What Is Gender-Affirming Care?

What is gender-affirming care?

Gender-affirming care is medical and non-medical support that helps a transgender or gender-diverse person live according to their gender identity. It runs from a chosen name and pronouns through counseling, puberty blockers, hormones, and surgery for adults. Each stage has its own criteria, and most people never reach the last one.

This page is not medical advice. It summarizes current clinical standards, published research, state policy, and federal actions. Medical decisions belong with patients, families, and qualified clinicians. The care treats gender dysphoria, the diagnosis that names the distress this care is meant to relieve.

What Gender-Affirming Care Involves

Much of this care involves no medication and no surgery. It starts with social transition, which means a chosen name, different pronouns, a haircut, and clothes that match how someone sees themselves. None of that requires a doctor, and for many gender non-conforming kids it is where things stay.

The medical steps come later and arrive in a fixed order. Each one is harder to undo than the last, and each one is gated to an older patient. Those two facts move together, which is the part the political debate almost always leaves out.

The stages of care, from a chosen name to surgery

How permanent Fully reversible Partly permanent Permanent

1. Social transition Any age

   A chosen name, pronouns, hair, and clothing. Nothing is prescribed, and a child can change their mind at any point with no medical consequence.

2. Mental health care Any age

   Counseling for the patient and usually the family. Required before any medical step for a minor. Many patients take this step and no other.

   Provided by psychologists, clinical social workers, and psychiatry when another condition needs treatment

3. Puberty blockers Puberty onset

   These drugs pause puberty and buy time to decide. The FDA approved them in the 1990s for children who start puberty too early. Puberty resumes if a patient stops.

   Provided by endocrinologists, sometimes primary care

4. Gender-affirming hormone therapy Usually 16+

   Estrogen or testosterone, started at a low dose and raised slowly. Some effects fade if a patient stops. A deeper voice and facial hair do not.

   Provided by endocrinologists and trained primary care physicians

5. Voice therapy and hair removal Mostly adults

   Voice therapy trains pitch and resonance and changes nothing physically. Laser hair removal is permanent. Neither is covered by most state bans.

   Provided by speech-language pathologists and dermatology

6. Top surgery 16+ at some centers

   Chest reconstruction. Rare before 18 and never automatic: it takes lasting dysphoria, a mental health evaluation, and a parent's consent for anyone under 18.

   Provided by plastic surgery

7. Genital surgery 18+ only

   Also called bottom surgery. No U.S. center performs it on a minor. Adults need 12 months of hormone therapy and referral letters from two different mental health providers.

   Provided by urology and plastic surgery

The stages of care, from a chosen name to surgery

Step	Who can access it	How permanent
Social transition. A chosen name, pronouns, hair, and clothing. Nothing is prescribed, and a child can change their mind at any point with no medical consequence.	Any age	Fully reversible
Mental health care. Counseling for the patient and usually the family. Required before any medical step for a minor. Many patients take this step and no other.	Any age	Fully reversible
Puberty blockers. These drugs pause puberty and buy time to decide. The FDA approved them in the 1990s for children who start puberty too early. Puberty resumes if a patient stops.	Puberty onset	Fully reversible
Gender-affirming hormone therapy. Estrogen or testosterone, started at a low dose and raised slowly. Some effects fade if a patient stops. A deeper voice and facial hair do not.	Usually 16+	Partly permanent
Voice therapy and hair removal. Voice therapy trains pitch and resonance and changes nothing physically. Laser hair removal is permanent. Neither is covered by most state bans.	Mostly adults	Partly permanent
Top surgery. Chest reconstruction. Rare before 18 and never automatic: it takes lasting dysphoria, a mental health evaluation, and a parent's consent for anyone under 18.	16+ at some centers	Permanent
Genital surgery. Also called bottom surgery. No U.S. center performs it on a minor. Adults need 12 months of hormone therapy and referral letters from two different mental health providers.	18+ only	Permanent

Sources: WPATH Standards of Care, 8th Edition (2022); Endocrine Society Clinical Practice Guidelines (2017).

Nobody moves through every rung. A trans adult may take hormones for years and never want surgery. Another may want voice therapy and nothing else. The ladder describes what exists, not a path anyone is expected to finish.

Finding a provider is its own obstacle. There is no single specialty for this. A patient may see a primary care physician for hormones in one town and need an endocrinologist two hours away in the next, and the mental health services that the standards of care require are the hardest piece to find anywhere. Getting in the door is only half of it: 48% of trans adults report at least one bad experience with a provider because they were transgender, from being refused care outright to being treated roughly (2022 U.S. Trans Survey).

One clinical step almost never comes up in legislative debate. Before starting hormones, patients are counseled about fertility preservation, because testosterone and estrogen can reduce fertility. Teenagers and their parents are asked to consider banking eggs or sperm first. The conversation that lawmakers describe as reckless includes asking a 16-year-old whether they want the option of biological children at 30.

How Doctors Decide Who Gets Care

The process involves multiple providers, months of evaluation, and formal criteria at every stage. Accredited programs do not hand out hormones after one visit. The typical pathway moves through distinct steps: counseling and social support first, then assessment by trained providers, then puberty-stage evaluation if relevant, then parent permission and youth assent for minors, then reversible blockers when clinically appropriate, then hormones only after further evaluation, and surgery mostly limited to adults.

The WPATH Standards of Care, 8th Edition (2022) and the Endocrine Society Clinical Practice Guidelines (2017) set the clinical framework. Both require a comprehensive biopsychosocial assessment before any medical intervention.

The assessment period alone takes months to years depending on the complexity of the case. The Endocrine Society Transition Readiness Assessment asks whether the patient can explain their diagnoses, advocate for their own care, and manage appointments independently. Providers evaluate family support, mental health stability, and informed consent capacity.

For minors, the process is family-centered. Parents provide permission. Adolescents provide assent. A mental health professional must confirm that dysphoria is long-lasting, intensified with puberty, and not better explained by another condition. Adults provide their own consent and need fewer gatekeeping steps, but the assessment is still required before hormones and mandatory before surgery.

Parents who have been through it describe something slower than the version debated in statehouses. Human Rights Watch interviewed 51 people across 19 states for a 2025 report on the bans. One father described what the first year looked like for his family.

Mental Health Outcomes and Regret Rates

The research compares people who received this care against people who wanted it and did not. The direction is consistent across studies. Depression, anxiety, and suicide attempts all fall in the group that got treated, and the effect shows up within the first year.

Youth who received care within the first year had 60% lower odds of moderate-to-severe depression and 73% lower odds of self-harm or suicidal thoughts (Tordoff et al., JAMA Network Open 2022).

When care was delayed 3-6 months, patients were 2-3x more likely to experience depression or suicidality.

The surgical regret rate for gender-affirming procedures deserves its own context. A 2024 meta-analysis pooling data across studies found a 1.94% surgical regret rate with a 95% confidence interval under 2%. Regret after knee replacement surgery runs 6-30%. Hip replacement runs 7-10%.

How Often People Detransition

Detransition means stopping or reversing a gender transition, and it is not the same as regret. Researchers separate social detransition, like returning to a birth name or pronouns, from medical detransition, like stopping hormones. Most people who do either still identify as transgender, and detransition is not evidence that the original care was a mistake.

How often it happens depends on how a study defines it. Follow-up studies of people who received care put medical detransition in the low single digits, while a broad survey that counts any temporary pause reaches higher. A 2023 review in the Archives of Sexual Behavior found the true rate genuinely uncertain, because definitions and time windows vary so much.

When people do stop, the reason is usually outside pressure. Most who detransition cite family rejection, lack of support, or financial barriers, not regret about their identity (AAMC).

The desistance debate sits beside this one and runs on the same problem. How researchers count children whose gender dysphoria resolves swings the reported rate from under 3% to over 90%, which the gender dysphoria explainer breaks down study by study.

The gap between how rare detransition is and how often it gets invoked is what the political fight exploits. In June 2026 the Texas Attorney General forced a hospital to open a detransition clinic and pay $10 million over care it had provided legally, turning a rare outcome into a weapon against the common one.

Common Claims vs the Evidence

Each of these claims about gender-affirming care circulates in political debate, much of it carried by the “gender ideology” label. Each is contradicted by published evidence.

27 States Banned Care for Minors

Whether a transgender teenager can get care depends on where they live. Twenty-seven states have passed bans for minors. Twenty-four are enforced, courts have blocked two, and Arizona bans surgery only while protecting other care by executive order. Fourteen states and D.C. passed shield laws that protect families who travel for care, and two more did the same by executive order.

The map is still moving, and lately it has moved one way. Arkansas passed the first ban in 2021 and spent four years enjoined until the Eighth Circuit reversed in August 2025, applying Skrmetti. New Hampshire finished phasing its ban in on January 1, 2026, becoming the first New England state to prohibit the care.

Care ban in effect (24 states)

Ban blocked by court (2 states)

Surgical ban only, medication protected (1 state)

Shield law protects access (14 + DC)

Executive order protection (2 states)

No ban, no shield law (7 states)

Sources: Movement Advancement Project, KFF Policy Tracker, UCLA Williams Institute. July 2026.

Gender-Affirming Care for Minors

State	Status	Detail
Alabama	Care ban in effect	Felony to provide care. Up to 10 years.
Arizona	Surgical ban only	Surgical care banned. Medication and other care protected by governor's executive order.
Florida	Care ban in effect	Full ban. Trans youth drive 8.5 hours further for care.
Georgia	Care ban in effect	Surgery and hormone therapy banned.
Iowa	Care ban in effect	Full ban on hormones, blockers, surgery.
Idaho	Care ban in effect	Felony to provide care.
Indiana	Care ban in effect	Full ban on medical interventions for minors.
Kentucky	Care ban in effect	Hormones and surgery banned for minors.
Louisiana	Care ban in effect	Full ban on hormones, blockers, surgery.
Missouri	Care ban in effect	Full ban on gender-affirming care for minors.
Mississippi	Care ban in effect	Full ban on medical interventions for minors.
Montana	Ban blocked by court	Ruled unconstitutional May 2025 on state constitutional grounds. Survives Skrmetti.
North Carolina	Care ban in effect	Hormones and surgery banned for minors.
North Dakota	Care ban in effect	Full ban on medical interventions for minors.
Nebraska	Care ban in effect	Full ban on hormones and surgery for minors.
Ohio	Care ban in effect	Full ban enacted.
Oklahoma	Care ban in effect	Full ban on gender-affirming care for minors.
South Carolina	Care ban in effect	Full ban on medical interventions for minors.
South Dakota	Care ban in effect	Full ban enacted.
Tennessee	Care ban in effect	Full ban. Upheld by SCOTUS in Skrmetti (6-3).
Texas	Care ban in effect	Full ban. 500+ families organized through TKFTX.
Utah	Care ban in effect	Full ban on hormones and surgery for minors.
West Virginia	Care ban in effect	Full ban on medical interventions for minors.
Wyoming	Care ban in effect	Full ban enacted.
Arkansas	Care ban in effect	First state to pass a ban (2021). Blocked for four years until the Eighth Circuit reversed in August 2025 and let it take effect.
Kansas	Ban blocked by court	Judge halted ban May 2026, questioned credibility of state witnesses.
California	Shield law protects access	Statutory protections for providers and families.
Colorado	Shield law protects access	Statutory protections for providers and families.
Connecticut	Shield law protects access	Statutory protections for providers and families.
District of Columbia	Shield law protects access	Statutory protections for providers and families.
Illinois	Shield law protects access	Statutory protections for providers and families.
Maine	Shield law protects access	Statutory protections for providers and families.
Maryland	Shield law protects access	Statutory protections for providers and families.
Michigan	Shield law protects access	Statutory protections for providers and families.
Minnesota	Shield law protects access	Statutory protections for providers and families.
New Jersey	Shield law protects access	Statutory protections for providers and families.
New Mexico	Shield law protects access	Statutory protections for providers and families.
New York	Shield law protects access	Statutory protections for providers and families.
Oregon	Shield law protects access	Statutory protections for providers and families.
Vermont	Shield law protects access	Statutory protections for providers and families.
Washington	Shield law protects access	Statutory protections for providers and families.
Massachusetts	Executive order protection	Governor issued executive protection order.
Rhode Island	Executive order protection	Governor issued executive protection order.
Alaska	No ban, no shield law	No legislation on gender-affirming care for minors.
Delaware	No ban, no shield law	No legislation on gender-affirming care for minors.
Hawaii	No ban, no shield law	No legislation on gender-affirming care for minors.
New Hampshire	Care ban in effect	First New England state to ban. Surgery banned January 2025, blockers and hormones January 2026. Patients already in care may continue.
Nevada	No ban, no shield law	No legislation on gender-affirming care for minors.
Pennsylvania	No ban, no shield law	No legislation on gender-affirming care for minors.
Virginia	No ban, no shield law	No legislation on gender-affirming care for minors.
Wisconsin	No ban, no shield law	No legislation on gender-affirming care for minors.

Nearly half of trans youth ages 13-17 now live somewhere the care is banned or restricted (Williams Institute). The clustering is regional. In the South, 95% of transgender and non-binary youth live in states with restrictive laws. Six states treat providing the care as a felony.

The restrictions no longer stop at 18. Seven states now limit adult access in some form: Alabama, Arkansas, Florida, Mississippi, Missouri, Nebraska, and North Carolina. In March 2026 the Fourth Circuit went further, ruling that West Virginia may exclude gender-affirming surgery from its Medicaid program for adults. The panel held the exclusion “applies to specific procedures, not specific individuals,” and it was the first federal appeals court to bless a restriction on adult coverage.

What the Bans Permit

The bans are defended on one idea: children cannot consent to procedures that permanently change their bodies, so the state should step in. That argument is worth testing against the statutes themselves, because the exceptions are written into the same laws as the prohibitions.

A 2025 review examined all 30 ban statutes passed across 28 states between 2021 and 2024. It found that 29 of 30 carve out an exception for surgery on infants born with variations in sex characteristics, the children usually described as intersex (Mar et al., 2025). These operations are done to make a baby’s genitals look more typically male or female. They are rarely urgent, they are permanent, and the patient is too young to be asked.

Four of the statutes also write in an exception for infant circumcision. New Hampshire’s, for example, lets a provider remove healthy foreskin for “religious, cultural or health reasons.” Cosmetic breast and genital surgery on non-transgender teenagers sits outside the laws entirely, neither restricted nor excepted.

How the bans treat it

Prohibited · Cannot consent

No statute in the review prohibits a procedure on the ground that the child could not consent to it.

Prohibited · Asked for it

• Puberty blockers for a 13-year-old, with parental permission
• Hormone therapy for a 16-year-old, after a mental health evaluation
• Top surgery for a 17-year-old, with two providers and a parent agreeing

Permitted · Cannot consent

• "Normalizing" surgery on intersex infants (excepted in 29 of 30 statutes)
• Infant circumcision (excepted by name in 4 statutes)

Permitted · Asked for it

• Cosmetic breast and genital surgery on non-transgender minors (neither restricted nor excepted)

Did the patient ask for it?

Source: Mar et al., review of 30 U.S. statutes restricting care for transgender minors, 2021-2024.

Fourteen of the statutes go further and bar procedures that alter a “healthy,” “functional,” or “nondiseased” body part. None of the fourteen says who decides whether a body part qualifies. That judgment, which every one of these laws rests on, is left undefined in all of them.

The definitions do work of their own. Twenty-four of the thirty statutes define sex as a fixed binary set at birth, and sixteen make “nonambiguous” genitalia part of that definition. So the laws fix a child’s sex by the genitals they are born with, and then permit the surgery that makes ambiguous genitals unambiguous.

Who Is Behind the Bans

The gender-affirming care bans did not emerge independently. The same organizations that fund the broader anti-LGBTQ movement and Christian nationalism campaign coordinate the legal strategy against gender-affirming care.

1. Wrote the legal framework Alliance Defending Freedom $119.8M/year. SPLC-designated hate group. ↓ ADF drafted model care ban legislation
2. Distributed model bills to 26 states Heritage Foundation $133.8M revenue. Published Project 2025. ↓ State legislators introduced near-identical bills
3. Passed bans with minimal changes to the template 26 state legislatures 22 full bans enforced. 3 blocked by courts. 6 classify care as a felony. ↓ Tennessee's ban challenged up to SCOTUS
4. Skrmetti (2025): upheld Tennessee ban 6-3 U.S. Supreme Court Every other state with a ban now has legal cover to enforce it.

Sources: IRS 990 filings, SPLC, SCOTUSblog

The care ban language is nearly identical across 26 states because it comes from the same sources. ADF wrote the legal framework. Heritage distributed model bills. State legislators introduced them with minimal changes. The Supreme Court, in United States v. Skrmetti (2025), upheld Tennessee’s ban in a 6-3 ruling, giving every other state legal cover to enforce its law.

After the Obergefell marriage decision made same-sex marriage bans unenforceable, the anti-LGBTQ legal infrastructure pivoted. Within five years, the same organizations shifted from fighting marriage to criminalizing healthcare.

1. 1979 WPATH founded Originally HBIGDA. First clinical standards for transgender care.
2. 1998 Dutch Protocol developed Puberty blockers introduced for adolescents with gender dysphoria.
3. 2015 Obergefell decided Marriage equality settled. Anti-trans pivot begins within months.
4. 2021 Arkansas passes first care ban HB 1570. Courts block enforcement. Template for 25 more states.
5. 2022 WPATH SOC8 published 100+ international experts update clinical standards.
6. 2022 Alabama makes care a felony Up to 10 years in prison for providing care to minors.
7. 2023 509 anti-trans bills filed First year to cross 500. Bans spread to 20+ states.
8. 2024 Cass Review published (UK) Found weak evidence for some youth interventions. Recommended research model, not bans.
9. 2025 SCOTUS upholds Tennessee ban Skrmetti: 6-3. States have authority to regulate minors' care.
10. 2026 Federal funding threats 12+ hospitals stop care even in states without bans.

From clinical standards to state bans, 1979-2026: 1979 — WPATH founded (Originally HBIGDA. First clinical standards for transgender care.). 1998 — Dutch Protocol developed (Puberty blockers introduced for adolescents with gender dysphoria.). 2015 — Obergefell decided (Marriage equality settled. Anti-trans pivot begins within months.). 2021 — Arkansas passes first care ban (HB 1570. Courts block enforcement. Template for 25 more states.). 2022 — WPATH SOC8 published (100+ international experts update clinical standards.). 2022 — Alabama makes care a felony (Up to 10 years in prison for providing care to minors.). 2023 — 509 anti-trans bills filed (First year to cross 500. Bans spread to 20+ states.). 2024 — Cass Review published (UK) (Found weak evidence for some youth interventions. Recommended research model, not bans.). 2025 — SCOTUS upholds Tennessee ban (Skrmetti: 6-3. States have authority to regulate minors' care.). 2026 — Federal funding threats (12+ hospitals stop care even in states without bans.).

1979: The World Professional Association for Transgender Health was founded as the Harry Benjamin International Gender Dysphoria Association. It published the first clinical standards of care for transgender patients.

1998: Researchers at the VU University Medical Center in Amsterdam developed the Dutch Protocol, introducing puberty blockers as a treatment for adolescents with gender dysphoria. The protocol became the clinical foundation used worldwide.

2015: The Supreme Court decided Obergefell v. Hodges, establishing marriage equality. The conservative legal infrastructure that had spent decades fighting same-sex marriage pivoted to trans healthcare. ADF and Heritage shifted their model legislation within months.

2021: Arkansas became the first state to pass a ban on gender-affirming care for minors. Courts blocked enforcement, but the bill became a template. Twenty-five more states followed.

2025: The Supreme Court ruled 6-3 in U.S. v. Skrmetti that Tennessee’s care ban did not require heightened constitutional scrutiny. The ruling gave every state with a pending ban legal cover to enforce it.

The Federal Threat, 2025-2026

Twenty-six states banned care through their own legislatures. The federal government is now using executive orders, funding rules, and agency pressure to extend the restrictions nationwide.

Executive Order 14187 (January 2025) directed federal agencies to rescind all policies relying on WPATH guidelines. The Senate HELP Committee called on WPATH to comply, describing evidence-based care as “chemical and surgical mutilation.”

CMS proposed rules in December 2025 that would bar any Medicare-certified hospital from providing gender-affirming care to anyone under 18. A separate ACA Marketplace rule bans coverage starting plan year 2026.

The hospital rule was never finalized, and in July 2026 it briefly vanished from the administration’s regulatory agenda before reappearing the same week. HHS called reports that it had been shelved “completely inaccurate and unfounded” and said it still intends to issue a final rule (NPR, July 13, 2026). Both the American Medical Association and the Children’s Hospital Association had asked the agency to withdraw it.

Leaving a rule pending is not the same as dropping it. An unfinalized rule still makes every hospital administrator weigh one children’s clinic against the Medicare certification that funds the whole institution. Hospitals have been making that calculation for months, and the rule has never taken effect.

The federal pressure reached hospitals in states without bans. 12+ hospitals stopped providing care after funding threats, including facilities in California, Illinois, and New York (NPR, April 2026). Vanderbilt University Medical Center in Tennessee stopped gender-affirming surgeries for adults (Southern Equality). Baystate Health in Massachusetts ceased youth gender medications in February 2026.

Provider landscape for trans patients

Period	Value
2020	Growing network of specialized clinics across the U.S.
2026	Dozens of programs closed in ban states and blue states alike
Change	Providers closing even where care is legal

In June 2026, the Texas Attorney General forced Texas Children’s Hospital to open a detransition clinic and pay $10 million as part of a settlement over care it had already provided legally. The same month, the administration’s Ryan White HIV/AIDS Program rules now bar providers from offering gender-affirming care as a condition of receiving federal HIV funding. Lambda Legal filed suit.

The newest tactic is investigation. In May 2026, the U.S. Attorney’s Office for the Northern District of Texas subpoenaed more than 20 hospitals nationwide, including NYU Langone and Children’s National, demanding trans patients’ names, birth dates, Social Security numbers, and diagnoses going back to 2020. U.S. District Judge Julie R. Rubin quashed a subpoena for Children’s National patients’ records, calling it a “fishing expedition” with “no purpose other than to intimidate and harass” (Bloomberg Law). Using federal investigations to seize private medical records is institutional transphobia at national scale.

Federal courts issued temporary relief. A Maryland judge granted a 14-day nationwide restraining order blocking HHS funding conditions in February 2025. Washington state obtained a similar order covering Washington, Oregon, and Minnesota. Both measures are temporary and may expire without further intervention.

Did Europe Ban Gender-Affirming Care?

The claim that “European countries banned gender-affirming care” is used to justify U.S. state bans. The claim misrepresents what happened. European countries restricted one pathway. They did not ban care.

The Cass Review (UK, 2024) found weak or low-certainty evidence for some youth interventions and recommended a more centralized, research-oriented model in England. It did not recommend criminal penalties or broad legislative bans. WPATH and USPATH formally objected to the review’s methodology, arguing it applied evidence standards designed for pharmaceutical trials to a field where randomized controlled trials are ethically impossible. You cannot give a control group of dysphoric teenagers a placebo and withhold treatment for years.

European countries restricted certain treatments for adolescents while keeping adult care intact and making adolescent care available through specialized pathways. U.S. state bans prohibit all medical interventions for minors and, in some cases, adults.

What Families and Providers Face in Ban States

In states where care was banned, families faced immediate consequences. Some relocated across state lines. Others drove hundreds of miles each way for appointments in neighboring states. More than 500 parents and children have organized through Trans Kids and Families of Texas rather than uproot their lives.

Human Rights Watch documented families in ban states who watched their children’s mental health deteriorate after established treatment plans were interrupted. Providers who had managed a patient’s care for years were forced to stop overnight.

The fear runs ahead of the law. Several states have floated treating support for a child’s transition as child abuse, which puts social services in the picture and leaves parents weighing medical decisions against the risk of an investigation. One advocate described to Human Rights Watch what that does to families before any case is ever opened.

The mental health data tracks the impact of care bans on LGBTQ youth. 44% of LGBTQ youth who needed mental health care could not access it (Trevor Project 2025). The 988 Suicide and Crisis Lifeline’s LGBTQ+ youth subnetwork had its federal funding cut in July 2025. The CDC’s 2023 Youth Risk Behavior Survey found that 41% of LGBTQ+ high-school students seriously considered suicide, compared with 13% of their heterosexual peers.

The provider shortage extends beyond ban states. When hospitals in states without bans close their youth programs preemptively, families who thought they were protected discover they are not. Waiting lists at the remaining clinics grow and the drive gets longer. The families with money travel. The families without money wait.

Human Rights Watch took the title of its report from an 18-year-old trans woman, who was asked what she would say to the legislators writing these laws.

If there is any talk of violence or self-harm, this is no longer a conversation problem. Call 911 if someone is in immediate danger. Call or text 988 (Suicide and Crisis Lifeline) if someone is in a mental health crisis. For LGBTQ youth, contact the Trevor Project: call 1-866-488-7386 or text START to 678-678.

Frequently asked questions

What does gender-affirming care include? It ranges from social support (chosen name, pronouns, clothing) through reversible puberty blockers, partially irreversible hormone therapy, and irreversible surgery. Each step requires its own clinical evaluation. Most people who receive care are adults.

Do children get surgery? No U.S. center performs genital surgery on minors. Top surgery (chest) is available at some centers for teens 16 and older with parental consent and provider agreement. The vast majority of surgical patients are adults over 18.

Are puberty blockers safe? Puberty blockers have been FDA-approved for decades for children with precocious (early) puberty. When used for gender dysphoria, they pause the onset of puberty. If stopped, puberty resumes. The Endocrine Society classifies them as fully reversible.

What is the Cass Review? An independent review of gender-affirming care in England published in 2024. It found weak or low-certainty evidence for some youth interventions and recommended a centralized, research-oriented model. It did not recommend criminal penalties or legislative bans. WPATH and USPATH formally objected to the review’s methodology, arguing it applied pharmaceutical trial standards to a population where randomized controlled trials are ethically impossible.

Who provides gender-affirming care? There is no single specialty. A primary care physician trained in transgender health can prescribe hormones, and many do. Endocrinologists handle puberty blockers and more complex hormone management. Psychologists and clinical social workers provide the mental health services the standards of care require, with psychiatry involved when a patient has another condition to treat. Surgery involves plastic surgery or urology. Voice therapy is done by speech-language pathologists.

Do the bans apply to transgender adults? Most target minors, but seven states now restrict adult access in some form: Alabama, Arkansas, Florida, Mississippi, Missouri, Nebraska, and North Carolina. In March 2026 the Fourth Circuit ruled that West Virginia may exclude gender-affirming surgery from adult Medicaid coverage, the first time a federal appeals court allowed a restriction on adult care.

Do the bans stop all permanent procedures on children? No. A 2025 review of all 30 ban statutes found that 29 exempt surgery on intersex infants, and four write in an exception for infant circumcision. Cosmetic breast and genital surgery on non-transgender minors falls outside the laws entirely. The prohibitions apply to care a patient asks for, not to permanent procedures generally.

What are shield laws? Laws passed by 14 states and D.C. that protect providers and families from prosecution if they cross state lines to access legal care. Two additional states have executive orders with similar protections. Eight states protect both reproductive healthcare and gender-affirming care under the same statute.

What happened in the Skrmetti case? In June 2025, the Supreme Court ruled 6-3 in U.S. v. Skrmetti that Tennessee’s ban on gender-affirming care for minors did not require heightened constitutional scrutiny. The ruling gave legal cover to every other state with a ban.

What you can do

1. Tell your members of Congress to oppose the CMS rules banning Medicaid coverage for minors. Name the specific rule numbers: CMS-2025-1823 and CMS-2025-23464. These rules would bar any Medicaid-certified hospital from providing gender-affirming care for patients under 18, including in states where care is legal. Use the letter below.

2. Support shield law legislation in your state. If your state has not passed a shield law, contact your state legislators and ask them to introduce one. Shield laws protect families from prosecution when they cross state lines for legal medical care. Movement Advancement Project tracks which states have protections and which do not.

3. Know where to find care. Trans Lifeline (877-565-8860) provides crisis support and connects callers to resources. The Trevor Project (1-866-488-7386, text START to 678-678) serves LGBTQ youth under 25. FOLX Health and Plume provide telehealth gender-affirming care in states where it remains legal.

4. Donate to organizations defending access. The ACLU is challenging bans in multiple states. Lambda Legal litigates on behalf of trans youth and families. Southern Equality tracks provider availability in the South and maintains a Trans Healthcare Fund for families who need help covering travel and care costs.

5. Share accurate information. The “Common Claims vs the Evidence” table above is designed to be shared. When someone repeats a claim about care being experimental or children getting surgery, the sourced data is what changes the conversation.

6. Write your representative about opposing federal restrictions on gender-affirming care. Use the letter below.