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Gender Affirming Care Toolkit

Lily, a 10-year-old trans girl, said she was devastated when her family felt forced to relocate to protect her from anti-trans hostility. Illustration by Barrack Rima, Art directed by Studio Safar for Human Rights Watch

In recent years, the United States has seen a rise in state-level legislation targeting the rights of transgender individuals, particularly transgender youth. Many of these efforts have focused on limiting access to gender-affirming care, a set of often critical social, medical, and psychological interventions that help transgender individuals align their physical bodies with their gender identity.

Since 2021, a wave of legislation targeting transgender health care has swept across the United States, with 25 states enacting blanket bans on gender-affirming care for transgender youth as of March 2025. These legislative bans, often vague and sweeping in scope, have disrupted healthcare access for over 100,000 transgender youth, and imposed significant geographic, financial, and emotional burdens on their families. (HRW)

Click on each tab for information and resources:

Gender Affirming Care Fast Facts

All facts come from HRW's "They're Runining People's Lives: Bans on Gender-Affirming Care for Transgender Youth in the US" report.

  • Most of the youth who receive gender-affirming care continue this care into adulthood, with a continuation rate of approximately 98%.
  • The reported mental health toll of these bans on transgender youth is particularly severe. A 2024 Trevor Project study found that suicide attempt rates among transgender youth increased by as much as 72% in the first year after the adoption of state-level anti-transgender laws. 
  • Families and advocates reported that insurance companies routinely deny coverage for out-of-state treatment, forcing families to bear significant financial burdens. Some families reported facing costs of up to $4,500 every six months for medications alone. These challenges disproportionately impact low-income families and rural residents, who often lack the resources to afford regular interstate travel for care. 
  • According to a 2024 study by the Centers for Disease Control and Prevention:
    • An estimated 875,000 high school students in the United States identify as transgender or are questioning their gender identity. 
    • Approximately 26% of transgender students reported attempting suicide in the past year, compared with 11% of cisgender female students and 5% of cisgender male students. These figures arise as US youth are reporting high rates of depression, anxiety, and suicidal ideation more broadly; however, transgender youth remain at significantly higher risk. 
  • 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. 
  • 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. 

Educational Resources

Frequently Asked Questions

Glossary

Testimonies

Myth vs. Fact

The cascading effects of these legislative bans on transgender youth, their families, and the broader healthcare system require urgent intervention. Less than half of US states have enacted comprehensive statutory protections against discrimination based on sexual orientation and gender identity. The United States lacks comprehensive federal legislation explicitly protecting LGBT people from discrimination in areas such as education, housing, public accommodations, and federally funded programs. 

To combat these challenges, STFers will:

On Campus Advocacy

  • Review school and district policies related to students preferred name and pronouns, uniforms, locker rooms and bathroom use, etc. to see where attention is needed
  • Work with campus curriculum teams to identify where LGBTQIA+ friendly lessons already exist, and where they can be embedded. Some initial entry points can include LGBT history and literature, sex education, gender identity in health classes, etc
  • Interview students to share their experiences and highlight them in on-campus media or with the STF Team
  • Escalate your advocacy to your school board where appropriate!

Local/Community Advocacy

With Elected City/County Officials: 

  • Participate in existing events that honor Trans Day of Remembrance (Nov. 20) and Trans Day of Visibility (March 31)
  • If your city does not currently honor these dates, ask your elected officials to officially acknowledge them with an annual proclamation

With local LGBT Centers, develop/update: 

  • Purple books with resources for local and traveling families in need of LGBTQIA+ friendly resources in your area
  • Landing guide for sanctuary states (see NY LGBT Network for an example of possible resources to develop)

Take Action: If You Only Have...

60 Seconds

  • Bookmark this toolkit for quick access
  • Create google alerts for "gender affirming care" and "trans rights" to stay current on this action plan

5 Minutes

  • Read this glossary of important vocabulary related to gender affirming care
  • Investigate your school’s website to see what resources are available to support and/or assist students who are transitioning

30 Minutes

In every report, Human Rights Watch makes recommendations for how to improve the human rights concerns addressed. These are just some of the recommendations HRW has made to improve the quality of life for youth seeking gender affirming care in the United States in the "They're Runining People's Lives: Bans on Gender-Affirming Care for Transgender Youth in the US" report.

While the below recommendations are specific to the United States, they can be adapted for anywhere in the world.

To State Legislatures

  • Lift barriers to medically prescribed gender-affirming care in line with best practice standards for transgender health established by WPATH, the Endocrine Society, and other leading medical professional organizations across multiple specialties.
  • Repeal existing bans on gender-affirming care and reject proposed laws and policies that would restrict access to such care.
  • Enact legislation protecting access to gender-affirming care and prohibiting discrimination against transgender youth and their families.
  • Ensure state Medicaid programs cover gender-affirming care.
  • Enact comprehensive shield laws to protect access to gender-affirming care by:
    • Protecting providers and families against out-of-state investigations and prosecutions.
    • Requiring insurers to maintain coverage and preventing discriminatory rate increases for providers of gender-affirming care.
    • Safeguarding medical records and the personal information of patients, providers, and facilities providing gender-affirming care.
  • Establish mechanisms to assist out-of-state families relocating in search of safer communities and access to gender-affirming care for transgender youth.

To State Attorneys General

  • Issue guidance protecting providers who offer gender-affirming care to the extent possible under state law.
  • Join multi-state efforts to challenge restrictions on gender-affirming care.
  • Enforce existing non-discrimination protections that protect transgender individuals’ access to health care.
  • Investigate discrimination against transgender individuals in healthcare settings, including cases in which medical facilities preemptively discontinue gender-affirming services despite no legal requirement to do so.
  • Exercise prosecutorial discretion to decline to enforce restrictions on gender-affirming care that conflict with medical best practices.

To State Medical Boards

  • Develop clear guidelines for providers offering gender-affirming care that align with established medical standards.
  • Protect medical professionals' licenses from out-of-state actions related to providing gender-affirming care.
  • Provide resources and training to healthcare providers on best practice gender-affirming care standards and practices.
  • Issue statements supporting best practice gender-affirming care when medically indicated.

To the US Congress

  • Reject attempts to ban gender-affirming care nationwide.
  • Retain legislative frameworks that prohibit sex discrimination in healthcare settings, and expressly codify protections against discrimination based on gender identity.
  • Allocate federal funding for scientifically based non-partisan research on gender-affirming care outcomes and best practices.
  • Ensure federal health programs cover the costs of gender-affirming care on the same basis as other forms of medically indicated care.
  • Pass legislation preventing states from criminalizing interstate travel for medical care, including gender-affirming care.

To the Executive Branch

  • Rescind executive orders that deny rights and recognition to transgender people and undermine access to gender-affirming care.
  • Restore previous guidance recognizing gender identity discrimination as a form of sex discrimination within the executive branch and ensuring federal civil rights protections are enforced to protect transgender individuals.

Sophia, an 18-year-old trans woman, said she was driven to attempt suicide, resulting in a week-long hospitalization, after she had been feeling attacked by anti-trans media and her state banned genderaffirming care.
Illustration by Barrack Rima, Art directed by Studio Safar for Human Rights Watch

Stay up to date on Human Rights Watch's LGBT Division's coverage about policies impacting LGBTQIA+ people around the world.

Report: They’re Ruining People’s Lives: Bans on Gender Affirming Care for Transgender Youth in the US

Human Rights Watch Country Profiles: Sexual Orientation and Gender Identity

Recent HRW News Articles:

Contact the STF Team if you would like additional educational resources: stf@hrw.org

Disclaimer: Anyone using these materials or participating in advocacy associated with this action plan should discuss this toolkit with your parent or guardian.