Legislation to Criminalize Gender-Affirming Medical Care for Transgender Youth.

Caring for Transgender Youth Transgender adolescents are those whose gender identity (ie, their psychological sense of their own gender) is incongruent with their sex assigned at birth.1 According to a 2017 study from the Centers for Disease Control and Prevention, 1.8% of 118 803 surveyed adolescents in the United States identified as transgender.2 In this same study, approximately 35% of transgender adolescents reported having attempted suicide, highlighting the importance of the mental health concerns affecting this population.2 Affirmation of an adolescent’s transgender identity is associated with favorable mental health outcomes.1,3,4 Major medical organizations have outlined best practices for supporting transgender adolescents.1,3,4 These include facilitation of a social transition (ie, taking on the name, pronouns, and other elements of gender expression that match the adolescent’s gender identity), consideration of pubertal suppression (ie, gonadotropinreleasing hormone analogues that temporarily and reversibly pause puberty to prevent the development of secondary sex characteristics that often cause psychological distress for transgender youth), and consideration of gender-affirming hormones (ie, medications including estradiol and testosterone that induce physical feminization or masculinization, respectively, that align with the adolescent’s gender identity). Although research has not established that these interventions cause infertility, guidelines recommend that adolescents be offered fertility preservation options prior to treatment with gender-affirming hormones, given the theoretical risk that these medications may impair fertility.1,3,4 Although gender-affirming genital surgery is generally not recommended until adulthood, these guidelines note that some transmasculine adolescents may benefit from masculinizing chest surgery to lessen chest dysphoria.1,3,4