How to Access Gender-Affirming Healthcare for Transgender Youth​

Gender-affirming medical care for nonbinary, gender diverse, gender nonconforming, and transgender individuals is essential to a patient's well-being and can be life-saving. According to the 2015 U.S. Transgender Survey, nearly 40% of respondents experienced serious psychological distress in the month before completing the survey, compared with 5% of the general population. Forty percent have attempted suicide in their lifetime, nearly nine times the rate in the U.S. population.

In spite of the profound need, access to gender-affirming care, particularly for transgender minors, is in many places highly restricted if not prohibited outright. And even if you can legally access health care services, the costs of gender transition, if you don't have an adequate insurance plan in place to cover them, are beyond many people's means.

These obstacles are not new to the transgender community. Despite continued efforts in some states to undermine transgender equality, human rights, and public health, more and more medical providers recognize that current health disparities for transgender children and transgender adults can only be remedied if gender-affirming healthcare is made widely available to ensure the best health outcomes.

You may have questions about legal barriers to accessing gender-affirming care. We provide some of the answers and further information below.

What Is Gender-Affirming Healthcare for Transgender Youth?

The World Professional Association for Transgender Health (“WPATH SOC") is the governing source that summarizes the standard of care for gender-affirming healthcare for transgender youth. WPATH SOC provides guidance on several access points, including therapy or counseling, hormone blockers and hormone therapy, Gender Confirmation Surgery, and other gender-affirming surgical procedures.

Therapy or Counseling

WPATH SOC recommends that transgender patients be evaluated by a therapist or counselor for a Gender Dysphoria diagnosis. When a transgender youth carries a formal diagnosis of Gender Dysphoria, the therapist or counselor will work with them to process their gender identity and learn to cope in healthier ways with the distress associated with suffering from dysphoria. The therapist or counselor will also provide additional support and guidance throughout the transitioning process.

Hormone Blockers and Hormone Replacement Therapy

Transgender youth who carry a Gender Dysphoria diagnosis may sometimes begin hormone treatments depending on age and development stage.

During early stages of puberty, transgender youth may be prescribed hormone blockers in order to prevent further progression of assigned-sex puberty. They may also be prescribed hormone replacement therapy in order to develop secondary sex characteristics matching their identity.

Gender Confirmation Surgery

Gender Confirmation Surgery (“GCS") is a surgical intervention that changes a person's reproductive anatomy to the anatomy usually associated with their gender identity. GCS is not typically performed for transgender youth because WPATH SOC requires someone to be at least eighteen years old in order to be eligible for the procedure.

There are other types of gender-affirming procedures that are not considered GCS, and are allowed by WPATH SOC on a case-by-case basis. For example, for transgender men, “top surgery" may be performed to eligible candidates under the age of eighteen.

Under the Affordable Care Act, it is illegal for most insurance companies to have exclusions of transition-related care in their health plans.

Why Access to Gender-Affirming Healthcare for Transgender Youth Is Important

Transgender young people may depend on access to gender-affirming healthcare in order to meet their mental health, emotional wellness, social, and legal needs.

Mental Health and Emotional Wellness Needs

A critical need for a transgender youth's mental health and emotional wellness is access to preventative gender-affirming healthcare. Transgender youth seek gender-affirming healthcare to reduce discomfort or distress caused by a discrepancy between gender identity and sex assigned at birth.

Medical experts and nationally recognized medical associations, including the American Psychiatric Association, the American Medical Association, and the American Academy of Pediatrics, agree that gender-affirming healthcare is medically necessary to reduce gender dysphoria by helping a person's physical body and gender presentation align with their gender identity.

Social Needs

Transgender youth wishing to “pass" as the gender with which they identify may need gender-affirming healthcare. “Passing" is not only desirable; it may also increase safety and security. Transgender youth are disproportionately bullied, harassed, and subjected to mistreatment more in the middle school and high school environments than their cisgender peers.

They may also experience difficulty fitting in with their cisgender peers because of the mental health issues that are associated with gender dysphoria.

Furthermore, when transgender youth develop secondary sex characteristics that do not align with their gender identities, trauma symptoms may intensify and become severely exacerbated.

Legal Needs

Transgender youth may be required to present medical documentation and evidence that supports their gender and/or name change on legal identity documents depending on their state residence. This may include driver's licenses and birth certificates.

Those that do not have access to gender-affirming healthcare consequently may not be able to use their preferred names and genders on legal identity documents, which could impact whether or not their preferred names, pronouns, and genders are recognized, honored, and upheld in the school setting.

The Legal Barriers to Gender-Affirming Healthcare Access for Transgender Youth

Legal battles that prevent access to gender-affirming healthcare for transgender people have existed for decades. Notably, the Supreme Court has held that the prohibition against sex discrimination applies to sexual orientation and transgender people under Title VII, but it has not yet directly and explicitly addressed the unconstitutionality of healthcare bans for transgender youth under other provisions of the Civil Rights Act or the Equal Protection and Due Process Clauses of the Fourteenth Amendment.

While the argument that bans on gender-affirming healthcare for transgender youth violate the Constitution is compelling, legislators from fifteen different states introduced bills that banned medical professionals from providing gender-affirming healthcare to transgender youth throughout the early months of 2020 alone.

Currently, access to gender-affirming healthcare is primarily governed by state regulations and varies from state to state. We encourage you to reach out to your local PFLAG chapter for access to LGBTQ+ resources specific to the state you reside in.

State Legal Barriers to Gender-Affirming Healthcare: Arkansas Example

Arkansas legislators introduced HB 1570: “Save Adolescents from Experimentation (SAFE)" on February 25, 2021. The bill prohibits healthcare professionals in Arkansas from providing or referring youth to gender-affirming healthcare. The bill also bars state funds or insurance coverage for gender-affirming healthcare for transgender people under the age of 18, and permits private insurers to refuse to cover gender-affirming care for people of any age. HB 1570 was enacted into law on April 13, 2021.

The impact of this bill on equal access to gender-affirming healthcare for transgender youth is troubling and disheartening to those who seek to access medically necessary gender-affirming healthcare in Arkansas and their support systems. A federal lawsuit had been filed, supported by advocacy groups, in response to HB 1570 challenging its constitutionality.

Even though the court granted the plaintiffs' motion for preliminary injunction in July of 2021, the Arkansas transgender youth, their support systems, and the LGBTQ+ community continue to rally in solidarity to fight for their legal right to access gender-affirming healthcare as the lawsuit continues to proceed in federal court.

How To Access Gender-Affirming Healthcare for Transgender Youth: New Jersey Example

Sam is a 14-year-old male transgender youth who was assigned female sex at birth. Sam is seeking gender-affirming healthcare and wants to know his legal right to access services. We have provided some guidance below to Sam as he explores his options.

STEP 1: Sam should seek mental health care, support, and guidance with a licensed practitioner.

The licensed practitioner may have any of the following credentials:

• LCSW (licensed clinical social worker)
• LPC (licensed professional counselor)
• LMFT (licensed marriage and family therapist)
• APN (psychiatric nurse practitioner)
• MD/DO (medical doctor specializing in psychiatry)

The licensed practitioner will evaluate Sam by performing a psychiatric diagnostic interview. They will determine whether Sam carries a diagnosis of gender dysphoria and will provide added support to Sam as he addresses symptoms related to gender dysphoria and continues his journey through transitioning.

Sam should seek a licensed practitioner who specializes in working with the LGBTQ+ population and has experience working with transgender youth.

STEP 2: Sam should identify gender-affirming healthcare providers if Sam is seeking hormone blockers or hormone replacement therapy.

Several hospital systems in New Jersey offer gender-affirming healthcare to transgender people seeking to transition. Among those systems, specifically, RWJ Barnabas Health offers the LGBTQIA Program, which is designed to provide gender-affirming healthcare to transgender people in New Jersey. Sam should contact RWJBarnabas to participate in consultation and phone screening prior to being scheduled for evaluation at the LGBTQIA Program. Costs may be covered by the Affordable Care Act.

STEP 3: Sam should check his health insurance coverage policy.

Under New Jersey law, Sam's gender-affirming healthcare is covered if Sam is a Medicaid recipient. Sam should know what his health insurance policy name is. If Sam holds private insurance, Sam would need to check with his carrier to determine whether gender-affirming healthcare is covered by his insurance.

Because treatment is costly without insurance coverage, this may present as a barrier to Sam and his family. Many systems that provide gender-affirming healthcare will provide assistance to Sam in order to prevent a financial barrier from barring Sam's desire to fully transition. Sam should ask these individual questions to his provider upon being evaluated for care.

STEP 4: Sam should seek mental health support group participation.

New Jersey offers support groups to transgender youth regardless of whether they are considering transitioning, transitioning, or not pursuing seeking additional gender-affirming healthcare. Sam may be interested in feeling a sense of community as a member of the LGBTQ+ population. Sam can find these local resources here and through his local PFLAG chapter.

Get Help on Your Journey

If you have faced barriers to accessing transition-related care, we recommend reaching out to an attorney to ensure your rights are protected.