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. Licensed practitioners have been banned from performing conversion therapy on minors in California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, Washington D.C., and Puerto Rico.
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.
Some states have laws banning discrimination in insurance coverage based on gender identity. The states include California, Colorado, Delaware, Hawaii, Illinois, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, and Washington D.C. In addition, some states do not have explicit laws banning discrimination in insurance coverage based on gender identity, but they have agencies that have issued “insurance bulletins” stating that they interpret existing state laws to already ban gender identity discrimination in insurance. These states include: Connecticut, Maryland, Massachusetts, Michigan, Montana, and Pennsylvania. 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.