What is gender affirming healthcare?
Why is it so critical for transgender youth?
Transgender, or gender-affirming healthcare, can best be defined as the psychological, social, and medical healthcare designed to affirm individuals’ gender identities.
Gender-affirming healthcare comes in many forms. It is not one-size-fits-all; like many medical therapies and treatments, it depends on the person’s age, condition, etc. The type and method of gender-affirming care look different for different age groups.
Gender-affirming care could be as simple as using a different name and the correct pronouns for children. As children get older, it may involve taking medication, such as puberty blockers, or receiving hormone therapy for adolescents. Later in life, these individuals may want to undergo surgery.
See the FAQs below for more detailed information.
What are the various forms of gender affirming healthcare?
Gender-affirming care is an umbrella term for developmentally appropriate supports that have been shown to reduce anxiety, depression, and suicidal ideation in young transgender and gender-diverse people.
For young children, such care includes non-medical social processes such as changes in names and pronouns and the affirmation of gender expression-related choices like clothing and hairstyles.
In older adolescents, gender-affirming care can also include medical interventions such as puberty blockers and supportive hormone therapies that may take place after careful consideration by families, professionals, and—most importantly—the youth themselves.
A growing body of research demonstrates that when transgender children and youth are supported in their identities, their mental health outcomes are similar to those of their cisgender peers. Transgender youth who are supported by their parents report greater life satisfaction and fewer depressive symptoms than those who report low levels of support. Additionally, supportive adults in school environments can increase transgender youth’s feelings of safety and reduce their school dropout rates.
Why is gender affirming medical care critical for transgender youth?
One in three transgender youth report having attempted suicide in the past 12 months, but research from the Trevor Project suggests that receiving gender-affirming supports may cut that risk in half.
Many research studies demonstrate overwhelmingly positive outcomes from gender-affirming care. A 2021 study of 11,000 gender-diverse adolescents showed that access to hormones reduced depression and suicidality.
Another showed gender-diverse youth receiving care in an interdisciplinary clinic experienced less depression, anxiety and suicidality compared with those without this care.
"As our patients grow older, they have repeatedly told us that gender-affirming care helped them survive adolescence and successfully transition into adulthood. They say early access to care allowed gender to simply be another aspect of identity, not the main focus."
Do the major medical associations support the use of gender-affirming medical care on transgender youth?
The American Academy of Child and Adolescent Psychiatry (AACAP) supports the use of current evidence-based clinical care with minors. AACAP strongly opposes any efforts — legal, legislative, and otherwise — to block access to these recognized interventions. Blocking access to timely care has been shown to increase youths’ risk for suicidal ideation and other negative mental health outcomes.
State legislatures across the country have advanced bills with the sole purpose of threatening the health and well-being of transgender youth. These bills are dangerous. Read our full statement here: ow.ly/DBQy50E0GkxAmerican Academy of Pediatrics@AmerAcadPeds16 Mar, 2021
The American Medical Association views these bills as a dangerous legislative intrusion into the practice of medicine and has been working closely with state medical associations to vigorously oppose them. In letters to legislators, the AMA has emphasized that it is “imperative that transgender minors be given the opportunity to explore their gender identity under the safe and supportive care of a physician.”
These three groups signed onto a statement opposing these bills along with the American Counseling Association, American Public Health Association, American School Counselor Association, American School Health Association, Child Welfare League of America, Mental Health America, National Association of School Nurses, National Association of School Psychologists, and the National Association of Social Workers
What are the criteria for children to be approved for puberty blockers used to treat gender dysphoria?
To begin using pubertal blockers, a child must:
1. Show a long-lasting and intense pattern of gender nonconformity or gender dysphoria.
2. Have gender dysphoria that began or worsened at the start of puberty.
3. Address any psychological, medical or social problems that could interfere with treatment.
4. Have entered the early stage of puberty.
5. Provide informed consent.
6. Particularly when a child hasn't reached the age of medical consent, parents or other caretakers or guardians must consent to the treatment and support the adolescent through the treatment process.
How are prepubescent transgender children supported in their gender identity?
For young children, gender-affirming care includes non-medical social processes such as changes in names and pronouns and the affirmation of gender expression-related choices like clothing and hairstyles.
What are puberty blockers, and what do they do?
Prescription medications called puberty blockers temporarily suppress puberty for transgender and gender-diverse kids. The medications mostly commonly used to suppress puberty are known as gonadotropin-releasing hormone (GnRH) analogues. These medications are most effective when administered at the onset of puberty.
Puberty's physical changes can cause intense distress for many gender-nonconforming adolescents. When taken regularly, puberty blockers suppress the body's release of sex hormones, including testosterone and estrogen, during puberty.
Sex hormones affect:
Primary sex characteristics. These are the sexual organs present at birth, including the penis, scrotum and testicles and the uterus, ovaries and vagina.
Secondary sex characteristics. These are the physical changes in the body that typically appear during puberty. Examples include breast development and growth of facial hair.
What are the benefits of puberty blockers for transgender and gender-diverse kids?
Gender dysphoria is the feeling of discomfort or distress that might accompany a difference between experienced or expressed gender and sex assigned at birth. Gender dysphoria that starts in childhood and worsens with the start of puberty rarely goes away.
For children who have gender dysphoria, suppressing puberty might:
Improve mental well-being
Reduce depression and anxiety
Improve social interactions and integration with other kids
Eliminate the need for future surgeries
Reduce thoughts or actions related to self-harm
A 2020 study found that trans people who had wanted to receive pubertal suppression but did not were 70% more likely to experience suicidal ideation in their lifetime than those who did receive it. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073269/
Are the changes caused by puberty blockers permanent?
The use of puberty blockers pauses puberty, providing time to determine if a child's gender identity is long-lasting. It also gives children and their families time to think about or plan for the psychological, medical, developmental, social and legal issues ahead.
If an adolescent child decides to stop taking puberty blockers, the puberty if their assigned sex will resume.
Are there any potential side-effects of puberty blockers?
Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings.
But doctors do not yet know how the drugs could affect factors like bone mineral density and fertility in transgender patients.
The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.