Trans in America, Part 2: Gender Affirming Healthcare in the New Era
In recent years, the conversation surrounding gender-affirming healthcare has shifted dramatically, driven by both increasing visibility of transgender and nonbinary individuals and a surge in political attention and stigma. This era of heightened focus has brought both progress and challenges. Policies and legislation from the last five years have profoundly impacted access to care, shaping the experiences of many gender-diverse individuals seeking care.
Progress in Advocacy and Access
One of the most encouraging trends in recent years has been the growing awareness and normalization of gender-affirming healthcare. Professional organizations, including the World Health Organization, the American Medical Association (AMA), the American Psychological Association (APA), and the American Pediatric Association have issued strong endorsements for gender-affirming care as an evidence-based, medically necessary, and life-saving branch of treatment.
Insurance coverage for gender-affirming procedures has also expanded in many states, spurred by legal victories affirming that denying such care constitutes discrimination under the Affordable Care Act (ACA). Programs supporting LGBTQ+ youth, such as gender clinics, have become more widespread, offering a critical lifeline for families navigating these journeys.
The Backlash: Targeted Restrictive Legislation
Despite these advancements, the past five years have seen an unprecedented rise in legislative actions targeting transgender individuals and their access to healthcare. In 2024 alone, 186 bills were presented to congress restricting gender-affirming care. These measures often include banning puberty blockers, hormone therapy, and even social transition support for youth under 18.
These legislative actions are typically framed as an attempt to "protect children," but they ignore the overwhelming medical consensus bout the benefits and safety of gender-affirming care. Studies consistently show that access to this care significantly reduces rates of depression, anxiety, and suicide among transgender individuals. Denying care doesn’t make these needs disappear; it exacerbates them.
The Ripple Effect: Broader Impacts of Policy Change
The effects of these political actions are not limited to the individuals directly affected. Families, providers, and entire communities feel the strain of navigating hostile legal landscapes. Providers face increased scrutiny and legal risks, leading some to shutter clinics or relocate to more supportive areas. Families seeking care are forced to travel long distances or even relocate entirely, placing emotional and financial strain on already vulnerable households.
This chilling effect also extends to the broader societal perception of transgender individuals. Policies targeting healthcare send a harmful message that delegitimizes the lived experiences of trans people, contributing to stigma and discrimination.
Resilience and Advocacy
In response to these challenges, the transgender community and its allies have demonstrated remarkable resilience. Grassroots organizations, advocacy groups, and legal teams have mobilized to challenge restrictive policies in court. In some cases, these efforts have been successful, with courts striking down bans as unconstitutional.
Moreover, healthcare providers and professional organizations have stepped up to advocate for their patients. Some states have become havens for gender-affirming care, passing protections to ensure that providers and recipients are shielded from legal repercussions originating in other jurisdictions.
Looking Forward
The new political era has illuminated the fragility of progress and the importance of continued advocacy. As the landscape continues to evolve, it is vital to center the voices of transgender individuals in policy discussions and to prioritize access to compassionate, evidence-based care. Supporting organizations that advocate for trans rights, educating oneself about the issues, and speaking out against discriminatory policies are all critical steps that allies can take. Gender-affirming healthcare is not a political talking point; it is a matter of dignity, equity, and human rights. The challenges of the last five years underscore the continued need for sustained, collective action to ensure that every person has access to the care they need to live authentically and thrive. And remember, if you’re needing support, please reach out.
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About the Author
Sara Walter Shihdanian (she/they) is a Licensed Mental Health Counselor specializing in trauma and gender + transition, providing virtual psychotherapy in Washington state. Her extensive training and unique expertise allows her to support clients who are ready for accelerated and lasting change.