Why gender-affirming care is crucial

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“I just don’t understand why they are so mean.”

Those were the words Lizette Trujillo heard from her son Daniel, who came home from school one day when he was 8, unsettled that a young classmate was being bullied.

Trujillo seized on the chance for a life lesson on empathy versus sympathy.

But Daniel, who is transgender, responded like a wise soul: “Mom, I think God made me this way on purpose: So I can be empathetic and teach empathy.” 

Seven years later, Trujillo still carries that moment close at a time of raging noise from conservative corners over rights of transgender and non-binary youths – even for something as basic as health care.  

“What we are missing in this world,” Trujillo said, “is empathy.”

Transgender Awareness Week puts spotlight on health care

For the 1.6 million transgender people in the U.S., Transgender Awareness Week that began Sunday raises the visibility of the community – and focuses on issues trans people face. Gender-affirming care for youths has been at the top of that list.

In 2022, at least 15 states have restricted access to gender-affirming care or considered laws that would do so, according to the Williams Institute. Some of the bills carry penalties for health care providers and even families.

A rule approved this month by Florida’s medical boards, at the urging of GOP Gov. Ron DeSantis, would bar transgender people under 18 from receiving hormones or undergoing surgeries as treatment for gender dysphoria. 

Last spring, Trujillo’s home state of Arizona restricted access to gender-affirming care for minors. The bias that Daniel, now 15, faces “is through his state lawmakers trying to legislate him out of the state and out of existence through their policies,” she said.

“So many stories are being told around” gender-affirming health care, she said. ”What’s not being told is why this is up for debate at this large scale.”

HORMONE THERAPY HELPS:Transgender children who get hormone therapy enjoy better mental health, study says

‘How do you debate the lives of kids who are happy?’

Lawmakers pushing bills that target young people do not represent the majority of the country, said Jen Grosshandler, co-founder and executive director of the GenderCool Project, a youth-led group that works to replace misinformed opinions with real experiences of transgender and nonbinary youths. Most people have no desire to interfere with parenting of others, particularly when it comes to a child’s physical and mental well-being, she said.

“Should trans kids be able to have care or not have care? Most people in the U.S. don’t care about this conversation,” Grosshandler said. “So why in the world is this conversation even happening?”

Lawmakers are using their political power to “whip up nonsense about families raising good, solid kids,” she said. “It’s not a debate. How do you debate the lives of kids who are happy, doing well in school, volunteering in their community, learning multiple musical instruments, going to college and building amazing lives?”

Trujillo says some legislators “don’t care about the health care of our children. They are trying to make this a wedge issue to win elections.”

TRIAL OVER ARKANSAS BAN:Landmark trial over Arkansas’ ban on gender-affirming care for transgender youths begins

What does gender-affirming care look like?

Gender-affirming care is a term for medical care that is “highly individualized,” said Dr. Kellan Baker, executive director of the Whitman-Walker Institute. “There is no set way to go through gender affirmation. Everyone’s needs are different.”

There can be social transitions such as changing a haircut, using different pronouns or wearing different clothes, he said. Medical care, which can include hormone therapy, can be crucial, he said. Puberty delaying medications, which are reversible, Baker said, allow youths time to explore their identity “free of a ticking clock.”

Backers of bills to restrict care often say they are saving young people from regret later in life. Says Baker: “The entire point is to prevent regret by giving them time. Not doing that is particularly cruel.”

Major medical associations – from the American Medical Association to the American Psychiatric Association – agree, lining up in support of gender-affirming care and against bills that criminalize it in recent years.

NOT A ONE SIZE FITS ALL TYPE OF CARE: What to know about gender-affirming care for transgender and nonbinary communities

Mental health toll of restricting or banning care is big

For young people who already feel vulnerable, even talk of harmful bills can be damaging on a physical level, Baker said, raising stress levels, taxing cardiovascular systems, producing inflammatory responses.

And the mental toll is heavy: “You literally are seeing people in power in society talking about whether you deserve access to the basic building blocks of who you are trying to become,” he said.

Gender-affirming care is “not provided on a whim as it might be portrayed sometimes,” said Kasey Suffredini, vice president of advocacy and government affairs for the Trevor Project, which provides crisis and suicide prevention services for LGBTQ people under 25.

Withholding care is “dangerous” in many ways, he said, pointing to higher rates of depression, anxiety and even thoughts of suicide.

Statistics bear out those concerns in recent Trevor Project polls:

• 93% of transgender and nonbinary youths said they have worried about transgender people being denied access to gender-affirming care because of state or local laws.

85% of trans and nonbinary youths say recent debates about state laws restricting their rights have negatively impacted their mental health.

Proposed bills that would ban doctors from prescribing gender-affirming medical care make 73% of transgender and nonbinary youths feel angry, 57% sad, 47% stressed, 40% scared.

“This is a moment where we need to slow down and use a little more common sense,” Suffredini said. “Medical decisions are better made by doctors, not politicians. The care is well established and supported.”

NATIONAL SURVEY:Many young adults now identify as transgender or nonbinary 

Transgender kids thriving in their communities

Daniel, a high school freshman, is one of GenderCool’s 20 “champions” – faces of a movement that illustrates how trans and non-binary youths are continuing to flourish.

He plays drums and guitar, enjoys Minecraft, creates stop-motion movies and “loves to build things and tell stories,” Trujillo said. “My kid is very thoughtful, kind and funny.”

In September, California Gov. Gavin Newsom signed legislation offering legal refuge for transgender youths fleeing harmful bills in conservative states, such as those banning or restricting medical care.

“I often tell people who ask ‘why don’t we just move’ that it is not normal in the United States of America that a family should have to flee to a safer state,” Trujillo said.

Daniel lives “a full life and is loved and affirmed,” she said. “We’d lose more than we’d gain if we had to leave” Arizona.

FAMILIES SEEK REFUGE:As state laws target transgender children, families flee and become ‘political refugees’

Grosshandler is the mother of four children, including Chazzie, 16, “a happy, kind and confident kid and leader in our town and community” who “happens to be trans.”

The family is fortunate to be living in a state, Illinois, where elected officials believe in basic human rights, she said. They all share meals together several times a week, Grosshandler said, and conversations often revolve around the importance of kindness and navigating life in ways that help not hurt people.

“We talk about these angry folks” behind bills that target transgender youths, she said. “What is their dinner table like?”

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