Gender Affirming Care FAQ

Families interviewed described the burdens imposed by these bands, including geographic and financial challenges in accessing care…Parents reported traveling long distances, sometimes across multiple states, incurring costs for airfare, gas, hotels, and lost wages…Some families reported facing costs of up to US$4,500 every six months for medications alone.

According to the HRW report, "Six states classify the provision of gender-affirming care as a felony offense. Eight states have vague, 'aiding and abetting' provisions that restrict providers from facilitating gender-affirming care, which could include offering referrals or medical records, discussing out-of-state treatment options, refilling prescriptions, or even running lab tests." Additionally, bans on gender-affirming care have progressed to the federal level. The report states: "On January 28, [US] President Trump signed an executive order titled 'Protecting Children from Chemical and Surgical Mutilation,' which prohibits federal funding for institutions that provide or research gender-affirming care for anyone under 19, cuts off access through federal health programs, and directs agencies to investigate and penalize providers…In 2024, the Supreme Court heard oral arguments in U.S. v. Skrmetti, a case challenging Tennessee's gender-affirming care ban, which selectively prohibits care for transgender youth while allowing identical treatments for cisgender youth. The case, expected to be decided in 2025, will determine whether such bans violate the Equal Protection clause of the Fourteenth Amendment to the US Constitution, potentially influencing similar laws nationwide." Additionally, "In early 2025…the [Trump] administration issued a series of other executive orders targeting education, military service, and legal recognition for transgender people."

The HRW report contextualizes: "The recent bans come at a time when the United States has experienced an increase in anti-LGBT legislation more broadly. While 2018 saw some 40 anti-LGBT bills introduced in state legislatures, by 2025 this number rose to more than 575 bills." The report continues, "Since 2022, clinics and hospitals have reported bomb threats, arson attempts, and coordinated harassment campaigns. Providers have reported receiving death threats, having their personal information exposed online, and being forced to implement costly security measures. This climate of fear has driven many providers to cease offering care or relocate to states with more supportive policies, further reducing access to gender-affirming care for transgender individuals." The report then described the impact of cultural changes that the bans have on care providers: "Every gender-affirming care provider interviewed by Human Rights Watch reported experiencing some form of anti-trans harassment–whether directed at themselves or their place of work–through phone calls, emails, social media, or mail." There is an observable correlation, though not necessarily causation, between gender-affirming care bans and violence against transgender people. The report states: "The rise in anti-transgender legislation has coincided with an escalation in violence against transgender individuals, even as violent crime overall decreased by approximately 3 percent from 2022 to 2023. Federal Bureau of Investigation data shows that gender identity-based hate crimes are on an upward trend, increasing from 307 offenses in 2021 to 515 in 2022, reaching 547 in 2023, the latest year for which complete data is available." It is also important to keep in mind that not all gender identity-based hate crimes are reported, or reported as such, so these numbers do not tell the full story.

HRW's report on transgender youth articulates the multitude of ways in which state legislation targets transgender youth, including that: "as of May 2025, 28 states have prohibited ransgender youth from participating in sports consistent with their gender identity; 19 states have restricted transgender youth from using bathrooms aligned with their gender identity in K-12 schools; 19 states have censored discussions of sexual orientation and gender identity in school curricula; and 8 states have mandated that school officials disclose students' transgender identity to parents."

The HRW report recommendations include: "action at multiple levels: state legislatures should repeal existing bans on gender-affirming care and ensure Medicaid coverage; Congress and state lawmakers should enact comprehensive federal non-discrimination protection; federal and state agencies should enforce existing civil rights protection to protect transgender people from discriminatory treatment and the executive office should rescind executive orders that deny rights and recognition to transgender people and undermine access to gender-affirming care."

The HRW report on gender-affirming care bans explains this about how it defines a so-called "ban" on gender-affirming care: "While 27 states have implemented legislative restrictions on gender-affirming care for youth, only two states–New Hampshire and Arizona–have specifically limited their bans to gender-affirming surgeries for those under 18 years old. The remaining 25 state laws, referred to in this report as 'bans' or 'blanket bans,' prohibit nearly all forms of gender-affirming medical care for those under 18 years old, including access to puberty blockers and hormone therapies. Given the exceedingly rare occurrence of gender-affirming surgeries on those under 18 years old…laws solely targeting these procedures have been excluded from our definition of gender-affirming care 'bans.'"

The HRW report describes gender-affirming treatments: "Historically, such treatments have been supervised by medical professionals and not legislators. Until 2021, no US states had legal restrictions in place limiting such care."

Gender affirming care is guided methodically by the minor involved, their parents, and their doctor. HRW found that: "In accordance with the standard [pre-ban] guidelines, youth, after undergoing a period of mental health counseling and receiving referrals from both a mental health professional and a general practitioner or pediatrician, may see a specialist to begin the process of medically assisted transition. Medical interventions are not to be pursued prior to the onset of puberty. For older patients who wish to medically transition, treatment may include hormone therapies." They also found that "Hormone replacement therapies are generally considered safe in both youth and adults with provider supervision and appropriate management." The report goes on to affirm that "While proponents of restriction on gender-affirming care often focus on surgical intervention, gender-affirming surgeries are exceedingly rare among transgender youth. In fact, they are more common for cisgender youth, who more frequently undergo medical procedures to align their bodies with their sex assigned at birth.

Gender affirming care is mostly reversible. As stated in HRW's report on such care, "The effects of puberty blockers and menstrual suppression medications are reversible, and are used to give youth time to continue exploring their gender identity before potentially moving on to more permanent transition-related care when they are older." Furthermore, "Depending [on] how long a person has been taking hormones, the effects may be fully or partially reversible as well."