Protecting Gender-Affirming Care The Fight Against Extremism in the Year Ahead

Every credible medical organization — representing over 1.3 million doctors in the United States — calls for age-appropriate, gender-affirming care for transgender and non-binary people. Parents, young people and medical professionals – including mental health providers – make decisions together, and no medical interventions with permanent consequences happen until a transgender person is old enough to give truly informed consent. Gender-affirming care is not provided without heavy consideration and consultation with all involved parties.

Yet, as we’ve seen with the “groomer” slur and the deadly shooting at Club Q, the rhetoric of hate groups is being mainstreamed by anti-equality politicians and leading to violent attacks. This includes harassment of gender-affirming care providers, doctors, and children’s hospitals simply for providing best practices medical care. Over the past year, numerous harassing phone calls, death threats and bomb threats have been called in at some of the nation’s largest hospitals.


Digital Hate: Social Media's Role in Amplifying Dangerous Lies about LGBTQ+ People

HRC Digital Hate Report 2022 PDF

To highlight this threat, HRC released Online Harassment, Offline Violence: Unchecked Harassment of Gender-Affirming Care Providers and Children’s Hospitals on Social Media, and its Offline Violent Consequences, a report showing how anti-equality, online extremists are leading a proactive and coordinated campaign of hate against children’s hospitals and medical providers who offer gender-affirming care for transgender, non-binary and questioning youth. The report identified online harassment campaigns against 24 different hospitals and health care providers, across 21 states, between August and November 2022 alone.

HRC identified a five-part cycle of violence from online harassment to offline violence against gender affirming care providers and children’s hospitals:

  1. Hate speech accounts such as Libs of TikTok or Matt Walsh, a known anti-trans extremist at the alt-right news site The Daily Wire, post an inflammatory message full of disinformation about gender affirming care and call out a specific hospital or doctor by name.

  2. The doctor and hospital almost immediately begin receiving a barrage of harassing and threatening messages online.

  3. Offline, doctors and hospitals named in social media harassment campaigns face harassment and threats at their homes and workplaces. In the most extreme examples, doctors face death threats and hospitals face bomb threats, halting care for all patients.

  4. Extremist politicians looking to rile up the most extreme members of their base join in spreading the same transphobic rhetoric from their platforms, in some cases going so far as to introduce legislation to regulate children’s hospitals and gender-affirming care providers.

  5. Hospitals halt gender-affirming services or remove online resources and websites in order to protect the safety of their patients and staff


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HRC’s report documents dozens of instances where social media posts led to violence and prevented patients from receiving the healthcare they need at places like Boston Children’s Hospital, Children’s Hospital of Pittsburgh, Vanderbilt University, and the University of Wisconsin. In other instances, online campaigns have been taken up by extremist politicians to justify investigations and legislation to block or pressure hospitals and doctors into ceasing providing gender-affirming care.

Yet even in the face of these threats, doctors, clinics, and children’s hospitals across the country continue to serve transgender youth with best-practice medical care — and HRC continues to fight for its provision.


Healthcare Equality Index 2022

Healthcare Equality Index 2022 PDF

HRC has a long history working with gender-affirming care providers, including with the Healthcare Equality Index, the national LGBTQ+ benchmarking tool that evaluates healthcare facilities' policies and practices related to the equity and inclusion of their LGBTQ+ patients, visitors and employees. HRC has also developed resources on supporting and caring for transgender and gender non-conforming youth, and maintains an interactive map of clinical care programs for transgender and gender-expansive youth. Now providers and families seeking this care for their children are facing both violent threats and a legislative assault by anti-equality politicians. Just four weeks into 2023, HRC is already tracking over 1250 anti-LGBTQ+ bills, most of which target youth.

In Alabama, HRC has joined The Southern Poverty Law Center, the National Center for Lesbian Rights, GLBTQ Legal Advocates & Defenders and co-counsel King & Spalding LLP and Lightfoot, Franklin & White LLC in a legal challenge to Alabama SB 184, which criminalizes the provision of best-practice medical care for transgender minors. The bill punishes parents for making important decisions about their children’s healthcare and doctors for providing – or even suggesting – well-established medically necessary care. The punishment can include up to 10 years in prison. The law is being blocked by a federal court. A civil penalties bill passed in Arkansas in 2021 and was also blocked in federal court. The Department of Justice sent a letter to all state attorneys general on March 31 warning that prohibiting access to healthcare because a person is transgender violates federal constitutional and statutory protections.

Besides violent rhetoric targeting providers, others attack gender-affirming care by presenting it as part of a false debate. Politicians and the media may pretend to be moderate and express “concerns” about gender-affirming care despite decades of studies proving its safety and efficacy. Bills banning gender-affirming care are also discriminatory, as they ban medically safe and effective treatments because the youth is transgender. This includes reversible puberty blockers to safely delay the effects of puberty. Puberty blockers are not “experimental” treatments, but FDA approved medications that have been used to treat conditions such as precocious puberty for several decades.

“If my child had diabetes, or cancer, or asthma, I deserve to be able to go to an asthma specialist to find out what things can we do to make it better, what things might make it worse. And if you have a child who is transgender, you deserve that same thing.”

Dr. Angela Goepferd, Medical Director of Children’s Minnesota Gender Health Program

By the Numbers

1/10 10.5 % of Millenials

Identify as LGBTQ+

1/5 20.8% of Gen Z Individuals

Identify as LGBTQ+

To be an ally, it is important to push back on this disinformation. We must state clearly that it is impossible to be compassionate toward transgender and gender non-conforming youth while advocating for bans on gender-affirming care. The alternatives presented by anti-equality politicians are either to provide no treatment or to provide harmful conversion therapy. Nor are their goals restricted to LGBTQ+ youth. Terry Schilling, president of the American Principles Project, recently confirmed that his organization’s long-term goal is to eliminate transition care entirely

However, bans on our healthcare, just like bans on our history and culture, will not stop LGBTQ+ people from existing. In fact, one in 10 (10.5%) Millennials and one in five (20.8%) Gen Z individuals in the U.S. identify as LGBTQ+, and those numbers are growing every year as young people find the safety and support to come out. As our society continues to grow more diverse, we are experiencing a harsh backlash from those stuck in the past. In time, attacks on transgender and gender non-conforming youth will be looked back on as another dark chapter in our nation’s history.

This year promises an escalation of attacks on transgender youth, their families, their doctors, and the LGBTQ+ community as a whole. At HRC, we refuse to stand by and let extremists dictate policy, and we will never stop fighting for a world free of hate. If you are an ally, please remember to take care of the LGBTQ+ people in your lives during this difficult moment. And remember that all of us are empowered to change hearts and minds away from hateful extremism. You can demonstrate your allyship by showing up and speaking out against violent rhetoric and disinformation. United, we can push extremism back to the fringes and create a future that guarantees equality for all.


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