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What the Data Tell Us About Transgender Care
We should look at evidence before making policy.
Posted May 6, 2023 Reviewed by Vanessa Lancaster
Key points
- Transgender care has become a significant source of political debate in the U.S.
- The evidence is clear that transgender care is safe and effective.
- Policymakers should look at the scientific evidence before making policy decisions.
In late March, the Kentucky state legislature voted to override a Governor’s veto and ban gender-affirming healthcare for transgender youth. This is only one of nearly 400 proposed or passed laws around the U.S. aimed at restricting access to medical and surgical care for people under 18 who identify as transgender.
We have often made the point that data from scientific inquiry is only one of the things that policymakers need to consider when constructing new legislation. In this case, though, the data on transgender people and the care provided to them is being largely ignored.
There are an estimated 1.3 million trans adults in the U.S. Opponents of offering care for them in childhood insist that those young people are being influenced to do something they will ultimately realize they don’t want and that gender-affirming care violates parents’ rights to decide what interventions are best for their children. They also refer to gender-affirming care as "experimental." But the results of decades of research call these ideas into question. Let’s review what we do know about gender-affirming care.
Gender-Affirming Care Improves Life Satisfaction
A recent Washington Post-Kaiser Family Foundation (Post-KFF) survey showed “Most trans adults knew when they were young that their gender identity was different from the sex they were assigned at birth.” As adults, most transgender people say that transitioning “made them more satisfied with their lives.”
We also know that without care, transgender and non-binary youth experience higher rates of depression and anxiety than cis-youth. More than 50 percent of transgender youth consider suicide. A recent Canadian study found that compared to cis-gender heterosexual adolescents, transgender adolescents were five times more likely to have suicidal ideation and 7.6 times more like to have made a suicide attempt. Transgender youth are also subject to bullying and violence. A 2021 report from the Trevor Project found that 61 percent of transgender and nonbinary students had experienced bullying, compared to 45 percent of cis-gender LGBQ students.
On the other hand, transgender youth who receive gender-affirming care, like puberty blockers and hormones, are less likely to experience depression and anxiety. In a recent study published in the New England Journal of Medicine, 315 people between the ages of 12 and 20 who received gender-affirming hormone treatment were followed for two years. Treatment was associated with “decreases in depression and anxiety symptoms and increases in positive affect and life satisfaction as assessed through validated instruments.”
In a passionate op-ed piece in the New York Times on April 1, Marci Bowers, a gynecologist who founded the Center for Transgender Medicine and Surgery at Mount Sinai Hospital in New York City, wrote, "Decades of medical experience and research has found that when patients are treated for gender dysphoria, their self-esteem grows and their stress, anxiety, substance use and suicidality decrease."
Gender dysphoria is the psychiatric diagnosis assigned to people who experience discomfort with their gender identity, although there is a debate about whether a psychiatric diagnosis is appropriate in this situation. Nevertheless, Bowers noted that regret about the decision to transition is uncommon and that “it makes sense that earlier intervention, which can lessen the permanent effects of puberty, would make gender transition easier for teenagers.”
Thus, if we look at the established scientific literature, we see that transgender youth are plagued with depression, anxiety, and suicidal thoughts, that gender-affirming care, including hormones and puberty blockers, leads to an overall improvement in life satisfaction, and that few people who undergo these treatments regret the decision. So, why are so many bills making access to gender-affirming care difficult or impossible?
Opposition to Gender-Affirming Care Is Not Fact-Based
At a Congressional hearing in March, some Republican representatives addressing U.S. Secretary of Health and Human Services (HHS) Xavier Becerra about transgender care repeatedly questioned whether federal funds could be used to provide gender-affirming care to minors even in states that ban or restrict such care, as an increasing number of red states have. Bower characterizes these attempts to restrict transgender care as “thinly veiled cruelty to a specific minority population of this country.”
To be sure, it is always appropriate to reserve special caution for any treatment we propose to advance to children who cannot legally consent and for whom developmental considerations must always be weighed. It is reasonable to be cautious about recommending any intervention that can alter a child’s development trajectory. Youth who experience discomfort with the gender they are assigned at birth and who request help should be carefully evaluated by experts in transgender medicine. That is the norm across the country, and there is no reason to believe that youth are being influenced to undergo transitions or that parents’ wishes are being overridden.
Contrary to misinformation about gender-affirming care, surgery is almost always delayed until at least age 18. When children are treated with puberty blockers, the effects are completely reversible if the decision is made to stop them. Hormone treatments are also generally reserved for older teenagers and adults, and if stopped, their effects are partially or completely reversible. On the other hand, the evidence suggests that failing to acknowledge gender issues in youth and provide meaningful care negatively affects development.
The recent mass shooting in a Nashville elementary school demonstrates how anti-trans rhetoric can be irrational. The shooter in that case was originally identified as female, a rarity among mass shooters, who are overwhelmingly cis-males. When a social media profile of the shooter revealed that she used masculine pronouns, a conclusion reached by some commentators that she was transgender. Anti-trans sentiment then raged in some circles, with Fox News hosts dubbing the shooter a “Trans Killer” and one member of Congress stating: “We are witnessing the rise of trans violence.”
These commentators blamed hormones sometimes administered as part of transgender care for the shooter’s violent outburst but neglected to mention several facts: Transgender people are far more likely to be the victims of violence than its perpetrators, the actual gender identification of the shooter remains unclear (police killed her), there is no evidence that the shooter took hormones, and research shows that most transgender people do not undergo hormone therapy.
Gender-affirming care in the U.S. has existed since the 1960s when the first university-based clinic was founded at Johns Hopkins University. Thus, there is nothing new or experimental about it. Most medical organizations in the U.S. oppose restrictions on evidence-based transgender care. What we still know very little about is the biology of gender identification. Perhaps that mystery–why some people do not feel comfortable with the sex assigned to them at birth–is part of why even rational people fail to grasp the reality of the transgender experience.
Although it is reasonable to call for more research into understanding the underlying biology of transgender identification, that should have nothing to do with the need to provide transgender people with evidence-based care, including providing transgender youth with access to puberty blockers and hormones when those are indicated. Here the data seem clear: Transgender youth who do not receive appropriate evaluation and care suffer, whereas gender-affirming care has been shown repeatedly to lead to improved life satisfaction and little regret. It is time that legislators stop acting irrationally about gender-affirming care for youth and follow the science.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory.
