As more and more states move to block genderaffirming care for minors, the issue of whether or not to give Americans under the age of 18 access to this type of medical treatment that includes puberty blockers, hormone therapies and surgeries is becoming more contentious.

In the first half of 2023 several states, including Texas, Missouri and Idaho, enacted laws that ban such care, bringing the total number of states that prohibit genderaffirming care up to 20. Advocates of the bans argue that this type of medical care is endangering children and there is a lack of scientific evidence to prove otherwise.

“Missouri is the first state in the nation to successfully defend at the trial court level a law barring child mutilation,” Missouri Attorney General Andrew Bailey said in a statement following a court ruling in August that upheld the state’s law to ban gender-affirming care. “I’ve said from day one as attorney general that I will fight to ensure that Missouri is the safest state in the nation for children.”

Many in favor of bans also argue that gender-affirming care can create long-term negative side effects such as the risk of fertility loss and reduction in bone density, especially with hormone therapies. Some researchers and medical professionals argue, however, that more research needs to be done to confirm the accuracy of these potential side effects.

“The science and medical evidence is conflicting and unclear,” Judge Steven Ohmer of the 22nd Judicial Circuit Court stated in his ruling against an injunction that would have stopped the enactment of Missouri’s ban on gender-affirming care. “Accordingly, the evidence raises more questions than answers. As a result, it has not clearly been shown with sufficient possibility of success on the merits to justify the grant of a preliminary injunction.”

Missouri’s law prevents health care providers from administering gender-affirming care for minors until at least Aug. 28, 2027. It also bars the state’s Medicaid program from paying for gender-affirming surgeries and hormones for youth, and it prohibits access to genderaffirming surgeries for adults in prison. Individuals who began gender-affirming treatment before Aug. 28, 2023, however, are not affected by the new law. Meanwhile, a judge in Texas ruled to block the enactment of that state’s ban on gender-affirming care that would have gone into effect Sept. 1.

“The Act’s prohibition on providing evidence-based treatment for adolescents with gender dysphoria stands directly at odds with parents’ fundamental right to make decisions concerning the care of their children,” Judge Maria Cantu Hexsel of the 53rd Judicial District Court wrote in her ruling. She also found the law discriminatory and stated that it interferes with doctors’ relationships with patients and their ability to provide care.

“The court decision is a critical victory for transgender youth and their families, supporters and health providers against this blatantly unconstitutional law,” Brian Klosterboer of the American Civil Liberties Union (ACLU) of Texas and a lawyer for the families who brought the lawsuit against the state said in a statement.

The ACLU is one of several organizations and associations in support of gender-affirming care. The American Academy of Pediatrics (AAP), American Psychological Association (APA) and American Medical Association (AMA) have all voiced opposition to bans and argued that gender-affirming care improves the mental health and reduces suicide risk of transgender patients. In August, the AAP reaffirmed its 2018 guidance advocating for youth to receive gender-affirming care and reported that it would commence a new literature review to provide pediatricians with more up-to-date advice on the issue.

The association’s CEO Mark Del Monte also said in a statement that the need for an updated literature review “reflect[s] the fact that the board is concerned about restrictions to accessing evidence-based healthcare for young people who need it.” Some faulted the AAP, however, and argued that the association should have conducted an updated literature review first before reaffirming its guidance. “It’s like building the airplane while you’re flying it,” said Quentin Van Meter, past president of the American College of Pediatricians. “It shouldn’t happen in any area of science, let alone this.”

The debate around gender-affirming care is likely to persist, especially as the scientific evidence about the issue continues to unfold and evolve. For more background, see the October 2021 issue of Congressional Digest on “LGBTQ Rights.”