Attacks on gender-affirming care are nothing new. From anti-trans rhetoric and legislation, gender-affirming care has been subjected to a long history of attacks and disinformation despite being well-established, evidence-based care. Over the past two years, state-based bills have increasingly targeted transgender and gender nonconforming (TGNC) people in half the country. Recently, these attacks have escalated to the federal level. Alarming Executive Orders now threaten to go even further. They aim to ban all youth gender-affirming care, refuse to recognize trans and gender-diverse identities, and remove related health information and research. Additionally, they seek to impose funding bans on those providing care and more. These actions pose a serious threat to the broader trans community.
Let’s unpack what’s going on here, set the record straight on the science, and debunk the false claims about trans folks and gender-affirming care.
Table of Contents
There’s No Debate – Trans and Gender Diverse People Exist
To understand what gender-affirming care is, let’s take a step back to better understand who it is intended to serve. Every person has a gender identity, and each individual’s gender identity journey can vary. How each individual identifies their perception of their gender – whether they identify as a boy or a girl, somewhere in-between, or do not identify with the notion of gender at all, is intensely personal. For some, this self-realization of their gender identity can occur at a very young age, whereas for others, it might happen later in life. In fact, being trans or gender diverse has existed for millennia across multiple cultures and is not a recent phenomenon. Today, trans people are reflected in every aspect of our society; they’re doctors, lawyers, engineers, soldiers, accountants, actors, baristas, teachers, elected officials, parents, uncles, and aunts – they’re your neighbors.
Gender-Affirming Care: Grounded in Science and Medical Consensus
Healthcare isn’t one-size-fits-all. Everyone deserves access to quality, evidence-based healthcare—trans people included. Just like a diabetic person might need insulin, some trans people need gender-affirming care, including hormone therapy. It’s not experimental, and it’s not up for debate. Gender-affirming care is a well-established medical practice and has been for over a century in the modern medical era.
The care pathways within gender-affirming care are supported by decades of research and endorsed by multiple major medical organizations such as the World Professional Association for Transgender Health (WPATH), the American Medical Association (AMA), the American Academy of Pediatrics (AAP), the Endocrine Society, the American Psychological Association and more.
- Backed by Scientific Evidence: Decades of research and scientific studies have long demonstrated that gender-affirming care improves mental health outcomes and well-being in transgender individuals of all ages. More than 2,000 scientific studies have examined aspects of gender-affirming care since 1975. A meta-analysis by Cornell University reviewed 55 key studies in this area and found that access to gender-affirming care was associated with significantly improved mental health outcomes and quality of life. Despite this overwhelming evidence, the federal government is actively removing and altering long-standing research instruments from agencies like the CDC in an effort to undermine research and care for marginalized communities, including the TGNC community. This is an intentional effort to suppress the facts and undermine access to life-saving care. But here’s the truth: gender-affirming care is backed by science, and no political interference can erase that.
- Safety and Efficacy: Gender-affirming hormone therapy, including the use of estrogen, testosterone, and puberty blockers, has been safely used for decades in cisgender individuals for other medical conditions. This is real, established healthcare—yet there’s a growing effort to paint it as dangerous or experimental, even though these treatments are standard medical practice. The question is, why are policymakers and agencies suddenly trying to erase decades of science? If gender-affirming care is so harmful, why are the same treatments considered safe for cisgender people?
- Puberty blockers are used to manage precocious puberty in children and are considered safe and effective. Additionally, puberty blockers are used for other conditions requiring hormonal intervention, such as endometriosis or hormone-sensitive cancers.
- Estrogen and testosterone therapies are frequently prescribed for cisgender individuals with hormone imbalances. For example, testosterone is widely used to treat hypogonadism in cisgender men and can also be an essential treatment supporting people with cancer. Estrogen is prescribed for postmenopausal cisgender women to address osteoporosis, cardiovascular health, and other hormone-related conditions.
- Hormonal treatments for non-transgender-related conditions often involve the same medications. For instance, hormone-modulating medications used for transgender patients undergoing GAHT are also used for managing polycystic ovarian syndrome (PCOS) or prostate cancer in cisgender individuals.
Why All the Hysteria Around Gender-Affirming Care?
Individuals who identify as trans or gender diverse make up a very small percentage or approximately 1.3% of the U.S. population, making it hard to comprehend the rationale behind disproportionate anti-trans attacks against trans people, including the targeting of medically necessary gender-affirming care that supports their needs.
The stigmatization around medically safe treatments when used by transgender individuals is rooted in prejudice, not science. The double standard reveals how ideological motivations rather than genuine medical concerns drive these attacks. When cisgender individuals benefit from these therapies without scrutiny, but transgender individuals face discrimination for the same, it exposes a troubling bias that undermines equitable medical care.
Opponents of gender-affirming care frequently label it as “experimental” to discredit its legitimacy, ignoring the rigorous studies and clinical guidelines underpinning gender-affirming care. A Yale Law School Integrity Project response to the much-cited Cass Review highlights how such claims cherry-pick data and ignore robust scientific consensus. As detailed in Yale’s critique, the Cass Review misuses its data, fails to contextualize the evidence for gender-affirming care, and elevates unsubstantiated claims. For instance, the Review questions the quality of evidence supporting gender-affirming care while ignoring that many areas of pediatric medicine rely on similar evidence standards. Moreover, its speculative assertions about social influences on gender dysphoria, like peer influence and social media, lack empirical support. These errors have already been weaponized globally to justify restrictions on gender-affirming care, as seen in the UK’s decision to restrict access to puberty blockers outside research settings, various state-sponsored gender-affirming care youth bans in the United States, and now through an executive order from the President of the United States. Such misuse underscores the politicization of transgender healthcare and the urgent need for accurate, evidence-informed advocacy.
Fighting Back With Facts, Science – and the Law
Many of the attempts to ban trans youth care or strip away trans rights have been challenged in the courts. Legal expert Chase Strangio cited the recent Executive Order “Protecting Children from Chemical and Surgical Mutilation” as blatant sex discrimination. By singling out transgender youth and their access to gender-affirming care, the administration enforces a discriminatory framework that violates constitutional protections under the Equal Protection Clause of the Fourteenth Amendment.
Legal scholars have consistently argued that targeting transgender individuals in this way constitutes sex discrimination because it reinforces harmful gender stereotypes and applies different rules based on a person’s transgender status. The deliberate conflation of gender-affirming care with harm, despite robust evidence to the contrary, reflects not just ignorance but a willful intent to marginalize transgender people. Historical precedents, such as the Supreme Court ruling in Bostock v. Clayton County, have affirmed that discrimination based on gender identity is a form of sex discrimination under federal law.
However, even if future courts attempt to narrow this interpretation, additional legal and ethical frameworks reinforce the legitimacy of gender-affirming care and the rights of transgender individuals to access it.
- The Americans with Disabilities Act (ADA): While being transgender itself is not classified as a disability, federal courts—including in Williams v. Kincaid (2022)—have ruled that gender dysphoria, a medical condition recognized by major health organizations, is protected under the ADA. This means that blanket bans on gender-affirming care could violate federal disability rights laws by denying necessary medical treatment based on gender identity.
- State-Level Equal Protection Clauses: Many state constitutions include equal protection provisions that provide additional legal grounds for challenging discriminatory policies.
- Medical and Ethical Standards: Major medical organizations, including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), and the World Professional Association for Transgender Health (WPATH), recognize gender-affirming care as evidence-based and medically necessary. Denying this care contradicts widely accepted medical guidelines and could be seen as violating ethical standards that govern medical practice.
- Parental Rights and Bodily Autonomy: The Supreme Court has long upheld parents’ rights to make medical decisions for their children (Parham v. J.R., 1979). Efforts to restrict gender-affirming care interfere with parental decision-making and the ability of families to seek appropriate healthcare in consultation with medical professionals. Furthermore, legal arguments surrounding bodily autonomy, which have been cited in cases involving reproductive rights and personal medical decisions, reinforce that transgender individuals should have the right to access gender-affirming care without undue government interference.
- Health Insurance Protections: Twenty-four states and D.C. prohibit transgender exclusions in health insurance service coverage.
Future State
While these more recent attacks are new, the attacks themselves are not. Irreparable harm has been done to the trans community as these ongoing attacks perpetuate harmful myths, undermine established medical practices, threaten providers, and place transgender individuals in jeopardy.
Sadly, we anticipate more of these attacks, which might come in other forms – efforts to further undermine WPATH standards of care, create additional false narratives about the efficacy or safety of the care being provided, and more. The damage—physical, emotional, and systemic—is real and ongoing, fueled by lies, political opportunism, and deliberate misinformation. The goal isn’t just to restrict care; it’s to erase trans people altogether.
By recognizing the scientific legitimacy of gender-affirming care, exposing the double standards in its criticism, and acknowledging the blatant sex discrimination at play, we must continue to advocate for evidence-based, equitable healthcare for all—regardless of gender identity. We will continue to fight for gender-affirming care—and for every trans person’s right to exist, thrive, and receive the healthcare they deserve.
