The Trans Youth Controversy That Isn’t

Republicans are leaning on anti-trans rhetoric and fear-mongering about “child surgeries” to consolidate power. But there’s no real issue in this issue. 

On a fall day in 2024, Donald Trump held a campaign rally at an airport in central Wisconsin. Accusations were made, names were called, the crowd chanted, and the once-and-future president blustered about the stupendous size of his rallies. A little over an hour into his speech, he asserted that his opponent, Vice President Kamala Harris, wanted state governments to be able to perform “sex change operations” on minors without parental consent.

Can you imagine you’re a parent and your son leaves the house and you say, “Jimmy, I love you so much, go have a good day in school,” and your son comes back with a brutal operation? Can you even imagine this? What the hell is wrong with our country?

Since his January inauguration, Trump has continued to sound the alarm about what his administration has labelled the “chemical and surgical mutilation” of children. At the same time, politicians across the country have inundated state legislatures and the U.S. Congress with bills whose titles read like slogans from a political haunted house. “Protect Adolescents from Experimentation!” “Stop the Mutilation of Children!” “Protect Children’s Innocence!” This week, the U.S. House of Representatives announced votes on two bills that would restrict or eliminate young trans people’s ability to access gender-affirming care: one that would deny access to care for young people whose families use Medicaid, and another that would ban it completely, with felony charges for providers. One might be forgiven for thinking that there must be some kind of real crisis underway. 

There isn’t one. 

No doctors are performing “transgender surgeries” on children’s genitals. No irreversible hormonal transformations are being enacted on the youth of our country without parental consent. None of the treatments used in gender-affirming care for youth are experimental.  There isn’t even any serious controversy among experts about how transgender youth should be cared for. 

What is the reality of gender-affirming care for young people? Behind the political smoke and mirrors are clear standards of care, active collaboration over years between children, parents, and providers to determine the right course of action for each individual, and safe, proven treatments with minimal side effects.

The Boogeyman Doesn’t Exist (Except When He Does)

Gender-affirming care for children and adolescents, as well as for adults, is fairly standardized in the U.S. Most specialists in gender-affirming care are trained in, and institutionally accountable to, the guidance of the World Professional Association for Transgender Health (WPATH)’s “Standards of Care for the Health of Transgender and Gender Diverse People,” currently in version eight. The Standards of Care outline a careful, step-by-step process for children and adolescents seeking gender-affirming care. The process emphasizes informed consent and minimizing young people’s distress while giving them and their caretakers ample time to weigh each new decision. No medical transition steps are taken for children earlier than puberty. Gender-affirming surgery on transgender minors is quite rare– just a handful of older teens each year who, with parental consent, and generally years after transitioning socially, may opt for chest masculinization or “top surgery.” Genital surgery, the focus of much of the right-wing’s rhetoric, is not a treatment option that is generally available to transgender minors in the U.S.¹

A common right-wing talking point about gender-affirming care, especially for youth, is that it is risky and “experimental.” The truth is, the treatments available to trans youth today have been in use for decades, and are generally considered to be safe.² In fact, the exact same gender-affirming treatments offered to transgender youth are routinely offered, without the slightest controversy, to cisgender youth. Puberty blockers have been used since the 1970s to treat “precocious” or early-onset puberty in cisgender kids. Hormone therapy– the same treatment protocol used to treat hormonal imbalance in cisgender youth and adults– is even older. Young cisgender men with gynecomastia (breast growth) access chest masculinization surgery in far greater numbers than transgender young adults. The activists and politicians alleging that these treatments pose an unacceptable risk to transgender young people are curiously silent on the use of the exact same treatments in other youth populations.

Gender-affirming healthcare for trans youth under the current Standards of Care is characterized by caution, collaboration, and giving young people as much time as possible for decision-making. But there is one situation in which children in the United States are being subjected to medically unnecessary, irreversible genital surgeries with a host of negative long-term effects when they are too young to give any meaningful consent. This is the reality for many intersex people and their families. 

Intersex people–born with sex characteristics that don’t align with a simple male or female sex designation–are often subjected to surgery as infants or toddlers to “correct” their bodies, regardless of medical necessity. Legislation targeting gender-affirming care for trans kids often includes fine-print protecting doctors who surgically alter intersex children.³ When politicians stir up moral panic about evidence-based, medically-supported, and consensual trans youth healthcare, while quietly protecting doctors who perform medically unnecessary surgery on intersex children, it becomes clear that the motivation is not protection of vulnerable young people– it is political point-scoring and social control. 

We Know How to Care for Trans Kids

Twenty-seven U.S. states and one territory are currently enforcing bans on gender-affirming care for transgender youth.⁴ Gender clinics across the country, even in states where care remains legal, are restricting what kind of care they provide, closing their doors entirely, or being threatened with funding cuts and subpoenas of protected patient information. Once again, it might be reasonable to assume the existence of considerable controversy among medical professionals about gender-affirming care for youth. In fact, there is remarkable consensus. Every major healthcare professional organization supports access to gender-affirming care for trans youth.⁵ The existence of vocal anti-trans groups with legitimate sounding names (for example, the “American College of Pediatricians”) may appear to contradict this, but the appearance erodes on closer examination of the numbers:

The American Academy of Pediatrics, an organization with about 67,000 members, has officially supported gender-affirming care since 2018. 

Meanwhile, the anti-trans American College of Pediatricians (officially recognized as a hate group by the Southern Poverty Law Center) has a membership of around 700. 

Support for transgender minors’ access to gender-affirming care is consistent across healthcare professions and specialities, including doctors, nurses, psychologists, and social workers; in pediatrics, endocrinology, reproductive medicine, general practice, psychiatry, and more. 

Life-Affirming Care that Meets Individual Needs

The specifics of what gender-affirming care is necessary vary from one person to the next, based on age, health status, developmental stage, and, especially, individual choice. Not all trans people (youth included) have a desire to transition medically. Some, especially those who identify outside the gender binary, may be interested in particular hormonal or surgical treatments and not others. Gender-affirming care teams are trained in supporting young people and their families as they discern their specific desires and needs and collaborating on the creation of gender-affirming care plans that meet those needs. 

Critics may look at this variety and conclude that if not all trans youth need the same care, it must not be truly essential– but that is not the case. Trans youth who are supported to access the care that feels right to them have significantly better mental health, social, and educational outcomes than those who are not. This includes a significant decrease in suicide risk for young people who have access to appropriate care options. 

One poignant description of the importance of gender-affirming hormones comes from Jack, a Florida teen profiled in Nico Lang’s 2025 book American Teenager. Jack was unable to access estrogen for five months due to misinformation from her doctor. 

“For me, it didn’t feel like turning back into a man– it felt like turning into something inhuman… You watch your body that you were so happy with deteriorate,” she said, “and you don’t know if it’ll ever come back the same way.”⁶

In contrast, Louis, a transmasculine and non-binary young person who came out at 13 and got gender-affirming surgery on his chest at 16, describes the increased ease, freedom, and joy that he has experienced since accessing gender-affirming care: “Now that I’m post top surgery, a lot of that survivalness about it is gone. It’s like I made it through the worst of it and now I can express myself in fun ways. It was definitely a rough journey, but I made it through and I’m a lot happier and I can have a lot more fun with how I present myself.” ⁷

Some opponents of gender-affirming care for transgender youth– as well as some people who consider themselves supportive– argue that young people should “just wait” until adulthood to access gender-affirming care. But waiting years to access care that is needed now causes suffering. It inhibits young people’s ability to have full, rich lives. And some young people, faced with years of life in a body that feels wrong to them and the societal hostility that pushes them toward that experience, will instead choose death. This is not conjecture– we know that these bans are already claiming the lives of trans young people, whose rates of suicide have climbed alongside the increase in anti-trans legislation. These facts have not discouraged our political leaders from the farce that they are “protecting” young people by cutting them off from life-saving care.

The Monster is Not Under the Bed. It’s in the Mirror. 

While there may not be any genuine controversy among subject-matter experts about care for trans youth, there is one point that right-wing politicians have gotten right with regard to trans youth healthcare access: the stakes are high. As high as the safety and well-being of our children– which is high enough. But the stakes are also as high as every real, critical issue facing us today that we are not addressing while we argue the non-issue of transgender youth. Healthcare. Education. Food and housing insecurity. A liveable planet, now and into the future. 

Politicians are working hard to sell us the idea that safe, effective, age-appropriate, and expert-approved care for transgender youth is the real crisis facing our country. They are selling moral panic over a non-issue, hoping to distract and divide us.⁸ But we can push back in defense of our children, our communities, and our planet. We don’t need to buy what they’re selling.

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Take Action

1. Use a website like 5calls.org to make sure your national, state, and local elected representatives know you support trans kids’ access to gender-affirming care.
2. Share this article with a friend or family member.
3. Make a donation towards trans youth advocacy. The author of this article offers education, advocacy, and coaching at no cost to clients through Trans Youth Coaching, and gratefully accepts financial support (non tax-deductible). The Trans Youth Emergency Project, Advocates for Transgender Equality, and Trans Lifeline are other organizations doing important work to support trans, non-binary, and questioning young people (and can accept tax-deductible donations). 

Learn More

There is an incredible amount of information online about trans youth healthcare, much of it unreliable. I recommend the following sources to learn more. When in doubt, look for projects that include transgender researchers and are supported by transgender organizations. 

• The Trevor Project conducts a large annual survey on mental health and well-being among LGBTQIA+ youth in the United States. Read 2024 survey results.
• Public health researcher Connor McGaffick maintains an online annotated bibliography on “Research and Misinformation on Gender-Affirming Care for Transgender Youth,” an indispensable guide to existing research studies.

See also: Erin in the Morning (news reporting) and the Trans Youth Emergency Project.

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Notes

1.  Numbers on surgical procedures for minors from a 2024 Harvard study. Read more: https://hsph.harvard.edu/news/gender-affirming-surgeries-rarely-performed-on-transgender-youth/ ↩︎
2. For a review of medical literature on gender-affirming care for trans youth, including safety and mental health impact, see Connor McGaffick’s “Research and Misinformation on Gender-Affirming Care for Transgender Youth.” ↩︎
3. For an example of this kind of exemption, see current U.S. House bill H.R. 3492 ↩︎
4. Movement Advancement Project, “Bans on Best Practice Medical Care for Transgender Youth.” ↩︎
5. GLAAD, “Medical Association Statements in Support of Health Care for Transgender People and Youth.”
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6. American Teenager, Nico Lang, 2025. ↩︎
7. Trans and Gender Diverse Teen Resilience Guide, Peta, Coolhart, and Testa, 2025. ↩︎
8. For one discussion of the political motivations behind anti-trans measures, see “Fossil Fuel Billionaires are Bankrolling the Anti-Trans Movement,” Yessenia Funes. ↩︎