GENDER AFFIRMING CARE: Setting the Record Straight As Extremist Politicians in Texas and Other States Continue Doubling Down on Attacking Trans Youth

by Delphine Luneau

A quick explanation on what is and isn’t true about gender affirming care

WASHINGTON, D.C. — Lawmakers in statehouses across the country are doubling down on attacking trans youth, embarking on a reckless, unprecedented misinformation campaign to justify harmful policies to prevent transgender children from being able to access age-appropriate, medically-necessary, gender affirming care - and in some cases, as in Alabama and Texas, attach criminal penalties to those who allow such care. While these attacks are popping up in states across the country — including in Alabama, Florida, Iowa, Oklahoma and many others — actions this week in Texas by Gov. Greg Abbott and Attorney General Ken Paxton are coming into national focus after bombshell reports indicate Texas officials are now actively investigating and targeting parents of transgender adolescents for what the governor is falsely calling “child abuse.”

Despite the fact that every major medical organization disagrees with Gov. Abbott and AG Paxton — recognizing that age-appropriate, medically necessary, gender-affirming healthcare for transgender adolescents and teens is critical — extremist legislators in Texas and other states continue driving a misinformation campaign about what gender affirming care is. For example, earlier today the Abbott campaign egregiously and incorrectly likened this necessary and lifesaving care to cutting off a child’s hand — and made it very clear they are attacking trans kids for political gain. Below is background information to set the record straight on what is and isn’t true about gender affirming care.


Every credible medical organization calls for affirming care for transgender and non-binary people. Sexual orientation and gender identity are real concepts recognized by major medical and mental health associations — including the American Medical Association, the American Academy of Pediatrics, the American Psychological Association and the American Academy of Child and Adolescent Psychiatry — as part of the normal spectrum of human experience. Health care providers who work with transgender and non-binary people — including young people — are providing life-saving care, with many patients driving hundreds of miles just to get to their doctor’s office.

National and Texas-based medical, mental health and education organizations, and others have condemned Governor Abbott’s actions. The National Physicians Associations, American Academy of Pediatrics, Texas Pediatric Society, American Academy of Child and Adolescent Psychiatry, Texas State Teachers Association, National Education Association, National Association of Social Workers, the Houston Chronicle, the Episcopal Diocese of Texas, and the Ray E. Helfer Society have all spoken out. More than 7,000 people, including parents of transgender, non-binary and cisgender children, have signed an open letter condemning state attacks on transgender and non-binary youth.

Transgender children are not undergoing irreversible medical changes. This is a fundamental misunderstanding about what transition looks like for kids, which is primarily about providing social support, using the right name and pronouns, and allowing them to present in a way that is consistent with their gender identity. Therapists, parents and health care providers work together to determine which changes to make at a given time are in the best interest of the child.

“Transition-related” or “gender-affirming” care looks different for every transgender and non-binary person. Some transgender and non-binary people may only socially transition, such as using a new name and pronouns, and dressing in a way that is consistent with their gender identity. Others may socially and medically transition, including undergoing hormone therapy and/or gender affirmation surgery. Each person’s journey is unique to them and their medical needs. At the same time, many transgender and non-binary people cannot afford gender-affirming medical treatment, nor can they access it. Hormone therapy and surgical care are not offered to young people, but reserved for those who can give truly informed consent.

Not all transgender and non-binary people who transition have surgery. Many transgender and non-binary people transition without surgery. Some have no desire to pursue surgeries or medical intervention. Transgender children do not undergo gender-affirming surgeries, but may receive fully reversible medications that put puberty on hold under the care of a licensed medical provider. More permanent medical interventions do not occur until a transgender person is of age to give truly informed consent.

Gender-affirming health care is lifesaving. For transgender people, being denied critically necessary transition-related care can extend and exacerbate the stress and discomfort caused by gender dysphoria, leading to increased incidences of depression and substance abuse, as well as health complications caused by delaying care. Ensuring that transgender and non-binary people have access to trans-affirming health care is lifesaving. A recent study from the Trevor Project provides data supporting this — transgender youth with access to gender-affirming hormone therapy have lower rates of depression and are at a lower risk for suicide. Another study, published in the Journal of the American Medical Association, agreed, saying, "receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up." Additionally, the Trevor Project study shows that parental support is vital in ensuring transgender youth’s mental and physical health.

Detransitioning is very rare. Medical regret is even rarer. According to the National Center for Transgender Equality’s 2015 U.S. Transgender Survey, only 3% of respondents have detransitioned permanently at some point. The vast majority of respondents who detransition only do so temporarily. Detransitioning is often conflated with medical regret; however, detransitioning can include nonmedical parts of someone’s transition, such as changes in their gender expression or legal changes to their identity. One study found that less than one-half of one percent of trans patients who have received gonadectomy report surgical regret. Also, there is no scientific evidence showing that surgical regret would cause trans people to forego surgery in hindsight. Surgical regret could include trans patients who do not regret receiving surgery, but may be disappointed with one or more minor details relating to the outcome of their surgery. Trans people who also regret one or more parts of their surgery do not always detransition. When respondents detransition, it could include reasons beyond surgical regret. According to that same survey by the National Center for Transgender Equality, respondents who detransitioned cited a number of reasons for doing so, including facing too much harassment or discrimination after they began transitioning (31%), having trouble getting a job (29%), or pressure from a parent (36%), spouse (18%), or other family members (26%).

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