Since 1979, the World Professional Association for Transgender Health has published the internationally recognized Standards of Care ("SOC") for trans people. The current version of the SOC has been adopted by many major associations of healthcare providers, including the American Academy of Pediatrics, the American Medical Association, the Endocrine Society, and others.
Social transition, puberty blockers, and/or hormone therapy can all be medically necessary for transgender youth. You should speak with your healthcare providers about which treatments are more appropriate for you, given your specific medical needs and history. The SOC does permit top surgery for transgender males under 18, but does not recommend genital surgery if you are under 18. You can find the most recent version of the SOC here.
Conversion therapy, also known as “reparative therapy” and “ex-gay therapy,” is the medically discredited practice of attempting to change someone’s gender identity or sexual orientation. Conversion therapy has been condemned by every major medical and mental health organization in the United States as not effective, and has been shown to increase depression, substance abuse, and suicide risk for LGBTQ youth. The following states ban conversion therapy: New Jersey, California, Oregon, Illinois, Vermont, New Mexico, Connecticut, Rhode Island, Nevada, Washington, Hawaii, Delaware, Maryland, New Hampshire, New York, Massachusetts, Colorado, Maine, Utah, Virginia, Michigan, Minnesota, District of Columbia, and Puerto Rico. You may find a more-updated list of states at the Movement Advancement Project. There is a currently a circuit split over whether bans on conversation therapy that only involves “talking" is constitutional.
If you are experiencing conversion therapy, either from a licensed provider or from other adults in your life, you should contact NCLR’s legal helpline by phone at (415) 392-6257 or (800) 528-6257. You can also contact the helpline by e-mail at info@nclrights.org.
Most of the time, if you are a minor you need a parent’s or guardian’s consent for transition-related care. If your parents are not married, you may need the consent of all your legal parent(s) or guardian(s). There are some exceptions to that general rule. For example, many states allow minors above a certain age to consent to their own mental health care. Whether you can consent to the care you need will depend on the laws in the state where you live, including if you are legally emancipated.For more guidance about what to do if one or more of your parent(s) or guardian(s) are not affirming your gender identity, please see Non-Affirming Care Environments.
Legislation limiting or outright prohibiting youth access to gender-affirming care, including puberty blockers and hormone treatment, is rapidly expanding. Your state may prohibit such care, and you should confirm with your doctor and state-level LGBT organizations. Some states are considering provisions that may have the effect of penalizing persons who leave the state in order to receive or facilitate such care, which could expose you to litigation risks. Please consult with an attorney if you are in a non-affirming state.
Some states have laws banning discrimination in insurance coverage based on gender identity. The states include Washington, Oregon, California, Nevada, Colorado, New Mexico, Minnesota, Wisconsin, Illinois, Michigan, Hawaii, Pennsylvania, Virginia, District of Columbia, Delaware, New Jersey, Connecticut, Rhode Island, Massachusetts, New York, Vermont, New Hampshire, Maine, and Puerto Rico.
Arkansas and Mississippi explicitly allow discrimination on this basis by insurance providers.
As mentioned, some states have enacted bans that restrict, partially or completely, access to gender-affirming healthcare. You can check whether there is a ban in your state by going to the Movement Advancement Project website. If you live in a state where there is a ban and you are unable to access care and are being discriminated against you can reach out to NCLR's legal helpline by phone at (415) 392-6257 or (800) 528-6257. You can also contact the helpline by e-mail at info@nclrights.org. You may also access community support through organizations listed at the back of this Handbook.
To get access health care, you can either pay for it by yourself, or get the care you need “covered” by your health insurance. In practice, most people can’t afford to pay for health care without health insurance coverage. To figure out whether your health insurance covers the type of care that you need, start by finding out what type of insurance you have.Minors usually get health care coverage through their parent(s) or guardian(s), although you could also be receiving care through Medicaid or another state program. You can ask your parent(s) or guardian(s) for help in getting a copy of your insurer’s member handbook and medical
policy listing the types of care they cover. You and your parent(s) or guardian(s) can then work with your medical provider to get the type of care you need pre-approved, or “pre-authorized,” by your insurer. The National Center for Transgender Equality has published this guide on how to get your care covered. If your plan doesn’t list or excludes the type of care that you need, it is possible to appeal that omission or exclusion with your insurer, and also to challenge the exclusion legally. It can also sometimes be possible to change your health insurance coverage.In practice, it can be easier to get some types of transition-related care covered than others. It can be easier to get coverage for hormones, blockers, top surgery, and bottom surgery. But it can still be difficult to get other procedures covered, such as facial feminization surgery and voice therapy. Insurers are also increasingly covering some procedures for non-binary people, such as top surgery for transmasculine people.
The Affordable Care Act bars discriminating on the basis of sex in providing health care. The Supreme Court has ruled that discrimination on the basis of sex includes discrimination based on transgender status.
Trans people have the right to be treated with dignity and to have their gender identity respected while receiving health care, regardless of the name and gender listed in your medical records. This means that your health care provider should not be misgendering you or singling you out for being transgender. It also means that your health care provider should provide the care that you need no matter what gender is listed in their medical records. You are entitled to whatever care is medically necessary for you, regardless of what your gender marker says.
Your provider should not be refusing to provide you care because you are trans. This is still true even if your provider claims that they cannot treat you because of their religion. Your health care provider should also not reveal your trans status to other people unless it’s medically necessary for them to know you are trans.
However, there are some states that may prevent doctors from providing gender affirming care or referring you to doctors who can provide that care.
If you are being discriminated against by a medical professional, you can contact NCLR's legal helpline by phone at (415) 392-6257 or (800) 528-6257. You can also contact the helpline by e-mail at info@nclrights.org.
In recent years, many states have launched a coordinated legislative attack on the ability of trans youth to access healthcare. These bans function in different ways in different states, and if you live in one of these states, your ability to access care in your state may be restricted. As of June 2023, 29% of trans young people live in states with some kind of ban on their healthcare.
North Dakota, Idaho, Oklahoma, Alabama, and Florida have enacted laws making it a crime to provide best practice medical care for trans youth. Florida, Oklahoma, and Alabama’s laws have all been temporarily blocked from being enforced, and so residents of those states should still be able to access care.
North Dakota, South Dakota, Utah, Arizona, Iowa, South Dakota, and Mississippi have enacted laws banning best practice medication and/or surgical care for trans youth.
Idaho, Georgia, Missouri, Montana, Nebraska, Texas, and West Virginia have enacted similar laws that have not yet gone into effect. Arkansas’ law has been permanently blocked, and Alabama, Florida, Indiana, Kentucky, Oklahoma, and Tennessee’s laws have all been temporarily blocked from being enforced. Residents of these states should still be able to access care. To get the most up to date information about whether or not your state has a healthcare ban, look at this map.
The landscape of these laws is changing fast, and the campaign to restrict our communities from the healthcare we need is coordinated, resourced, and powerful. However, the movement battling these laws is also coordinated, resourced, and powerful, and the legal and ideological basis for the laws does not stand up in court. Most bans on trans healthcare that have been put before a judge so far have been defeated.
If you live in one of the states that is trying to restrict trans healthcare, you might find that you can't find a doctor to help you, or that a doctor that you have been seeing is no longer able to provide care.
Start by reaching out to NCLR's legal helpline by NCLR's legal helpline by phone at (415) 392-6257 or (800) 528-6257 or by e-mail at info@nclrights.org to make sure you understand the laws that are affecting you. Our top priority as the legal arm of the trans liberation movement is to make sure that you are safe and have the care you need.
Then, strategize with your family and community. They can't shut us down as fast as we can build new ways to care for each other. Many states are enacting shield laws to protect trans people who live in or are coming from states like yours, and make sure you can still access the healthcare you need. Check to see if your state has such laws here.
Lastly, hold on tight to your hope. These bans are already falling, and even if one is impacting you right now, it won't last forever. Our community will outlast the hate.
