The health care that transgender people need, sometimes referred to as gender-affirming care or transition-related care, is health care for transgender people of all ages. It includes a range of services, including mental health care, medical care, and social services. At all ages, clear, well-established, evidence-based standards of care exist. Gender-affirming care helps transgender and non-binary people live openly and authentically as their true selves. Just like any other form of health care, it also helps transgender and non-binary people live safe and healthy lives.

Gender-affirming care is treatment for a diagnosis of gender dysphoria, which impacts many transgender and non-binary people. Gender dysphoria happens when one’s gender identity does not match their sex as assigned at birth.

Trans people’s health care is always delivered in age-appropriate, evidence-based ways, and decisions to provide care are made in consultation with doctors and parents, just like health care for all other people. Collectively representing more than 1.3 million doctors across the United States, every major medical and mental health organization — including the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association — recognizes that it is medically necessary to support people in affirming their gender identity.

Gender transition, or “transitioning,” is the process through which a transgender or non-binary person takes steps to live authentically in their true gender identity. It is a personal process that looks different for every person and individual paths can vary greatly. Some people take medication, and some do not; some adults choose to have surgeries, and others do not. For some people, it can include steps as simple as changing clothes, names, and hairstyles to fit their gender identity. Regardless of the age at which a person transitions, how they do so is their choice to be made with their doctors, and for younger people, their family as well. 

Transgender and non-binary children or adolescents may, with their parents’ support and consent, discuss with their doctor whether they have gender dysphoria.  If so, the care recommended to the child will be based on their age and stage of physical development.  

Prior to puberty, transition is entirely social, and may involve changing names, pronouns, clothing, and hairstyles. During and after puberty, some medical treatments may be recommended, but only after significant consideration and agreement between the youth, their families, and their health care providers, including mental health providers.  The medical team works with the young person and their parents to ensure that any course of treatment is appropriate for this particular person’s needs. At all stages, parents, young people, and medical professionals make decisions together, and no permanent medical interventions happen until a transgender person is old enough to give truly informed consent.

Social transition is when a person takes non-medical, fully reversible steps to begin living and presenting publicly as their gender. This can include changes such as:

- Using a new name and pronouns
- Adopting a new hairstyle
- Wearing different clothing
- Disclosing gender identity to others in their lives

Gender-affirming care is a broad approach to health care and support that recognizes and respects an individual’s gender identity, ensuring that all individuals can live healthy, fulfilling lives by addressing their unique needs.

"Puberty blockers” (or simply “blockers”) are a type of medication that can temporarily pause puberty and are fully reversible.

Puberty blockers are safe. They were approved by the FDA to treat precocious puberty in cisgender youth in 1993, citing minimal side effects and high efficacy; 30 years later, puberty blockers remain the gold standard treatment for precocious puberty in cisgender youth. All youth who are taking puberty blockers — cisgender or transgender — are monitored by their care team for any side effects or complications.

Puberty blockers are fully reversible. If a person stops taking puberty blockers, normal puberty will resume, with minimal long-term effects, if any. While there may be some loss of bone mineral density, this can be easily addressed with calcium and vitamin D supplements. Previous research has also shown that cisgender youth who take puberty blockers for precocious puberty have normal fertility and reproductive function. 

For transgender and non-binary youth who are aware of their gender at a young age, going through puberty may cause intense distress and dysphoria, as it leads their body to develop into a gender that is not theirs — including in ways that are irreversible, or only reversible later with surgery.

In these instances, puberty blockers may be prescribed by doctors early in puberty, in consultation with the person’s parents and therapists, in order to temporarily stop the body from going through the unwanted physical and developmental changes that come with puberty. They are used to give youth time to continue exploring their gender identity before potentially moving on to more permanent health care interventions when they are older.

Hormone replacement therapy medications are prescription medications that are synthetic versions of testosterone or estrogen, the same hormones that naturally develop at various levels in cisgender men and cisgender women. These same medications are used safely every day by millions of people worldwide, for a variety of medical conditions

Hormone replacement therapy medications are safe for both youth and adults with provider supervision and appropriate management. Depending on how long a person has been taking hormone replacement therapy medications, the effects may be fully or partially reversible as well. The informed consent process involves discussions about side effects and benefits — as with any informed consent process for medication or treatments — including discussions about fertility. 

Hormone replacement therapy medications are typically not prescribed until a person is at least 18 years old. Though adolescents may receive hormone replacement therapy medications starting in their late teens, this is only done with physician approval, parental consent, and informed consent from the adolescent in question, and is typically reserved for those adolescents who have been on puberty blockers and/or socially transitioned for some time.

As part of their transition, some transgender and non-binary people may be prescribed hormone replacement therapy medications to cause their bodies to begin physically developing into the gender they identify as. These medications allow transgender and non-binary people to live more fully as their identified gender, significantly reducing negative psychological outcomes such as gender dysphoria, depression, anxiety, and suicidality.

Gender-affirming surgery includes a wide range of procedures such as plastic surgery to change features in the face to be more typically masculine or feminine, “top surgery” to make changes to the chest or torso, or “bottom surgery” to make changes to genitals. None of these surgical procedures are unique to transgender people. They are the same procedures that have safely and effectively been given to cisgender and intersex people for decades, for a host of cosmetic and medical reasons. 

Prior research shows gender-affirming surgeries are both safe and positively received by patients.  Post-surgical complication rates are similarly low among transgender and cisgender people receiving the same type of surgery — if not lower among transgender people.  And satisfaction with gender-affirming surgeries is high, including for chest/top surgery, bottom/genital surgery, and facial surgery. 

Transgender and non-binary people typically do not have gender-affirming surgeries before the age of 18. In some rare exceptions, teenagers under the age of 18 have received gender-affirming surgeries in order to reduce the impacts of significant gender dysphoria, including anxiety, depression, and suicidality. However, this is limited to those for whom the surgery is deemed clinically necessary after discussions with both their parents and doctors, who have been consistent and persistent in their gender identity for years, have been taking gender-affirming hormones for some time, who have undergone informed consent discussions and have approvals from both their parents and doctors and who otherwise meet standards of care criteria (such as those laid out by WPATH).  

It is also exceedingly rare: In one study that conducted a retrospective chart review of a U.S. national pediatric surgical database, authors were only able to identify 108 trans minors who had received any form of gender-affirming surgery over four years (2018-2021) — accounting for 0.04% of all transgender youth nationwide. Only 10 of these patients were under the age of 16. And approximately 95% of these surgeries were chest surgeries. In all cases, regardless of the age of the patient, gender-affirming surgeries are only performed after multiple discussions with both mental health providers and physicians (including endocrinologists and/or surgeons) to determine if surgery is the appropriate course of action. 

As of December 2024, a total of 26 states, home to an estimated 40% of all trans youth aged 13-17, have passed a ban on accessing/utilizing gender-affirming medical care for youth.

Who these laws cover, and what procedures are regulated, differ from state to state:
- Two of these states (Arizona and New Hampshire) focus their ban only on gender-affirming surgeries. The remaining 24 ban access to all forms of transgender health care for youth, including puberty blockers, gender-affirming hormones, and surgery
- In two states (Alabama and Nebraska), these laws ban access to care for those under the age of 19. In the remaining states, care is banned for those under age 18.
- In 6 of these states (Alabama, Florida, Idaho, North Dakota, Oklahoma, and South Carolina), these laws target physicians and health care providers, by making it a felony to provide gender-affirming medical care to youth 

addressing the constitutionality of bans on medical care for transgender youth. The case challenges a Tennessee law (Senate Bill 1) that bans gender-affirming health care treatments for transgender youth including puberty blockers and hormones in the state, regardless of parental consent and medical recommendations. The legislation was signed into law in March 2023. 

In April 2023, the American Civil Liberties Union, the ACLU of Tennessee, Lambda Legal, and Akin Gump Strauss Hauer & Feld LLP sued the State of Tennessee on behalf of families and transgender youth to block the state’s ban.  Soon after, the United States Department of Justice, under the Biden Administration, joined the litigation supporting transgender youth and their families. At first, a district court judge ruled in their favor and issued a preliminary injunction that blocked the law from going into effect. Tennessee appealed this ruling to the 6th Circuit, where a panel reversed course allowing the law to go into effect. The plaintiffs filed petitions for a Writ of Certiorari, asking the U.S. Supreme Court to review the case. In June 2024, the Supreme Court agreed to take up the United States’ petition.

Oral arguments were heard by the Supreme Court on December 4, 2024, and a decision is expected before the end of June 2025.  The plaintiffs argue that Tennessee's law unconstitutionally violates the Equal Protection Clause of the 14th Amendment to the U.S. Constitution and that because the law discriminates on the basis of sex, the 6th Circuit applied the wrong standard. The Tennessee Attorney General continues to defend the law.

When legislators attempt to regulate who can access gender-affirming care, they are inserting political beliefs into private and personal conversations between parents and their children, and patients and their doctors. These laws are not about safety — as the safety and efficacy of gender-affirming care for transgender and non-binary youth and adults is clear. Instead, in ignoring a wealth of scientific evidence and overwhelming support from the medical community, these legislators are attempting to enshrine discrimination into law. Rather than protecting kids, these laws are preventing parents and young people from making informed medical decisions, and doctors and health care providers from providing best-practice care to their patients.

Every single major medical organization, including the American Academy of Pediatrics, the American Medical Association, and the American Psychiatric Association, supports the provision of age-appropriate, gender-affirming care for transgender and non-binary people. These organizations represent millions of doctors, researchers, and mental health professionals in the United States. Gender-affirming care has always existed and isn’t a new phenomenon — it’s just that in recent years, extremist politicians have made it into an issue for their own self-gain.

Clear, well-established, evidence-based standards of care exist for who can get gender-affirming care and when — and these standards have existed for decades. In 2022, for example, the World Professional Association of Transgender Health (WPATH) released its 8th Standards of Care for treating transgender patients. The Endocrine Society and the American Academy of Pediatrics have also issued guidelines.

The process to access gender-affirming care can differ from state to state, and hospital to hospital, due to differences in state laws around who can access gender-affirming care, and when. But, in general, transgender patients (along with their families, if they are minors under the age of 18), will start by visiting a health care provider or clinic that specializes in gender-affirming care. Some may be referred to this clinic after first disclosing their gender dysphoria to a primary care provider or therapist, and others may start with a gender clinic.

For patients seeking out gender-affirming medical care, they often receive counseling for extended periods of time. If medications or surgery are part of their gender journey, they are only prescribed after further assessments to ensure they meet prescribing criteria. This can include but is not limited to documentation and referral letters, parental consent, and ongoing mental health support. At all stages, gender-affirming care is only delivered after patients and their families have been counseled, and informed consent has been given.

Gender-affirming care for transgender people is best-practice, medically necessary health care. And research has consistently found that receipt of gender-affirming care can significantly improve the lives of people who receive it.

A recent study from the Trevor Project shows that transgender youth with access to hormone replacement therapy medications have lower rates of depression and are at a lower risk for suicide. A study by Stanford University School of Medicine found that positive mental health outcomes were higher for transgender people who accessed hormone replacement therapy medications as teenagers, versus those who accessed it as adults. A third study, published in the New England Journal of Medicine, found that two years after initiating hormone replacement therapy medications, transgender youth reported higher levels of life satisfaction and positive affect, and lower levels of gender dysphoria, depression, and anxiety.  Previous studies have also found that transgender and non-binary youth who are able to receive puberty blockers report positive psychosocial impacts, including increased well-being and decreased depression. Other recent studies have found that receipt of puberty blockers can dramatically reduce risk of suicidality — in some cases by over 70% — among transgender youth, compared to those who were unable to access desired treatment.

Similar results have been seen for transgender adults: In two separate systematic reviews, one focused on 53 studies exploring mental health following gender-affirming surgeries, and the second focused on 29 studies exploring mental health impact across multiple forms of gender-affirming care, authors found that quality of life and happiness increased among trans adults following receipt of gender-affirming care, and depression, anxiety, suicidality, and suicide attempts, and gender dysphoria were reduced. 

Conversely, bans on access to gender-affirming health care for youth can have devastating consequences.

These laws interfere with the ability of transgender youth, their families, and their providers, to make the health care decisions that are right for them, and access the medical care they need. No parent should ever be put in the position where they and their doctor agree on one course of action, supported by the overwhelming majority of medical experts, but the government forbids it. But that’s exactly what these health care bans do. 

The simple existence of legislation to ban gender-affirming care can also have substantial negative consequences. 

Researchers and pollsters have consistently found that LGBTQ+ youth report worsening mental health, and increased anxiety and fear, as a result of anti-LGBTQ+ legislation, with effects substantially worse for transgender and non-binary youth.  Even among LGBTQ+ adults, who to date have largely not seen the same level of legislative attacks on their health care, this legislation is wreaking a toll. 

The single most important thing anyone can do to support transgender and non-binary people in their lives, regardless of their age, is to support and affirm them and their journey. A simple first step is committing to use their chosen name and pronouns — and, if you make a mistake, simply apologize, correct yourself, and move on.

For transgender youth, this can be particularly important.

When parents, caregivers, and teachers support a transgender youth’s journey in transitioning, they are helping them to live authentically and grow into the person they are meant to be — just like all other children and adolescents of their ages do. Adolescence is typically the time when all youth begin to develop autonomy and independence and learn about themselves and their identity, as they prepare for adulthood. When parents and families support their children through actions such as respecting their opinions, showing interest in their activities and interests, and providing a loving, affirming, and trusting home, it can go a long way toward ensuring they will successfully develop into happy and healthy adolescents and adults.

And parental support can save lives. Previous research has found that transgender youth who are able to socially transition and simply have their gender identity, name, and pronouns affirmed report higher levels of resilience and positive well-being and lower levels of depression, anxiety, gender dysphoria, and suicidality, relative to transgender youth who are not affirmed.

Previous studies have found that de-transitioning is quite rare —with some studies finding levels of de-transition and regret as low as 1% or 2%. Transgender youth who meet criteria for gender dysphoria and who undergo social or medical transition are actually the least likely to de-transition — and those vast majority of transgender youth remain consistent and persistent in their gender identity over time: One recent study, published in the academic journal Pediatrics, followed over 300 transgender youth after first initiating social transition, and found that over 92% remained consistent and persistent in their gender identity 5 years later. However, evidence-based standards of care exist to ensure that no one, regardless of their age, undergoes any permanent, irreversible changes without informed consent and careful consultation with medical and mental health care providers.