In 2021, Republicans in at least 25 states introduced over 60 pieces of legislation that directly target transgender youth, making it the worst year in history for the number of anti-LGBTQ+ bills signed into law. This year, South Dakota became the 10th state to implement gender-discriminatory restrictions in youth sports, and so far 27 others have introduced similarly harmful bills. Recent anti-trans legislation also includes Arizona’s SB 1045, which requires teachers and other authority figures in public schools to disclose information on students’ gender identity to parents, regardless of the safety of the student’s home life. Other bills, such as Florida’s HB 1557/SB 1834 (nicknamed “Don’t Say Gay”), effectively erase the presence of the LGBTQ+ identity in educational settings. Oklahoma, Arizona, and South Carolina have introduced similar censorship bills.
The list goes on and on: Iowa’s HF 170 allows people to refuse “services, jobs, housing, medical care, and more” under the justification of “religious beliefs” that oppose a certain lifestyle or identity. Florida’s HB 747 allows medical providers to deny services that “violate their consciences.” Arizona, Kentucky, Indiana, and other states have introduced legislation that protects the “right” to discriminate against LGBTQ+ parents in adoption and foster care. (You can track the progress of anti-transgender legislature via Freedom for All Americans.) For queer people all over the United States, this raging culture war presents a daily terror.
As we combat the transphobic and homophobic rhetoric that is becoming increasingly mainstream, it’s important to talk about the facts. Read on to learn about gender-affirming care and why it matters.
If you are new to the topics of transgender health care, you may be unsure what exactly “gender-affirming” means. You may feel uneasiness or even fear—especially as politicians stir up transphobia by misrepresenting gender-affirming care as “mutilation.”
In truth, gender-affirming care is a model of practice wherein a patient’s gender experience is accepted and appreciated. The American Academy of Pediatrics posits the importance of creating a safe space—indeed, all physicians should seek to make their patients feel safe in the exam room. Respecting a patient’s pronouns and chosen name is an incredibly easy way to affirm their identity, autonomy, and humanity. Failing to do so breaks down the trust between patient and provider. According to the US Transgender Survey Report of 2015, nearly one fourth of respondents reported that they avoided seeking health care they needed in the past year due to fear of being mistreated as a transgender person.
Another aspect of gender-affirming care is the alteration of hormones. Not all transgender-identifying people will feel that body alteration is a necessary part of their gender expression, but many do require puberty blockers, hormone replacement therapy (HRT), and/or affirming surgery to address gender dysphoria. Fear-mongering public figures often incite panic around these procedures, especially in the realm of pediatrics, but in reality there is nothing whatsoever to cause concern. Hormonal treatment does not begin until puberty, at which point, it is common for patients to employ puberty blockers to suppress testosterone and estrogen. HRT functions similarly, and is a treatment that can be implemented at any age. Regulating the body’s creation of sex hormones will affect physical characteristics like breast development, bone structure, and facial hair growth. Hormone therapies are safe to use and reversible—in fact, many people use HRT to lessen the side effects of menopause.
Similarly, when it comes to gender-affirming surgery, you can find countless cis-gender examples of successful operations: post-mastectomy breast implants, facial plastic surgery procedures, hair implants, and more. You may not have considered these treatments to fall under the umbrella of gender-affirming care, but they absolutely do! Any process that enhances an individual’s expression of their gender identity can be considered gender-affirming.
When we talk about gender-affirming care, it’s important to avoid the scare tactics that many politicians use (they often employ same tactics when it comes to abortion rights). No one is forcing children to undergo surgery, and hormone therapies are not prescribed on a whim. Right-wing pundits characterize gender-affirming care as abuse, but in truth, gender affirmation is a life-saving antidote for depression, low self-esteem, self-harm, social anxiety, and suicide ideation. Gender-affirming care makes a difference. Legislature that criminalizes freedom of gender expression and prohibits adequate medical care for transgender individuals is an infringement on our bodily autonomy and must be treated as such.
As health care providers, we have a responsibility to meet our patients’ needs. Regardless of what any law might say, it is unethical to deny health care to anyone based on an aspect of their identity. Though we do not serve a pediatric population, we support organizations who provide gender-affirming care for youth. CommunityHealth stands strongly in support of LGBTQ+ rights, and we are dedicated to providing quality, gender-affirming care to all of our patients.