Lawmakers have filed several bills to limit or outright ban gender-affirming care for minors in Indiana. But there are a lot of misconceptions about what that type of health care is and isn’t.
Members of the Indiana Two-Way asked us questions about gender-affirming care. To join, text “Indiana” to 73224.
What is gender affirming care?
Gender affirming care is health care that encompasses mental, social, medical and surgical care designed to treat gender dysphoria.
Dr. Sumanas Jordan directs Northwestern’s Gender Pathways program. She explains gender-affirming care is a “really big umbrella” of services.
“That can be anywhere from mental health to medical support to, of course, surgical support – which, it tends to get the most attention,” Jordan said. “But certainly it really encompasses the entire spectrum of health care.”
That includes but isn’t limited to mental health and social services, puberty blockers, hormone therapy, and gender-affirming surgeries.
Jordan said the patients she’s met through her clinic come from a wide variety of experiences – including folks who have already transitioned and folks who are questioning their gender identity.
“So that might start with mental health and exploring one’s gender,” Jordan said. “It might be a conversation that we have about what is really the source of the dysphoria, is it the appearance incongruence? Is it something else?”
What is gender dysphoria?
Gender dysphoria is clinically significant distress or impairment over someone’s gender identity not matching their sex assigned at birth.
Not all transgender and non-binary people experience gender dysphoria.
Is gender-affirming care age-appropriate?
Yes. Jordan said people have a pretty good concept of gender from a young age.
“If a 4-year-old said – if a cisgender 4-year-old girl said, I want to wear a pink frilly dress, no one would question that. And so I don’t think it should be very different for any child that is exploring who they are,” she said.
The Endocrine Society – an international organization focused on endocrinology – has clinical guidance for treating gender dysphoria at all ages. For pre-pubescent youth, puberty blockers help buy time for the child to explore their gender without exacerbating gender dysphoria.
“The puberty blockers have gotten a lot of attention,” Jordan said. “They really are an excellent tool to pause everything – just put a pause on it.”
The Endocrine Society recommends holding off on more permanent gender-affirming care – like surgery – until after the youth is 18.
But most major medical associations and organizations support access to gender affirming care, including the American Academy of Pediatrics, the American Psychiatric Association, and the American Medical Association.
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Are hormone therapies safe?
Yes, but like other medications have side effects and require medical monitoring.
“It’s not this one-time decision where you’re like, that’s it! I’m trans. I’m going to take all the drugs!” Jordan said. “It really is an ongoing process where you continue to – like any other kind of medication you start at one dose and kind of change that accordingly.”
Puberty blockers can have some effects on bone mineralization and hormone therapy can affect future fertility. Jordan said these medications have been used for years and are approved by the Food and Drug Administration.
“We are treating the conditions that are in front of us,” Jordan said. “So we’re treating gender dysphoria.”
The Endocrine Society recommends waiting to start hormone treatments until the adolescent can consent to the therapy. It said in a statement, “Cisgender teenagers, together with their parents or guardians, are currently deemed competent to give consent to various medical treatments. Transgender teenagers should be afforded the same legal rights.”
Why can’t transgender youth just wait until they’re adults to receive gender-affirming care?
Jordan compares it to diabetes or a broken arm.
“You wouldn’t sit there and say, well, you’re only 12. You may have this health condition. I’m going to sit around and wait until you’re 16 or 18 or 25 before I treat you,” she said.
According to the Trevor Project’s 2022 survey on LGBTQ+ youth, 54 percent of transgender and nonbinary youth in Indiana seriously considered suicide and 80 percent reported anxiety. Recent studies suggest gender affirming care lowers those rates to nearly mirror their cisgender counterparts.
“It is particularly important in our gender diverse population because we do have an incredibly high rate of anxiety and depression and suicidality,” Jordan said. “And again, it’s part of that delay in care that’s not ethical.”
The Endocrine Society said in a statement, “Denying access to care for transgender and gender diverse teens is not a neutral action. It raises the risk of suicidal ideation and self-harm and denies the benefits of treatment, including improved psychological functioning.”
Jordan also points to the rewards having access to gender-affirming care provides.
“It is incredibly rewarding to see folks who are uncomfortable in this world, unable to take a shower with the lights on – really just doing all sorts of tricks to hide their bodies – and then to see them blossom afterwards,” Jordan said. “You know that they’re doing better in school. They’re able to go out in the world.”
So far, none of the bills banning gender-affirming care for minors have received committee hearings.