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Children are exposed to gender at a young age. Girls wear dresses, boys wear pants. Girls have long hair, boys have short hair. Girls play with dolls, boys play with cars.
“Gender gets talked about from day one in a child’s life,” says Moe Ari Brown, a licensed marriage and family therapist.
Yet, “gender-affirming care” for transgender and nonbinary people is a topic that sparks debate and controversy. Misconceptions abound about what the term even means.
“What we can do is continue to educate people on the wide variety of identities that people can hold,” Brown says.
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What is gender-affirming care?
For starters: Gender identity is a spectrum, experts say. Someone who is born with sex characteristics of boys or girls may actually be the opposite gender, or may not identify with either gender at all. These people require care as they navigate their identities; this care saves lives, according to The Trevor Project.
Gender-affirming care includes everything from talk therapy to hormone therapy to (in rare instances) surgical intervention. Keep in mind that transgender adults make up less than 2% of the U.S. population; about 5% of young adults identify as transgender or nonbinary.
Gender-affirming care is not a one-size-fits-all method and only medical doctors provide this type of care.
“Medical-affirming care is an option for many people,” says Brown. “But it’s not always something that everyone pursues.” Gender-affirming medical care begins at an intake form and should end well beyond.
The care can also simply look like a social transition such as using a name, picking out different clothes or styling hair differently. “Helping a young person express their identity in ways that are separate from medical care is a form of expressing gender-affirming care for who they are,” says Jonah DeChants, research scientist at The Trevor Project.
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What does gender-affirming care look like for minors, young adults?
For those who can access care, pubescent adolescents exploring their gender identity can start on puberty blockers that stop the body’s natural puberty process. This is temporary and reversible.
“As soon as you stop them, your body’s natural puberty will happen,” DeChants says.
For example, a child as young as 10 may only be prescribed puberty blockers if they’re already starting to show some signs of puberty.
“The role of puberty blockers is to give people time, and to prevent some of those irreversible changes that would happen if they weren’t on puberty blockers, which may cause them a ton of distress, and which if they decide they want, they can still do,” DeChants says. “They can still stop puberty blockers and still experience them.”
Hormone therapy can later include testosterone or estrogen.
Not everyone who actually wants gender-affirming care has the means to access it. Only 14% of young people (through age 24) who said they wanted gender-affirming hormone therapy actually received it, according to a study last year from The Trevor Project.
About 80% of those who received gender-affirming hormone therapy had at least one parent support their gender identity.
“There are extensive conversations to make sure both the adolescent and their caregivers understand what these interventions do and what they don’t do,” says Dr. Jack Turban, assistant professor of child & adolescent psychiatry at The University of California, San Francisco, where he researches the mental health of transgender youth. “There are discussions to make sure they understand the risks, benefits and any potential side effects of these treatments. Current clinical guidelines also require that any minor pursuing gender-affirming medical interventions have a comprehensive ‘biopsychosocial’ mental health assessment prior to starting any medical interventions.”
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Why is gender-affirming care important?
It saves lives. Those under age 18 who received gender-affirming hormone therapy were linked with 40% lower odds of recent depression and a past-year suicide attempt, according to research from The Trevor Project. The organization found this year that 45% of LGBTQ youth seriously considered attempting suicide within the last year.
“Not only is it good medicine, we know that it works, we know that it actually is safe, we know that it is effective,” says Kate Steinle, chief clinical officer of FOLX Health. “And we also know that it saves lives, because the other option is withholding, and therefore possibly risking suicide.”
This care looks different for everyone. Transgender people don’t all go through a binary transition that involves top surgery (like removing breasts) or bottom surgery (altering genitalia to match gender identity). Others may opt for tracheal shaving to curb an Adam’s apple.
And gender-affirming care is anything but linear. “It is completely individualized,” Steinle says. “And some people take all of those steps, and some people take none of them. And that makes them no less trans or nonbinary. Their identity is still their identity, regardless of whether or not they have done gender-affirming surgery or taken hormones.”
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Why are some people angry about gender-affirming care?
Anti-LGBTQ sentiment and legislation are pervasive; more than half of U.S. states introduced or enacted such bills, including health care restrictions.
Much of “the rhetoric around these bills proposing to ban gender-affirming medical care for adolescents with gender dysphoria is simply false,” Turban says. “It seems that misinformation and confusion regarding what gender care entails and how it is practiced is driving much of what is going on in the legislative arena recently. It’s worth highlighting that every major medical organization opposes such legislation.”
DeChants recommends researching experts quoted regarding this type of health care. What are these people’s backgrounds? What is their expertise?
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Where can I go to learn more about medical care for transgender people?
Parents of transgender children should look to PFLAG or local LGBTQ centers for information and support groups. Those trying to learn can read or watch reputable media sources, check out medical association standards or chat with a personal trusted medical professional.
Great places to start:
Education is also necessary for all medical providers – not just those who are transgender nor only ones in large cities.
“This should not be specialized. This should be just incorporated into every type of medical program and training program,” Steinle says.
Most importantly: gender identity is a spectrum. “It’s not assigned at birth. It’s not biological. It is not determined by anybody else but the individual,” Brown says.
If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 988 any time day or night, or chat online.
Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.
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