Gender-affirming care is defined by the Association of American Medical Colleges and the World Health Organization as “a range of social, psychological, behavioral, and medical interventions designed to support and affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth.” This may include a wide range of services, such as counseling and therapy, speech therapy to match the vocal characteristics of gender identity, breast binding and genital tucking, hormone therapies such as puberty blockers, and surgeries such as top surgery.
Increase in Anti-Trans Legislation
2023 has seen an unprecedented increase in bans on gender-affirming care. According to the Trans Legislation Tracker, 169 bills limiting transgender healthcare have been passed so far in 2023, a steep rise from 37 bills in 2022. Many of these bills target gender-affirming care on some level: Some have created stringent guidelines preventing access to gender-affirming care, whereas others have banned it completely for individuals below the age of 18.
Notable bills include Oklahoma Senate Bill 129, which prohibits “gender transition procedures or referral services relating to such procedures to anyone under the age of 26,” and Wyoming Senate Bill 111, which does the same for anyone under 18. These bills refer to gender-affirming services as “mutilation.” In Wyoming, for example, professionals who violate this bill by providing gender-affirming services can be punished with up to ten years of imprisonment — the same sentence as child abuse — regardless of parental and child consent to the procedures.
The recent wave of anti-transgender and anti-LGBTQ+ legislation is often partially explained as a result of increased queer visibility in the media. The 2021-2022 GLAAD report found “quick progress made” that year in intersectional television representation of LGBTQ+ characters; Netflix shows like “Heartstopper” and “Young Royals” topped charts.
Youth transgender activist and Harvard student Safara Malone ’27, who began socially transitioning during high school and medically transitioning this January, told the Harvard Political Review that the end of COVID-19 may have been a catalyst for the political targeting of transgender youth. For example, during the 2021 legislative session, though visibility of LGBTQ+ individuals had increased, local and state governments did not have the capacity to address the “issue” of LGBTQ+ individuals on top of COVID-19. However, now that the pandemic has subsided, many conservative politicians are taking advantage of transgender youth with vulnerable rights, using slogans of protecting children to further their political power.
On why transgender rights specifically are being targeted, Michael Bronski, the author of “A Queer History of the United States” and a professor of the practice in media and activism at Harvard, explained to the HPR that queer sexuality is easier for the general population to understand and accept than gender queerness: “People, even asexual individuals, understand that sex can give pleasure. The human impulse to have pleasure makes a lot of excuses for people — for example, the two ‘straight’ guys in the fraternity getting drunk and fooling around.”
Citing gender studies scholar Judith Butler, Bronski added that, “Gender is a much firmer binary; we have a far narrower range of what’s acceptable. Among the most powerful ‘speech-acts’ are ‘It’s a boy!’ and ‘It’s a girl!’ No one says, ‘How wonderful, it’s a human!’” Bronski noted that, “Literally seconds after we’re born, we’re given a gender identity, and it’s instilled and instilled and instilled.”
Influence of Religion and Undemocratic Politics
Malone found that conservative legislators have noticed parents, who are oftentimes Christian, becoming infuriated by the existence of transgender people. Politicians capitalize on these parents, as well as society’s general lack of understanding of transgenderism, to gain political power. “These parents are terrified of their child being transgender. Some of these legislators might feel the same way, but most just want to capitalize on the vote of these highly religious parents,” explained Malone.
Harvard student Trinity Dysis ’27, who identifies as Christian and transgender, believes that interpretations of the Bible to oppose gender-affirming care are “a gross misinterpretation of the text that has been found to be profitable,” adding that religious arguments against LGBTQ+ individuals misappropriate verses targeting pedophilia and rape.
Dysis finds it more productive to follow the values of Christ to be a better person rather than to debate over semantics in the text, as the recorded text itself is imperfect. For example, the overwhelmingly popular edition of King James’ translation of the Bible altered verses, replacing the word “slave” with “servant.” These alterations could have been done to mislead Christians, since the type of slave trade that flourished in the American South was explicitly condemned in the Old Testament. Dysis explained that the Bible was not written by God, but was instead passed down through oral tradition and translated between many languages, allowing for thousands of years of bias to seep into the project.
Misunderstandings of science likewise play a larger role in fueling this war on gender-affirming care. Conservative parents have formed anti-transgender protest groups, such as Parents of ROGD Kids, which pathologize transgender identity as an “epidemic” of “rapid-onset gender dysphoria.” The organization describes itself as “a group of parents whose children have suddenly — seemingly out of the blue — decided they identify strongly with the opposite sex and are at various stages in transitioning.” However, the validity of “rapid-onset gender dysphoria” has been scientifically disproven: The median time from realization to sharing one’s gender identity with others is typically over a decade and not “rapid” as Parents of ROGD Kids suggests.
Dysis, who was repeatedly denied access to gender-affirming care by her family, found politicians’ and parent groups’ claims that flocks of adolescents are suddenly being externally influenced to transition in an “epidemic” to be baseless. In reality, public access to gender-affirming care is still extremely limited. While politicians cherry pick vocal detransitioners who may have been rushed into the process without being properly informed and subsequently regret their transition, studies have shown that the vast majority of transgender individuals who have received gender-affirming do not regret their decision. In fact, the regret rate of knee replacement surgery (6-30%) can be more than 100 times that of the regret rate of gender-affirming surgery (0.3%).
Ultimately, the political atmosphere has led to other elected officials fearing the loss of support among parents if they do not actively champion transphobic legislation. This dynamic creates a dangerous competition of who can run the most anti-transgender platform. “Elections can no longer be won on the basis of racist commentary,” Dysis said. “That’s widely unacceptable. And gay rights have become less contested. However, transgender people are still a very vulnerable community to this kind of disruption.”
While Dysis believes that the rights of transgender individuals should be taken seriously, she believes it has no place being appropriated as conservative politicians’ entire platform. “The ‘anti-woke platform’ — opposing transgender rights — is Desantis’ and Trump’s main running slogan,” Dysis explained. “However, transgender individuals comprise less than 1% of the U.S. population.”
Unfortunately, the momentum of anti-transgender legislation is unlikely to stop at the state level. This spring, Malone testified at the Texas Capitol against House Bill 1686, the companion bill of Senate Bill 14, which bans gender-affirming care for individuals under the age of 18. Malone witnessed the Capitol legislators providing the opportunity for carefully selected detransitioners who came from out of state to speak before Texas citizens like herself, who was forced to wait 15 hours before being given the platform to testify. She felt sickened by the state’s refusal to hear the voices of transgender youth who would actually be impacted by the bill.
“Having to hear people who were supposed to be representing me in my government deny me as a person and say that all the work I have done is spreading toxic, nasty ideology — it’s just ridiculous,” Malone said. “It made me think, ‘I can’t wait to be out of this state, and I don’t want to come back.’”
Future of Transgender Rights
Malone is not alone in the sentiment of wanting to leave her conservative state. One direct consequence of states banning gender-affirming care is the increased movement of families with transgender youth temporarily or permanently to more liberal states. Because this momentum cannot stop on its own, the only political pathway to stopping the momentum of anti-transgender legislation is through cementing transgender healthcare rights and access to gender-affirming care through bills at the national level or through Supreme Court precedents.
The outcomes of the 2024 presidential election may impact gender-affirming care in a variety of ways. Malone believes that the best case scenario would be the re-election of Joe Biden. However, she does not see Biden passing the legislation required to codify gender-affirming care into national rights; she expects that such progress can happen no less than four years from now, if not longer. In Malone’s opinion, the worst case scenario is the election of Donald Trump or a similar politician, which would set back any progress by several years.
Eve Howe, a transgender lawyer who graduated from Harvard Law School, agrees that the worst case scenario is the election of Trump, which she believes may result in a national ban on gender-affirming care. In this case, she predicts a shift towards companies like Plume, which is digitally accessible regardless of physical location. “Transgender individuals may have to go through shady back alleys, fly to another country, or take road trips down to Mexico to get hormones,” Howe explained, likening this potential scenario to the current state of abortion access.
Howe hopes that if Republicans continue to lose on this issue like they have in the past, they’ll move on. “A few years ago, access to transgender care was a non-issue, but Republicans decided to make this an issue for fundraising and get people to vote for them. Eventually, the bully will get tired of attacking one kid and move onto the next kid. And I feel bad for whoever that next kid is.”
Ultimately, Bronski has a positive outlook on the long-term future of transgender care, emphasizing that change takes time. “You have to push for change sometimes very quickly, and too quickly for culture to accept it, but culture will ultimately accept it: Women in America began lobbying to have the vote in about 1840 and they didn’t get the vote until 1920,” Bronski said. “If the Republicans lose in 2024, I am optimistic for what will happen after that.”
For Malone, the normalization of transgender individuals is the first step toward turning this political state around. “In order to change the laws, we have to begin having positive and natural conversations about trans existence,” Malone said, “slowly normalizing us in modern society.”
The past two decades have been socially transformative in many ways, from the emergence of #MeToo to the legalization of gay marriage to the Black Lives Matter movement. Through continued intersectionality and allyship, America can likewise achieve tremendous progress in building a more equitable society for transgender individuals.
The Harvard University Student Health Insurance Plan covers gender-affirming services including, but not limited to, hormone therapy, top surgery (mastectomy), breast augmentation, and genital surgery for transgender and gender-diverse individuals whose gender identity differs from assigned sex at birth. Learn more here.
