WARNING: this post contains in-depth language and information about suicide. If you are in acute crisis looking for help, please call the National Suicide Prevention Lifeline at 988 or dial 911.
Stories about gender-affirming care for youth have been all over the news lately, making headlines in Florida, Alabama, Texas, and many other states across the US. Some articles are inspiring and heartwarming, while others spread misinformation or call into question the benefits of care for transgender youth.
As explained by The Trevor Project, the nation has recently witnessed a record number of state-level anti-transgender bills. This movement in the courts is a disheartening development for transgender and nonbinary youth. A 2021 poll showed that 85 percent of transgender and nonbinary youth and 66 percent of all LGBTQIA+ youth reported that recent debates about restrictive state laws have had a negative impact on their mental health.
Charlie Health is in the business of reminding the world that everyone deserves to be loved, empowered, and provided with equitable access to mental healthcare. So we’re here to focus on the facts—starting with the definition and purpose of gender-affirming care.
The term gender-affirming care encompasses a wide range of social, behavioral, and medical interventions that are designed to support and affirm an individual’s gender identity. As a reminder, gender identity is a person’s sense of being male, female, a combination, or another gender, and it doesn’t always align with the sex that they were assigned at birth.
Gender-affirming care is patient-centered, meaning it empowers transgender, gender diverse, and nonbinary youth to be their own advocates and active participants in how they care for their body.
It can also help combat something called gender dysphoria: the cognitive dissonance that occurs when someone doesn’t identify with the gender they were assigned at birth. For those who haven’t experienced dysphoria, it’s hard to image the distress that this dissonance causes, but it’s actually quite common among transgender teens and other members of the LGBTQIA+ community. Teens, especially, are susceptible to gender dysphoria due to changing hormones and social pressures.
Here, we’ll review why so many transgender youth are receiving gender-affirming care, as well as the difference between social and medical transitions and which one might be right for you.
Benefits of gender-affirming care
Gender-affirming care has the power to change the way that transgender, gender diverse, and nonbinary youth view themselves. It offers a plethora of mental and physical benefits and is backed by recent research and major medical organizations.
According to the American Academy of Pediatrics:
“Proper gender-affirming care can mitigate a patient’s clinical distress and lead to significant improvements in the overall well-being of youth and adolescents who are at risk of or have been diagnosed with gender dysphoria … studies show that transgender adults who received appropriate treatment during adolescence had a lower incidence of lifetime suicidal ideation than those who wanted but could not obtain such treatment.”
The Pediatric Endocrine Society offered a similar endorsement for the practice in a court filing earlier this year:
“Gender-affirming care, including puberty suppression and hormone therapy, is potentially lifesaving.”
Mental health benefits
The link between gender-affirming care and improved mental wellbeing among teens is well documented. A 2021 peer-reviewed study found that gender-affirming hormone therapy is associated with significantly reduced rates of depression, suicidal thoughts, and suicide attempts among transgender and nonbinary youth. Another small self-reported study of 47 youth who received gender-affirming hormones found that treatment reduced the likelihood of suicidal tendencies (the number dropped from 21 out of 47 to 6 after the start of treatment).
Additional research suggests that transgender youth with gender dysphoria, something which gender-affirming care can ameliorate, are significantly more likely than non-transgender youth to experience emotional distress, depression, bullying, or attempt suicide.
Gender-affirming care also improves body image and self-esteem, which is so important for transgender youth who are navigating social and political dynamics.
Data from The Trevor Project reports that transgender and/or nonbinary kids who have socially transitioned showed levels of self-worth and depression that were comparable with non-transgender and/or nonbinary children—a marked difference from transgender and/or nonbinary kids who didn’t have the support to socially transition.
Types of gender-affirming care
Gender-affirming care includes a variety of medical, surgical, and social services, and choosing which treatment is right for you is a very personal decision. There is social transitioning—which includes things like clothing and pronouns—which is completely reversible and often used by children and younger teens who are easing into their chosen gender. Then there’s medical transitioning, which alters the physical and sexual characteristics of the body and can be irreversible.
There are plenty of non-invasive ways to help align the way that others see you with the way you see yourself. Transgender, gender diverse, and nonbinary youth often ease into their transition with social affirmations, such as choosing a name and preferred pronouns to better reflect their authentic self.
“Pronouns are an aspect of our gender expression, and using pronouns that affirm our identities can help a great deal in helping to reduce gender dysphoria and in fostering feelings of authenticity,” explains Ley David Elliette Cray, PhD, Director of LGBTQIA+ Programming at Charlie Health. “No matter who they are or how they identify, respecting a person’s affirmed pronouns is crucial—to do otherwise is to falsely suggest to them that you know their first-person experience of their identity better than they do,” she said.
Other simple, yet effective ways to declare your identity to others are by changing your clothing, hair, or makeup to match your identity. You can also experiment with chest binding, breast padding, genital tucking, and even padding around the hips or butt.
Again, these are all reversible methods of gender-affirming care and don’t require parental permission (unlike others that we’ll discuss below).
Also known as hormone blockers, puberty blockers are drugs used to postpone puberty in children. Sometimes likened to "hitting a pause button," they’re designed to block the sex hormones testosterone and estrogen in order to delay the developmental changes that are the hallmark of our teen and adolescent years.
For those who were assigned female at birth, puberty blockers can stop or slow breast growth, the widening of hips, and prevent menstrual cycles. For those who were assigned male at birth, they can reduce facial hair growth and prevent voice deepening. Puberty blockers are often also prescribed to cisgender children who experience precocious puberty.
It’s important to note that puberty blockers are reversible, meaning once they’re out of a person’s system, they will still experience puberty based on the sex they were assigned at birth. In fact, puberty blockers are often used as an option to allow youth who are questioning their gender the option to live with their identified gender, while considering a more permanent change. If you decide to make a more permanent transition, you might consider gender-affirming surgery or hormone therapy.
According to a national study of more than 27,000 transgender and gender non-binary individuals, 25 percent of respondents reported having had some form of gender-affirming surgery.
Below are some of the gender-affirming surgeries that are available to help people transition to their chosen gender. It’s important to note, however, that most states do require counseling and permission from a parent or guardian for anyone under age 18 to undergo these procedures.
- Top surgery: Also known as chest reconstruction or masculinizing chest surgery, this procedure either enhances breasts or creates a male-typical chest shape.
- Voice surgery: Treatment to adjust a person’s voice or tone to better align with communication patterns that match their gender identity.
- Facial feminization or masculinization surgery: Facial feminization encompases a variety of procedures that change masculine facial features into feminine features. Examples include cheek augmentation, jawline reduction surgery, a nose job, and hairline reconstruction. Facial masculinization surgery has the opposite effect by creating a more masculine and angular face. This procedure usually focuses on the cheeks, chin, forehead, nose, and throat.
- Feminizing genitoplasty: Surgeries to alter or build female genitals such as the clitoris, labia, and vagina.
- Metoidioplasty: Lower body surgery that creates a penis from the clitoris after it’s been enlarged using testosterone therapy.
Hormone treatment during puberty can help a transgender teen match their physical characteristics with their gender identity. The treatment is available as a shot, pill, patch, gel, or implant, and will contain either testosterone or estrogen. Wondering what its effects are? Depending on the treatment, it can help you develop breasts, grow facial hair, or deepen your voice.
According to a study published earlier this year, access to gender-affirming hormones during adolescence is linked to better mental health outcomes—such as lower rates of suicidal ideation, psychological distress, and drug use—compared to those who accessed the care during adulthood or wanted care but were unable to access it at all.
You’ll have to wait until you’re 16 years old to begin hormone treatment, so many teens will consider puberty blockers in the meantime.
Understanding your gender identity doesn’t happen overnight, and some people find real value in
gender-affirming therapy. Whether you're suffering from gender dysphoria, navigating transphobic behavior in your community, or finding the best way to invite others in, speaking with a mental health professional can be a really useful tool. LGBTQIA+ therapy focuses on the intersection of your sexual orientation, gender identity, and mental well-being, all while providing a safe environment to discuss any mental health concerns and build healthy coping skills.
Empower yourself with Charlie Health
Charlie Health is committed to serving LGBTQIA+ teens and young adults in a safe, compassionate, and empowering environment. Our virtual programs are designed to meet individual needs through assigning patients to therapists who understand their unique challenges, and connect teens with LGBTQIA+ specific group therapy to build community.
Interested in learning more? Connect with Charlie Health today.