Gender-Affirming Care and Young People

HHS Office of Population Affairs

Web: opa.hhs.gov | Email: opa@hhs.gov | Twitter: @HHSPopAffairs

YouTube: HHSOfficeofPopulationAffairs | LinkedIn: HHS Office of Population Affairs

Gender-affirming care is a supportive form of healthcare. It consists of

an array of services that may include medical, surgical, mental health,

and non-medical services for transgender and nonbinary people.

For transgender and nonbinary children and adolescents, early gender-

affirming care is crucial to overall health and well-being as it allows the

child or adolescent to focus on social transitions and can increase their

confidence while navigating the healthcare system.

Research demonstrates that gender-affirming care improves the mental

health and overall well-being of gender diverse children and

adolescents.

Because gender-affirming care encompasses many facets

of healthcare needs and support, it has been shown to increase positive

outcomes for transgender and nonbinary children and adolescents.

Gender-affirming care is patient-centered and treats individuals

holistically, aligning their outward, physical traits with their gender

identity.

Gender diverse adolescents face significant health disparities compared

to their cisgender peers. Transgender and gender nonbinary adolescents

are at increased risk for mental health issues, substance use, and

suicide.

2,3

The Trevor Project’s 2021 National Survey on LGBTQ Youth

Mental Health found that 52 percent of LGBTQ youth seriously

considered attempting suicide in the past year.

A safe and affirming healthcare environment is critical in fostering better

outcomes for transgender, nonbinary, and other gender expansive

children and adolescents. Medical and psychosocial gender affirming

healthcare practices have been demonstrated to yield lower rates of

adverse mental health outcomes, build self-esteem, and improve overall

quality of life for transgender and gender diverse youth.

5,6

Familial and peer support is also crucial in fostering

similarly positive outcomes for these populations. The presence of affirming support networks is critical for

facilitating and arranging gender affirming care for children and adolescents. Lack of such support can result in

rejection, depression and suicide, homelessness, and other negative outcomes.

7,8,9

What is gender-affirming care?

Why does it matter?

Common Terms

Cisgender: Describes a person

whose gender identity aligns with

their sex assigned at birth

Gender diverse or expansive: An

umbrella term for a person with a

gender identity and/or expression

broader than the male or female

binary. Gender minority is also used

interchangeably with this term

Gender dysphoria: Clinically

significant distress that a person may

feel when sex or gender assigned at

birth is not the same as their identity

Gender identity: One’s internal

sense of self as man, woman, both

or neither

Nonbinary: Describes a person who

does not identify with the man or

woman gender binary

Transgender: Describes a person

whose gender identity and or

expression is different from their sex

assigned at birth, and societal and

cultural expectations around sex

HHS uses LGBTQI+ (lesbian, gay,

bisexual, transgender,

queer/questioning, or intersex) to reflect

the diversity of this community. More

specific terms are used in alignment with

research and information sources.

However, people who are part of this

community may use various other

terms to define their identity.

Additional Information

• Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical

Practice Guideline

• Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and

Adolescents | American Academy of Pediatrics

• Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People

| World Professional Association for Transgender Health

Gender-Affirming Care and Young People

HHS Office of Population Affairs

Web: opa.hhs.gov | Email: opa@hhs.gov | Twitter: @HHSPopAffairs

YouTube: HHSOfficeofPopulationAffairs | LinkedIn: HHS Office of Population Affairs

Affirming care What is it? When is it used? Reversible or not

Social Affirmation

Adopting gender-affirming hairstyles,

clothing, name, gender pronouns, and

restrooms and other facilities

At any age or stage

Reversible

Puberty Blockers

Using certain types of hormones to

pause pubertal development

During puberty

Reversible

Hormone Therapy

Testosterone hormones for those who

were assigned female at birth

Estrogen hormones for those who were

assigned male at birth

Early adolescence

onward

Partially reversible

Gender-Affirming

Surgeries

“Top” surgery – to create male-typical

chest shape or enhance breasts

“Bottom” surgery – surgery on genitals

or reproductive organs

Facial feminization or other procedures

Typically used in

adulthood or case-

by-case in

adolescence

Not reversible

Resources

• Discrimination on the Basis of Sex | HHS Office of Civil Rights

• Lesbian, Gay, Bisexual, and Transgender Health | Healthy People 2030

• Lesbian, Gay, Bisexual, and Transgender Health: Health Services | Centers for Disease Control and Prevention

• National Institutes of Health Sexual & Gender Minority Research Office

• Family Support: Resources for Families of Transgender & Gender Diverse Children | Movement Advancement Project

• Five Things to Know About Gender-Affirming Health Care | ACLU

• Gender-Affirming Care is Trauma-Informed Care | The National Child Traumatic Stress Network

• Gender-Affirming Care Saves Lives | Columbia University

• Gender Identity | The Trevor Project

• Genderspectrum.org

• Glossary of Terms | Human Rights Campaign

• Health Care for Transgender and Gender Diverse Individuals | ACOG

• Transgender and Gender Diverse Children and Adolescents | Endocrine Society

Green, A. E., DeChants, J. P., Price, M. N., and Davis, C. K. (2021). Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of

Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. Journal of Adolescent Health, 70(4).

https://doi.org/https://doi.org/10.1016/j.jadohealth.2021.10.036

Rimes, K., Goodship N., Ussher, G., Baker, D. and West, E. (2019). Non-binary and binary transgender youth: Comparison of mental health, self-

harm, suicidality, substance use and victimization experiences. International Journal of Transgenderism, 20 (2-3); 230-240.

Price-Feeney, M., Green, A. E., & Dorison, S. (2020). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent

Health, 66(6), 684–690. https://doi.org/10.1016/j.jadohealth.2019.11.314

Trevor Project. (2021). National Survey on LGBTQ Youth Mental Health 2021. Trevor Project. https://www.thetrevorproject.org/survey-2021/

Wagner J, Sackett-Taylor AC, Hodax JK, Forcier M, Rafferty J. (2019). Psychosocial Overview of Gender-Affirmative Care. Journal of pediatric and

adolescent gynecology, (6):567-573. doi: 10.1016/j.jpag.2019.05.004. Epub 2019 May 17. PMID: 31103711.

Hughto JMW, Gunn HA, Rood BA, Pantalone DW. (2020). Social and Medical Gender Affirmation Experiences Are Inversely Associated with Mental

Health Problems in a U.S. Non-Probability Sample of Transgender Adults. Archives of sexual behavior, 49(7):2635-2647. doi: 10.1007/s10508-020-

01655-5. Epub 2020 Mar 25. PMID: 32215775; PMCID: PMC7494544.

Brown, C., Porta, C. M., Eisenberg, M. E., McMorris, B. J., & Sieving, R. E. (2020). Family relationships and the health and well-being of transgender

and gender-diverse youth: A critical review. LGBT Health, 7, 407-419. https://doi.org/10.1089/lgbt.2019.0200

Seibel BL, de Brito Silva B, Fontanari AMV, Catelan RF, Bercht AM, Stucky JL, DeSousa DA, Cerqueira-Santos E, Nardi HC, Koller SH, Costa AB.

(2018). The Impact of the Parental Support on Risk Factors in the Process of Gender Affirmation of Transgender and Gender Diverse People. Front

Psychol, 27;9:399. doi: 10.3389/fpsyg.2018.00399. Erratum in: Front Psychol. 2018 Oct 12;9:1969. PMID: 29651262; PMCID: PMC5885980.

Sievert ED, Schweizer K, Barkmann C, Fahrenkrug S, Becker-Hebly I. (2021). Not social transition status, but peer relations and family functioning

predict psychological functioning in a German clinical sample of children with Gender Dysphoria. Clin Child Psychol Psychiatry, 26(1):79-95. doi:

10.1177/1359104520964530. Epub 2020 Oct 20. PMID: 33081539.