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Health Care and Support for Transgender and Gender Diverse Adolescents

Issue Brief

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Overview

The American College of Obstetricians and Gynecologists (ACOG) is committed to ensuring all individuals can access high quality medical care provided by its members with compassion, dignity, and respect, regardless of gender identity or sexual orientation. ACOG has long opposed unnecessary, unjustified government restrictions on access to medical care and has consistently urged politicians to listen to medical experts when making policy that affects public health. State policies to deny transgender and gender diverse adolescents care to realize their gender identities undermine evidence-based care, compromise the patient-clinician relationship, and would have grave consequences for the health and lives of young people.

ACOG Position

  • Transgender and gender diverse individuals, like all people, must have access to respectful, equitable, evidence-based
    care, free from discrimination and political interference.
  • Policies that dictate medical practice, restrict patient-clinician communications, and criminalize or penalize
    clinicians for practicing according to their professional judgement and training represent dangerous and ill-advised
    interference in quality, ethical patient care.
  • Efforts to affirm and uplift the civil, human, and reproductive rights of the LGBTQIA and gender diverse
    communities should be supported at all levels, from the individual clinical environment to the government.
  • Evidence, science, and the needs of patients should drive public health policies.

How do government restrictions negatively impact transgender adolescents?

Policies driven by discrimination and misinformation create a harmful environment for transgender youth and compromise
quality patient care, including by:

  • Exacerbating existing inequities. Transgender individuals face pervasive mistreatment and violence, and experience
    high rates of suicide attempts, poverty, unemployment, and homelessness. Discriminatory policies in the health care
    system will further widen the health care gap and exacerbate structural inequities These inequities are particularly
    pronounced for transgender and gender diverse individuals of color.
  • Criminalizing health care professionals. Threatening clinicians with civil, professional, and even criminal penalties
    undermines their professional and ethical obligations to their patients. No physician should be criminalized or otherwise
    penalized for providing compassionate, evidence-based necessary medical care and information.
  • Limiting clinician speech. Requiring that clinicians withhold information and counseling about evidence-based
    care compromises open, honest, and confidential communications. This chilling effect undermines patient trust and
    compromises the informed consent process.
  • Impacting care across the spectrum of services. Presenting to a health care office can be anxiety-provoking for a
    transgender individual. Bans on transgender care can add to this stress and diminish confidence that the health care system will
    meet their needs, even serving as a deterrent to seeking treatment and preventive services spanning the continuum of care.
  • Threatening mental health. Transgender adolescents experience disproportionate psychological distress, including
    reporting staggering rates of suicide attempts. Social and familial acceptance, and access to gender-affirming care are
    both associated with improved mental health. i, ii
  • Encouraging discrimination. Denying transgender youth needed health care and prohibiting participation in their
    communities according to their true identities will further marginalize transgender adolescents, resulting in poorer health
    outcomes and undermining their ability to live happy and healthy lives.

How can clinicians, health care systems, and communities create an inclusive environment for adolescents?

  • Medical care and community support that affirms adolescents’ gender identities improves the health and lives of transgender
    and gender diverse young people.
  • Adolescents must be able to live openly and consistent with their gender identity, without fear of stigma, discrimination, or
    retaliation from clinicians, support systems, schools, communities, and elected officials and other policymakers.
  • Health care professionals can play an important role by creating a welcoming, confidential clinical environment iii where
    adolescents can openly discuss issues and needs, including sexual and reproductive health, disclosure of gender identity
    to their families and communities, community resources and support, and gender transition care.
  • ACOG joins major medical associations in supporting access to evidence-based gender affirming care for transgender
    youth, free from political interference. iv, v, vi
  • Medical experts in transgender care, including the World Professional Association for Transgender Health, the Endocrine
    Society, and the Pediatric Endocrine Society, have published guidelines on how best to care for transgender adolescents,
    including the provision of gender affirming care. vii
  • There is no uniform transgender experience. Each individual will desire different outcomes, underscoring that as with all
    care, health care and counseling for transgender youth should be individualized, confidential, evidence-based, and free
    from discrimination and government interference.
  • Health care professionals alone cannot provide the support transgender adolescents need.

How can policymakers advance the health and wellbeing of transgender and gender diverse individuals?

ACOG calls for policies that affirm and uplift the civil, human, and reproductive rights of the LGBTQIA and gender diverse communities.

  • Despite important strides to address disparities and advance civil rights for these communities, there are still tremendous
    barriers in access to equitable health care. Efforts to reduce inequities should be supported at all levels, from the
    individual clinical environment to systemic public health and policy interventions.
  • For example, policymakers can work to improve the health and wellbeing of transgender and gender diverse individuals,
    including adolescents, by:
    • Supporting LGBTQIA nondiscrimination protections in health care, housing, employment, public spaces, state and
      federally funded programs, and other areas of civic and community participation
    • Requiring coverage for all evidence-based treatments for transgender patients under public and private health
      insurance plans
    • Ensuring LGBTQIA youth can live openly and consistent with their gender identity, including participating in school
      and community activities such as athletic programs, without discrimination
    • Promoting comprehensive, LGBTQIA-inclusive sexuality education curricula
    • Confronting gender-based violence, intimate partner violence, and hate crimes
    • Improving access to physical and mental health services

Additional Resources from ACOG

i James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National
Center for Transgender Equality.
ii American Medical Association Issue Brief, Health Insurance Coverage for Gender Affirming Care of Transgender Patients (March 2021) at https://www.amaassn.org/system/files/2019-03/transgender-coverage-issue-brief.pdf
iii American College of Obstetricians and Gynecologists Committee Opinion 823, Health Care for Transgender Individuals (March 2021) at
iv Joint statement of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and
Gynecologists, the American College of Physicians, the American Osteopathic Association, and the American Psychiatric Association, Frontline Physicians
Oppose Legislation That Interferes in or Penalizes Patient Care (April 2021) at https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/equality/STG6-
FrontlinePhysiciansOpposeLegislationThatInterferesInOrPenalizesPatientCare-040221.pdf
The American Medical Association, the American Academy of Pediatrics, and the American Psychiatric Association
v Rafferty J, Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents, Pediatrics Oct 2018, 142 (4) at https://
pediatrics.aappublications.org/content/142/4/e20182162
vi North American Society of Adolescent and Pediatric Gynecology Position Statement, Gender Affirming Care for Minors (ACOG Endorsed), (April 2021) at
https://www.naspag.org/assets/docs/NASPAG%20Position%20Statment%20Gender%20Affirming%20Care%20for%20Minors.pdf
vii American College of Obstetricians and Gynecologists Committee Opinion 823, Health Care for Transgender and Gender Diverse Individuals (March 2021) at
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/03/health-care-for-transgender-and-gender-diverse-individuals