Gender-Affirming Support Needs to Move Beyond State Limits

Chicago has become a safe haven for many LGBTQ+ people and families fleeing states where they are being persecuted, but the future is looking stark and policymakers need to step up.

Published: Jul 10, 2023  |  

Assistant Professor of Family Medicine at Rush University Medical Center


A Kentucky federal judge recently blocked Kentucky Senate Bill 150 calling for restrictions on gender-affirming care for transgender youth in that state, and in Tennessee a judge blocked a similar ban that would have denied such care beginning July 1.

However, these rulings follow a Florida judge’s decision recently striking down the state’s ban on Medicaid coverage for gender-affirming care, affecting potentially thousands of transgender children and adults.

Noting in his 54-page ruling that “Gender Identity is real,” U.S. District Judge Robert Hinkle determined that the health code rules and laws disallowing access to puberty blockers and cross-sex hormones violated transgender people’s rights to equal protection and the Affordable Care Act’s prohibition of sex discrimination.   

As a board-certified family physician who provides evidence-based care for the local LGBTQ+ community, it is a welcome relief to see legal reasoning starting to catch up with what is already recognized by the American Medical Association and numerous other professional medical societies: Transgender people are real, and gender-affirming care is medically necessary care.   

Gender-affirming care is the medical term for what is commonly referred to as transgender care, transgenderism, or cross-sex therapy. It encompasses a wide spectrum of care depending on how a person identifies, which is frequently different from the gender someone was assigned at birth.

A 2022 study by Pew Research Center revealed that 5% of adults aged 18-29 and 1.6% of adults aged 30-49 consider themselves transgender (the opposite gender of what they were born) or gender non-binary (no specific gender). 

In my medical practice, I care for LGBTQ+ patients, including transgender and gender non-binary patients, using the best available scientific evidence to guide my patients in making health decisions that are right for them. 

Often, I treat them for gender dysphoria, a condition that results when one’s appearance does not match their gender identity. Gender dysphoria often results in increased levels of depression and anxiety. Treating my patients’ gender dysphoria with gender-affirming hormone therapy consistently improves their mood.

A 2021 longitudinal study followed nearly 200 transgender patients on gender-affirming hormone therapy and showed that their mood improved with treatment of their dysphoria. 

Treating gender dysphoria and advocating for acceptance of transgender people, and all LGBTQ+ people, is of critical importance, particularly in young people. 

Research in 2020 found that among LGBTQ+ youth, transgender and gender nonbinary adolescents were two times more likely to report severe depression, thoughts or attempts of suicide, than their cisgender LGBTQ+ peers. Twenty-three percent of LGBTQ+ youth attempted suicide in the previous year compared to 5% of non-LGBTQ+ youth.

The Trevor Project Foundation confirmed these numbers in its 2022 survey on the mental health of LGBTQ+ youth in America. The survey found that one in five transgender and non-binary youth attempted suicide in the past 12 months.  

This same survey showed the importance of an accepting community and revealed that all LGBTQ+ youth (cisgender and transgender alike) who lived in communities supportive of their identities were half as likely to seriously consider or attempt suicide as those who lived in unsupported communities.  

Far from benefiting their constituents, state lawmakers who pass or propose bans that attack transgender and cisgender children and adults are causing real harm.

The Trevor Project released the results of a national 2021 survey showing that two-thirds of LBGTQ teens were suffering negative mental health impacts as a result of the ongoing debate about state bans.

In my practice in Chicago, new LGBTQ+ patients frequently come to me who have recently moved to this state from Indiana, Texas, Missouri, and Florida. All are states that enacted bans on transgender care or LGBTQ+ care in some manner. That number of states is expected to grow.  

To be sure, many have raised the concern that some who undergo gender transition later regret it and want to change back. While this theory has been a driver for many laws banning gender-affirming care, the prevalence of regret is largely overblown.   

A large meta-analysis that looked at nearly 8,000 transgender patients who underwent some type of gender-affirming surgery found that less than 1% of them regretted having surgery and wanted to detransition. This is consistent with other available research on the percentage of people who regret having transitioned.  

Illinois is a safe haven for many LGBTQ+ people and families fleeing states where they are being persecuted. But this city and this state cannot be content with just being a destination for those seeking safety.

It is important for policymakers, elected officials, funders, administrators, healthcare providers, and residents to be vocal examples of why including LGBTQ+ rights and concerns in the national fabric is vital to American democracy.

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