Gender affirming care, as defined by the World Health Organization, refers to a range of social, behavioral, and medical interventions designed to support one’s gender identity when it conflicts with that assigned at birth. Care has increased in popularity over time and become accessible to younger age groups as restrictions have been reduced. However, minors across the United States still have restricted access, usually being limited to puberty blockers and hormone therapy.
A full medical transition may involve blockers to stop unwanted puberty, although these are only available to those aged approximately 8-14, depending on their biological sex. Blockers limit the production of testosterone and estrogen, the female and male sex hormones that cause puberty. While they can be very useful in giving transgender youth time to decide how they want to proceed in their transition, there are side effects that become more problematic the longer they’re used.
For those who are at least in their teenage years and are too old for blockers, hormone therapy limits the production of one sex hormone and induces the production of the other in order to produce feminine or masculine features. Some people opt to take smaller doses if they do not want the full effects.
Surgery is the most invasive option for gender-affirming care and is usually only performed for adults. Top surgery refers to anything affecting the chest area, while bottom surgery encompasses altering the genitals. Surgery may also include facial plastic surgery, more often in the case of those transitioning to female who are assigned male at birth.
Sex reassignment surgery in the United States started with Alan L. Hart around the year 1917. In the early twentieth century and for a long time afterwards, the main difficulties in receiving gender affirming care were the scarcity, the cost, and the poor quality of providers. However, there has recently been a large surge in the number of people, including children, who are seeking to medically transition. In response, there have been a number of bills passed to limit or completely remove the ability for minors (and sometimes even adults) to receive gender affirming care. Thus far, nineteen states have banned minors from receiving care, with some considering banning it for people of all ages. However, medical care isn’t the only obstacle that transgender people in the United States face.
Before medical transition usually comes social transition, which typically involves having others refer to someone by different pronouns and often a different name. But recently Florida passed a bill stating that teachers could not refer to students with pronouns that did not “correspond to their biological sex,” and other states require parental approval for transgender children to be addressed by the correct pronouns and name. While seeming innocuous to some, this can pose a significant danger to children who live in transphobic households.
The website Trans Legislation Tracker (https://translegislation.com) is helpful for anyone who wants to see the current state of bills limiting the rights of transgender people that have been passed, are being considered or have failed to pass in any state.