Written by Julie, RSEI Educator | Published January 29th, 2025
If you or someone you know needs support, please reach out to either of these helplines:
Trans Lifeline (877 565 8860)
1-866-488-7386 | Text | Chat (The Trevor Project)
Why are we talking about this topic right now?
In 2024 alone, 672 anti-trans bills were introduced in the United States. The constant bombardment of rhetoric that is not only bigoted, but may even be life-threatening has taken a massive toll on trans and gender-expansive folks in this country. Much of the legislation is focused on banning gender-affirming care (GAC) on different levels, all of which would negatively affect folks who are seeking such care.
In this blog, we will briefly discuss the established standards regarding GAC, which contradict the anti-trans values flooding the political climate. As with any health care standards, they are not without issues, but they serve as a starting point and, if followed, could save lives. In light of the blatant lack of support for folks seeking GAC, we will also discuss how youth-serving adults can support young people, whose autonomy is at increased risk. If you are an adult who wants to take action to improve the wellbeing of young trans and gender-expansive folks, please read on.
Gender-affirming care is lifesaving for many trans and gender-expansive folks. When people who need GAC have access to it, they have significantly better mental and physical health outcomes than those who cannot access that same care. Along with social transition, medical interventions like puberty blockers, hormone therapy, and affirming surgeries are essential elements of care for many. The improved outcomes for folks who seek GAC are greatly impacted by the ease of access to care as well as folks’ intersecting identities. One factor that plays a big part in a person’s access to GAC is their age. Minors have a much harder time receiving the care they need and deserve due to both legal and systematic limitations. The reality is that young people are living in states where access to transition-related support is greatly restricted, and it is essential that the adults in those young folks’ lives provide as much support as they can. Of course, many young people do not have an adult like this in their home or family, in which case a clinician or other youth-serving adult may find themselves in a position of support.
How do we know what GAC is safe for young people? Who determines what medical interventions should be available to them?
The World Association for Transgender Health (WPATH) as well as the Human Rights Campaign are global governing bodies who have released explicit recommendations when it comes to GAC based on decades of research and experience. In 2022, WPATH updated their Standards of Care to specify best practices for health care providers serving young people, due to the increased need for quality GAC for minors. These recommendations promote a comprehensive approach to medical GAC for young people, which includes providing education and ongoing support to families, schools, and other prominent people in a young person’s life. This is meant to promote everyone’s understanding of the importance of affirming the young person’s identity. In the U.S. context, both the American Medical Association and the National Institutes of Health also encourage families and health care providers to collaborate in support of young people’s transition and gender exploration. The standards and the plights of all of these organizations recognize the added layer of difficulty for young folks’ accessing GAC, but they also affirm that GAC is imperative to the wellbeing of young trans and gender diverse people.
Despite these recommendations from globally and nationally recognized leaders in health care, many young folks’ access is limited by laws that are not rooted in best practices. Last year, 48 bills were passed to ban or limit access to lifesaving health care for people seeking GAC, many of which are targeted toward youth. Much of the anti-trans rhetoric that supports these bills focuses on informed consent, which is, of course, a central aspect of medical care, yet often becomes murky for minors. Consent laws in regards to GAC are often treated differently than other areas of care, as evidenced by what type of medical care a young person has the legal right to choose for themselves. Because of these laws, lack of parental consent can bar access to GAC, even though trans and gender-expansive youth are the best decision-makers when it comes to the health care needed to affirm their gender. Anti-trans people who want to restrict medical care for young people push a narrative that GAC is dangerous and those who receive it are filled with regret, despite evidence to the contrary. They often use language that is confusing or that masquerades as protecting young people when, in reality, those ideas and effects of them can cause great harm to folks who need this care.
If laws restrict or ban GAC, how can young people still receive gender affirmation?
Because of this complex web of barriers, some young people may seek health care that affirms their gender without being explicitly labeled so. For some young folks, such care may be all that is available to them. For those who have started puberty and are experiencing menses that are causing dysphoria or discomfort, contraceptives may be an option. There are several types of birth control that can help someone limit or avoid their bleeding cycle altogether. Many of these methods can help someone change or eliminate their cycle without any outward signs of use. This concealment provides another layer of security for young folks who could be chastised for using contraceptive methods for any reason.
It is well known that people use contraceptives for myriad purposes besides preventing pregnancy, so this is an example of a medical intervention that can affirm one’s gender without being subject to the same restrictions as other forms of GAC. Access to contraceptives are limited by parental consent in some states, and young people and adults alike should be aware of whether this is a viable option. Mental health services with the right provider can also serve as part of GAC for some young folks, though they, too, are restricted for minors in some states. In some places, mental health care may also still be required to access GAC, and thus might be a primary step. For adults who want to support the young people in their lives, it is important to be aware of options like birth control or mental health care, as they may be easier for young folks to access than care that is explicitly labeled as gender-affirming. Of course, financial barriers including insurance coverage may prevent folks from accessing even these options.
Beyond assisting with health care options, supportive adults could also share information about things like binding, tucking, or packing with young folks who show interest. These items can make a substantial difference in the comfort someone has with their body, creating the desired look and feel of different bodies/parts and helping to alleviate dysphoria. Offering these tools can help show young people that their identity is not only seen, but is celebrated. It is common for young people to find creative ways to get such desired effects on their own by using improvised packing and binding items as well as trans tape, but there can be health risks associated, specifically with unsafe binding practices. Providing information about how to tuck or bind safely is critical in supporting young people who want to do so. Oftentimes, these tools are more accessible for young folks because they are temporary, though in some cases, items for tucking or binding are only available to purchase by adults.
Additionally, anti-trans rhetoric often overemphasizes the ‘permanent’ physical effects of GAC to improperly limit young folks’ access to care, even when a permanent physical impact is limited or non-existent. As stated previously, long-term or permanent effects of folks accessing GAC are consistently reported to be positive. It is also important to note that young people may feel comfortable using gender-affirming items in some contexts and not others. Concern about bullying, harassment, or safety at school and even at home could impact how a young person decides to express their gender. You may see differences in the clothes they wear, the names they use, and any other form of gender expression. This should not be taken as evidence that they aren’t serious about transitioning – it could reflect a genuine lack of safety to be their authentic self in different settings.
How else can I be a supportive adult?
For adults who aim to support trans and gender-expansive youth, there are several resources that outline how to be affirming that explicitly apply to youth-serving adults. This resource from the Trevor Project is a great place to start. Creating an intentional and consistent environment of support for trans and gender-expansive young folks may include:
- Using the name and pronouns they ask you to use (sometimes they may change depending on the context or the day) and correcting yourself if you mess up
- Decentering the gender binary in your language and actions; start with your own understanding
- Supporting them as they navigate the complicated process of name and gender marker changes on legal documents
- Celebrating diverse representations of people throughout history and in present day
- Helping young people understand exactly what their rights are and connecting them to resources
- Helping with reporting and addressing issues in school and reminding them that their safety is a right
- Showing young folks where a safer restroom for them to use is located. This is especially important in states and areas where non-gendered restrooms are unavailable and in the fourteen states that currently ban trans folks from using the restroom consistent with their identity.
Legislation has already been passed this year that will deny gender affirmation for trans and gender-expansive folks, and several more threaten to bar access to GAC completely. For adults who have the privilege of voting, it is essential to vote in favor of people and bills that uplift and protect young gender-expansive folks. You can take action and become involved in local or national activism for the rights and safety of the young people you love and those whose wellbeing is at stake.
We also have to be acutely aware that there are a large number of trans and gender-expansive youth that do not have an adult in their life who is putting in the work, or who even wants to. This blog is by no means exhaustive of all of the obstacles that young people face, nor of every single way to be an allied adult; however, it is a stepping stone to use if you are an adult who wants to support young people in your family or your community. We encourage you to ask the young people you want to support what they need and want – you simply cannot know without their input!
*** This blog uses the terms trans and gender-expansive. These are not the only terms people might use for themselves and they may not feel right to some folks. It is always up to a person to decide which terms or labels, if any, apply to themselves.