethical challenges, such as whether they should make a mandated report if they learn that a child’s parent is supporting them in undergoing gender-affirming care in a state where it is banned. In states with more restrictions around gender-affirming care, there are fewer mental health providers trained to support trans youth, which already makes it challenging for youth in these areas to find comprehensive mental health support for their needs.
“Medical and mental health professionals who work with trans youth by providing medical and mental health [gender-affirming care] services are crucial for the overall well-being of trans youth,” the authors of the literature review wrote. “In the face of the ever-increasing shortages in health care providers, anti-trans legislation has implications not only for trans youth but for the broader population since medical and mental health provider shortages impact all patients.”
Meanwhile, caregivers of trans youth have been targeted by laws that threaten to punish them, such as through loss of child custody for supporting their youth’s access to gender-affirming care. These caregivers have reported elevated symptoms of anxiety, stress, depression and hypervigilance, as they struggle with how to give their child the care and affirmation they need. While some families can relocate to other states where it is legal to access gender-affirming care medical services, many cannot afford to do so.
Because these laws exacerbate socioeconomic disparities, the authors note that trans youth of color in restrictive states particularly feel the impacts of these bans, as they may be less able to access care outside the state. They may also face multiple layers of discrimination, based on their racial identity and their trans identity.
The research on gender-affirming care bans and its impact on trans youth specifically is limited, due to the newness of recent policies and the challenges of conducting research with minors. For this reason, the recent literature review focuses not only on the impacts of recent proposed legislation on trans youth, but also on their caregivers and health care providers, Garcia Gutiérrez said.
Still, research that is available points to the negative mental health impacts for trans youth living in states where their access to care and bodily autonomy is being debated and decided in statehouses, leading to increased rates of depression, anxiety, and suicidality compared to their cisgender peers, as well as increased gender dysphoria. Meanwhile, policies that are supportive of trans youth, such as nondiscrimination laws, have been associated with a decrease in depressive symptoms.
“Trans youth, trans youth of color and those with other intersecting identities should be allowed to be children,” Garcia Gutiérrez said. “I don't think one's identity should be politicized to the point where children are aware that they are being oppressed, that their agency or truth is being minimized. I cannot imagine what that must be like to grow up and know that there are people making policies in your state or talking about your identity like it’s part of a political agenda. I can’t imagine that experiencing that is good for any youth’s mental health.”
The authors note that future research is important for better understanding the intersectional nature of health disparities for trans youth. For instance, how are trans youth who are neurodivergent or who have disabilities impacted by gender-affirming care bans? As social and community networks for trans youth are attacked — from their caregivers to their health providers — more research is necessary to show the impact this has on these youth.
The authors of the paper include Garcia Gutiérrez and fellow UW School of Public Health researchers Emerson Dusic of the Institute for Public Health Genetics; Audren J.K. Bambilla, graduate of the Department of Health Systems and Population Health; and Arjee Restar, assistant professor of the Departments of Epidemiology and Health Systems and Population Health.
Husky HelpLine is available 24/7 at 206.616.7777 to provide mental health support to UW students on all campuses. Students can also visit wellbeing.uw.edu for information on additional resources. The National Suicide and Crisis Lifeline is available to any person needing help by calling 988.