Anti-Gender-Affirming Care Laws Constitute Child Abuse, Argues Bombshell Paper

In 2023, more than 500 anti-LGBTQ+ bills were introduced in U.S. states, and more than half targeted transgender youth. Already in 2024, more than 275 such bills have been filed. In total, 23 states have some sort of ban on gender-affirming care (GAC) for trans youth, barring more than 105,000 trans youth from accessing these treatments. These widespread bans amount to the serious offense of child maltreatment, including medical neglect and emotional abuse, according to a new paper in the journal Pediatrics.

In the paper, three pediatricians explain that some of the laws banning GAC for trans youth frame parents and caregivers as committing child abuse when they allow children to access GAC, opening the door for child protective services investigations and for their children to be taken away from them. But the authors argue the opposite is true — that these caregivers are in the right for supporting trans kids’ access to GAC, and laws banning this medical care are actually a form of child maltreatment.

Laws banning GAC “operate under the guise of protecting children,” write the authors, Emily Georges, M.D., Emily C.B. Brown, M.D., and Rachel Silliman Cohen, M.D. “In reality, they punish caregivers and physicians when they choose to support children.”

GAC for trans youth isn’t what its opponents make it out to be. No young, questioning kids are being pumped full of hormones or are going under the knife. Children typically don’t receive GAC until they begin puberty, at which time they could start puberty blockers — a fully reversible treatment that simply presses pause on puberty, and has been used in cisgender children since the 1980s, according to the paper.

After age 14, teenagers may be able to start gender-affirming hormone therapy. Transmasculine teens who wish to have top surgery to flatten their chests must wait until age 15, and any bottom surgeries on genitalia are delayed until at least age 17, according to guidelines from the World Professional Association for Transgender Health.

Trans youth are at increased risk of depression and suicidality; a survey from The Trevor Project found that 56% of trans men, 48% of trans women, and 48% of non-binary or genderqueer people aged 13 to 24 considered suicide in the past year. Studies show that GAC lowers the high rates of depression and suicidality in trans youth. Some even show that receiving this care alongside caregiver support brings down depression and suicide risk to that of cisgender youth.

“A lthough some individuals make it seem that GAC is a new, experimental area of medicine, GAC is evidence-based,” the authors write. It’s supported by major medical organizations such as the American Medical Association, the Endocrine Society, the American Academy of Pediatrics, and the American Psychiatric Association. The evidence clearly shows that whatever risks there are to GAC are greatly outweighed by the benefits of these safe and effective treatments. It should also be noted that the vast majority of kids who receive GAC continue to as adults.

What’s more, bills that target GAC for trans youth and the rhetoric used to support them “fuel discriminatory rhetoric” that hurts the mental health of trans youth and “imperils their safety,” the authors write. “Examination of the evidence and expert opinions highlight how these legislative efforts are, at minimum, the result of a lack of understanding, and in some cases fueled by malice and a desire to spread misinformation to propel forward an antitransgender agenda.”

Not only should facilitating trans youth’s access to GAC not be considered child abuse, but laws denying them GAC should be considered child maltreatment, the authors argue. For one, these laws are a form of medical neglect because they prevent children from receiving a potentially life-saving form of care, and they’re emotional abuse because they impede trans youth’s “basic psychological needs.”

“That children may be separated from their caregivers in certain states, on the basis of legislative efforts to classify GAC as child abuse, is abhorrent, misguided, and harmful,” the authors write. “All children deserve love, acceptance, and care. Parents should be commended, not punished, for accepting their children for who they are.”