Caring for trans youth in a contentious political climate

By Jules Murtha | Medically reviewed by Kristen Fuller, MD
Published August 23, 2022

Key Takeaways

  • The rise of anti-trans legislation, which limits access to or criminalizes gender-affirming care, may contribute to poorer mental and physical health outcomes and increased suicidality in trans youth, according to studies and medical experts.

  • Prominent medical societies including the American Medical Association (AMA), American Psychiatric Association (APA), and the American Academy of Pediatrics (AAP) have issued public statements recognizing the importance and necessity of evidence-based, gender-affirming care for trans and gender-diverse youth.

  • Physicians may feel caught in the middle of this controversy. They can care for trans youth by studying the evidence, educating themselves on the debate, and offering gender-affirming care as indicated. A collaborative approach between clinicians, mental health professionals, and families is advised.

A wave of federal and state legislation that bans or criminalizes gender-affirming services for transgender youth has spilled over into the exam room, leaving doctors to wonder how to care for these patients without landing in hot water—or even prison.

Their fear is real.

On Aug. 19, Rep. Marjorie Taylor Green (R-Ga) introduced a bill that would make it a class C felony to provide gender-affirming medical care such as puberty blockers or gender confirmation surgery to trans youth—punishable by up to 25 years in prison. She referred to this type of care as “child abuse.”

A number of states including Texas, Alabama, Arkansas, and Arizona, recently enacted laws or policies restricting youth access to gender-affirming care and, in some cases, imposing harsh penalties on doctors and parents who facilitate access (several of these laws have been temporarily blocked by court rulings). Similar policies have been proposed in dozens of other states.[][]

Restrictions like these may contribute to the mental health issues so many trans kids are experiencing, according to many medical experts, trans youth advocates, and many of the nation's most prominent medical societies, including the AMA, APA, AAP, and others.[]

Mental illness among trans and questioning youth

It's becoming increasingly common for children to openly express gender identities that are incompatible with their assigned gender at birth—to come out as transgender.

Being transgender does not make one mentally ill, the Cleveland Clinic noted.[] But transgender individuals face unique challenges like discrimination, bullying, and gender dysphoria, which can set the stage for mental illness or suicidal thoughts.

In 2021, 52% of transgender and non-binary youth reportedly considered taking their own lives, according to the Trevor Project’s 2022 national survey on LGBTQ+ youth mental health.[]

Moreover, 60% of LGBTQ+ kids weren’t able to attain the mental healthcare they wanted, and less than one-third of trans children reported living in gender-affirming homes.

Trans youth have struggled to attain quality healthcare for years. A study published by Pediatrics stated that 62.1% of trans and gender-nonconforming students reported having “poor,” “fair,” or “good” health, as opposed to “very good” or “excellent health.”[]

Only 33.1% of cisgender youth showed similar results (cisgender refers to individuals whose gender identity aligns with the sex they were assigned at birth).

While clinicians agree that further studies and a wider range of treatment options are needed to better support transgender youth, they are concerned that politicization of this issue harms trans youth and medical professionals.

Response from major medical associations

In the heat of this controversy, a wide consensus is growing among major medical associations, which are speaking out against efforts to ban or make it a crime to provide these services.

The AMA, the APA, the AAP, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the Endocrine Society, among others, have issued public statements that recognize the medical necessity of gender-affirming care for youth and outline the negative impacts of denying access to these services. They also decry the intrusion of government into medical practice.

“Evidence has demonstrated that forgoing gender-affirming care can have tragic consequences,” the AMA wrote in an April 2021 letter to the National Governors Association.

“Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder,” the letter said, pointing to stigma and discrimination as linked causes.

"Because of this stress, transgender minors also face a significantly heightened risk of suicide."


Later in 2021, the AMA strengthened its position, saying it opposed the “dangerous intrusion of government into the practice of medicine and the criminalization of healthcare decision-making,” adding that gender-affirming care is "medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people.”

How you can help trans youth

Physicians are in a unique position to address the struggles facing trans kids.

A 2022 study published by JAMA Network Open found that trans and non-binary youths who had access to gender-affirming care over the course of a year experienced a significant decrease in mental health disparities.[]

The use of hormonal therapies and puberty blockers was associated with a 60% decreased risk of moderate or severe depression among participants. Participants also reported a 73% lower likelihood of suicidality at the conclusion of the trial.

So, what might gender-affirming care entail for your patients?

According to an article published by the American Association of Medical Colleges (AAMC), some forms of gender-affirming care HCPs can provide may include:[]

  • Pointing trans kids to counseling services and resources that can assist with changes in their appearance, such as affirming makeup and haircuts

  • Introducing trans kids to chest binding, genital tucking, hip/buttocks padding, speech therapies, and hair removal processes

  • Potentially prescribing puberty blockers (medications which suppress the release of sex hormones like estrogen and testosterone) if the child is eligible

  • Potentially prescribing hormone therapy (the addition of estrogen or testosterone to aid in the development of characteristics that align with each person’s gender identity) if the child is eligible

In the AAMC article, Jason Rafferty, MD, MPH, a pediatrician and child psychiatrist at the Gender and Sexuality Clinic at Hasbro Children’s Hospital in Providence, RI, encouraged all doctors to give trans kids the clinical care they need to prosper.

"It’s important for providers to know that what they do, even if it’s just affirming someone’s [asserted] name, can have a positive influence on the health and development of that child."

Jason Rafferty, MD, MPH

"This support has to take place within a clinic. It’s not something that can be legislated," he added.

What this means for you

Clinicians can provide compassionate care to their trans youth patients by studying the evidence, getting educated on the issues, and working closely with family and mental health professionals. Gender-affirming care may include social, psychological, behavioral, and medical support. Physicians should strive to be inclusive with their language, thoughts, and actions, and provide the safest, most informed care to transgender patients.

In Medical Hot Potatoes, we tackle controversial and divisive issues with an objective eye, making it easier for physicians and healthcare professionals to navigate the places where medicine and politics intersect. We invite you to share your own experiences and knowledge. Submit any topic you'd like to see covered and let us know if you'd like to be a guest author.

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