What is gender-affirming care, and what does it entail for minors?

Lawmakers are increasingly working to restrict gender-affirming care.

As of March 2025, 27 states have banned or put restrictions on gender-affirming care for minors, according to data from the nonprofit think tank the Movement Advancement Project. And in January, President Trump issued an executive order directing agencies to limit access to those services, though it’s unclear how the order would be enforced.

Much of that legislation is fueled by “misinformation” and misunderstanding of what gender-affirming care for minors entails, Elana Redfield, federal policy director at the Williams Institute, a think tank and research organization at the University of California, Los Angeles, told Healthcare Brew.

“What we’re seeing with trans healthcare is that ideology is being treated as far more important than reality, and the result of that is, unfortunately, that a lot of trans people, especially trans kids, could get harmed by that,” Redfield said.

So, what is gender-affirming care?

Gender-affirming care includes a range of “social, psychological, behavioral, or medical…interventions designed to support and affirm” someone’s gender identity, according to the WHO. Most major medical associations, including the American Medical Association and the American Academy of Pediatrics, recognize gender-affirming care as vital to trans people’s well-being.

For kids as well as adults, gender-affirming care can include social interventions like wearing clothing or hairstyles that affirm someone’s identity or legal measures like changing identity documents, Redfield said. Medical interventions, she added, include treatments like hormone therapy, puberty blockers, and surgical procedures.

While President Donald Trump and other conservative politicians have frequently said that “countless children” are accessing gender-affirming medications and procedures, data shows that’s not the case.

For those under 18 in the US, receiving medical treatments like prescription drugs or surgical procedures is uncommon, studies show. Plus, minors undergo medical assessments and “a pretty strenuous set of protocols” before they can access such care, Redfield noted.

By the numbers

There are about 20.9 million people ages 13 to 17 in the US, and of those, about 300,100 (or 1.4%) identify as transgender, according to the Williams Institute, a research institute that focuses on sexual orientation and gender identity law and public policy.

A cross-sectional Harvard study published in January found that over a five-year period, for every 1 million people under the age of 18, 180 had ever been prescribed a puberty blocker and 370 had ever accessed hormones. Plus, no trans or gender-diverse children under age 12 received any hormones.

Gender-affirming surgeries or procedures for minors are even rarer.

A separate Harvard study published in June 2024 analyzed the prevalence of surgeries among transgender and gender-diverse minors in 2019.

Researchers found that for patients between ages 13 to 14, the rate of surgeries was 1 per 1 million and for those ages 15 to 17, it was 21 per 1 million. No children under age 12 underwent a gender-affirming surgery or procedure, according to the study.

“We know from working with clinicians that surgeries have always been rare for those under the age of 18, and the surgeries that were most typical to occur were mastectomies for those at older ages of adolescence,” Landon Hughes, a postdoctoral research fellow at Harvard and an author on both studies, told Healthcare Brew.

Additionally, of the 151 breast reductions performed on minors in the second study period, 146 (or 97%) were performed on cisgender males, who undergo the procedure due to conditions like gynecomastia, which causes increased breast tissue due to a hormonal imbalance, according to Cleveland Clinic.

“It’s important to note…that gender-affirming care is for everybody,” Hughes said. “It’s really important for us to begin thinking about gender-affirming care as not just something that transgender people engage with.”

What the research shows

There’s a “pretty wide body of evidence” that shows gender-affirming care improves trans people’s well-being, Redfield said.

For example, the What We Know Project at Cornell University analyzed 56 peer-reviewed studies published in English between 1991 and June 2017 that researched the effects of gender transition on people’s well-being, and found a consensus that “gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.”

Early results from the 2022 US Trans Survey, conducted by the nonprofit Advocates for Trans Equality Education Fund, also found that 98% of respondents who had received hormones and 97% of respondents who had received a surgical procedure to affirm their gender identity were more satisfied with their lives.

On the other hand, lacking access to gender-affirming care is associated with negative mental health outcomes like depression and suicidality, research shows. A 2022 study from the University of Washington, Seattle, found that people ages 13 to 20 who received puberty blockers or gender-affirming hormones were 60% less likely to develop depression and 73% less likely to show suicidality.

“With these bans, [providers] expect, unfortunately, kids to commit suicide,” Hughes said. “Some of the kids, their friends, may only know them as one gender, and now they’re going to go through the puberty of another gender, so they’ll be outed and [that’ll] cause stigmatization and harm in that way.”