Presentation Information
[P-8-04]Restricting Access: Recent Legislative Trends in the US on Opposing Gender-Affirming Care for Transgender Youth
*Victoria Evelyn Lindegaard, Christopher Justin Gideon (Michigan State University(United States of America))
Keywords:
transgender youth,access to care,LGBTQ+,United States of America,diversity
Gender-affirming care (GAC) for transgender and gender diverse individuals encompasses medical and non-medical interventions. Medical components include hormone therapy, puberty blockers, and rarely, surgical intervention. Gender diverse youth experience significantly higher rates of depression, anxiety, and suicidality compared to their cisgender peers, with national surveys (The Trevor Project & Youth Risk Behavior Survey) consistently showing elevated risk for psychiatric pathology even prior to accounting for access to care.
Recent years have seen an exponential increase in the introduction of bills in state legislature to ban GAC for transgender youth. In 2018, two such bills were introduced; this rose to 185 by 2023. As of June 2025, 27 states had enacted laws limiting youth access to GAC, with 24 states imposing professional or legal penalties on clinicians providing GAC. On June 18, 2025, the US Supreme Court upheld Tennessee’s ban on GAC for minors (United States v. Skrmetti), ruling it did not violate the 14th Amendment’s Equal Protection Clause. This decision has allowed 25 state bans on GAC to remain in effect. Approximately 40% of trans youth (ages 13-17 years) live in a state which has enacted laws limiting GAC access, representing a substantial population of at-risk youth who face legal and structural barriers to evidence-based care.
Major medical organizations have issued statements in support of GAC and opposing such bans, including the American Psychiatric Association, American Medical Association, World Professional Association for Transgender Health, and the Pediatric Endocrine Society. The consensus reflects that such legislative prohibitions contradict the prevailing evidence base and raises serious concerns regarding worsening psychiatric morbidity among gender diverse youth. We present a narrative review of recent American legislation affecting access to GAC for already at-risk youth, with a focus on its relevance to psychiatric practice and the ethical challenges physicians may face in evolving regulatory environments.
Recent years have seen an exponential increase in the introduction of bills in state legislature to ban GAC for transgender youth. In 2018, two such bills were introduced; this rose to 185 by 2023. As of June 2025, 27 states had enacted laws limiting youth access to GAC, with 24 states imposing professional or legal penalties on clinicians providing GAC. On June 18, 2025, the US Supreme Court upheld Tennessee’s ban on GAC for minors (United States v. Skrmetti), ruling it did not violate the 14th Amendment’s Equal Protection Clause. This decision has allowed 25 state bans on GAC to remain in effect. Approximately 40% of trans youth (ages 13-17 years) live in a state which has enacted laws limiting GAC access, representing a substantial population of at-risk youth who face legal and structural barriers to evidence-based care.
Major medical organizations have issued statements in support of GAC and opposing such bans, including the American Psychiatric Association, American Medical Association, World Professional Association for Transgender Health, and the Pediatric Endocrine Society. The consensus reflects that such legislative prohibitions contradict the prevailing evidence base and raises serious concerns regarding worsening psychiatric morbidity among gender diverse youth. We present a narrative review of recent American legislation affecting access to GAC for already at-risk youth, with a focus on its relevance to psychiatric practice and the ethical challenges physicians may face in evolving regulatory environments.