Transgender children and their families are under attack. In the last two years, politicians and lawmakers have sought to limit transgender youth from accessing health care, education, and other basic rights.
Through a campaign of moral outrage based on misleading, incorrect, and at times outright fabricated information, state legislators have introduced at least 306 bills from 2020 to 2022 that target the trans community. Most concerning, the majority of these laws, 86%, center on transgender youth.1
Transgender youth face unique challenges when it comes to their health and well-being. Many of them experience gender dysphoria, which is a condition of deep discomfort with one’s assigned gender and a strong desire to live as their true gender identity.2
Gender-affirming care – which can be medical or social in nature, or both – is essential for these youth.
Unfortunately, there are a growing number of people, including major political figures, who believe that providing this care to minors constitutes child abuse.Detractors argue that providing hormone blockers, puberty blockers, and other treatments to transgender children is a form of child abuse and should be legally banned.3
This is simply not true. In fact, it is the denial of gender-affirming care, which can be harmful and even deadly for transgender youth, that may qualify as child abuse.
Facts on Gender-affirming Care for Children
Being transgender is not a choice, according to the American Academy of Pediatrics (AAP).4 It is a deeply ingrained aspect of a person's identity that they have no control over. For many transgender youth, gender-affirming care is not a choice either – it is a necessity. Without access to this care, they may experience depression, anxiety, and other mental health issues that can have a negative, lifelong impact.
It is important to note that there is no existing medical intervention appropriate or prescribed for children who have not yet reached puberty.The only recommendation for prepubescent transgender and gender-nonconforming children is a “social transition” – that is, allowing the child to socially present as their identified gender. This may include clothing choice, growing or cutting their hair, and using their correct pronouns. Under no circumstances are doctors performing genital surgeries on transgender children.5
Puberty blockers are medications used to pause the onset of puberty. They work by suppressing the release of hormones that cause physical changes, such as the development of breasts or the growth of facial hair.6
These medications are commonly used for transgender youth who experience distress or discomfort with the physical changes that occur during puberty. By delaying these changes, trans youth are given more time to explore their gender identity and make thoughtful decisions about their transition. Puberty blockers are reversible and are typically administered in early adolescence, when puberty begins. They can be a vital part of a comprehensive approach to supporting transgender youth.
One of the most important aspects of gender-affirming health care for older transgender youth is access to hormone therapy. Hormone therapy can help teens and young adults develop secondary sex characteristics that align with their gender identity, such as breasts or facial hair. It can also help alleviate some of the mental distress associated with gender dysphoria.
Studies have shown that hormone therapy is a safe and effective treatment for transgender teens, and denying it can have serious consequences. Hormone replacement therapy is not suitable for prepubescent children and is not prescribed to them.7
Gender confirmation surgeries are by far the most controversial treatment method for trans youth. However, surgeries such as mastectomies for transmasculine youth are not approved for any child younger than midteens – the same age requirements for other surgical interventions like breast reductions and gastric bypass surgery.8
Additionally, transgender youth and their families are not making these decisions lightly – they are making informed decisions with the guidance of medical professionals who have expertise in this area.
Monika Allis,, Marquette Class of 2024, holds a master of social work and is a former child welfare social worker. She has been an LGBTQ+ advocate and educator for more than 20 years and provides professional consulting services for social service agencies.
Why Gender-affirming Care Is Not Child Abuse
Critics of gender-affirming health care for transgender youth often claim that it is tantamount to child abuse. They argue that providing these treatments to minors is "experimental" and "risky."
However, the reality is that gender-affirming health care is backed by decades of research and has been shown to be safe and effective. The World Professional Association for Transgender Health (WPATH)9 and the American Academy of Pediatrics (AAP) both recommend gender-affirming health care for transgender youth.10
Why is gender-affirming care for children not child abuse?
Gender-affirming health care for transgender youth is not child abuse because it is medically necessary. Transgender youth experience gender dysphoria, which is a serious mental health condition that can lead to anxiety, depression, and even suicide. Gender-affirming health care, including hormone blockers and other treatments, has been shown to reduce gender dysphoria symptoms and improve mental health outcomes in transgender youth.It is essential that transgender youth have access to the medical care they need to live happy, healthy lives.11
Gender-affirming health care for transgender youth is not child abuse because it is supported by medical professionals. The American Academy of Pediatrics, the American Medical Association, and many other medical organizations have issued statements supporting gender-affirming health care for transgender youth.12 These organizations have recognized that transgender youth have unique medical needs and that providing them with gender-affirming health care is essential for their physical and mental health.
Gender-affirming health care for transgender youth is not child abuse because it is reversible. Many opponents of gender-affirming health care argue that providing hormone blockers to transgender youth is irreversible and will lead to regret later in life. However, the reality is that hormone blockers are reversible and have been used safely for decades to treat other medical conditions.13
What is irreversible, however, is child suicide, which is among other consequences of denying transgender and gender-nonconforming youth support and care.
Denial of Support and Care as Emotional Abuse
Denying transgender youth support and care may qualify as a form of child abuse under Wisconsin law, because such a denial can cause children significant “emotional damage.”
According to the Wisconsin Children’s code at Wis. Stat. 48.02(5j):
“Emotional damage" means harm to a child's psychological or intellectual functioning. “Emotional damage" shall be evidenced by one or more of the following characteristics exhibited to a severe degree: anxiety; depression; withdrawal; outward aggressive behavior; or a substantial and observable change in behavior, emotional response or cognition that is not within the normal range for the child's age and stage of development.
Transgender children often experience distress and discomfort when their gender identity does not match the sex they were assigned at birth. This can lead to anxiety, depression, and even suicidal ideation.14
Failing to support these children by denying them access to medical interventions – such as puberty blockers or hormone therapy or by not using their preferred name or pronouns – can exacerbate these negative effects and create a hostile and unsupportive environment.
According to a 2016 study in LGBT Health, parental rejection increases the risk of substance abuse and suicide attempts in transgender and gender-nonconforming people.15
A lack of acceptance can be particularly damaging during a critical period of development, when children are forming their sense of self and their relationships with others. By failing to support transgender children, caregivers are putting their emotional and physical health at risk.
However, a study of over 8,000 trans youth by The Trevor Project, published just this year, found that acceptance of a child’s gender identity from family and friends is associated with significantly lower odds of attempting suicide among transgender and nonbinary youth. “The findings of this study are clear: transgender and nonbinary young people who feel accepted by the people in their lives, are less likely to attempt suicide,” wrote Dr. Myeshia Price, senior research scientist at The Trevor Project.16
Conclusion: Gender-affirming Care is Care for Our Transgender Youth
Providing gender-affirming health care for transgender youth is not child abuse. It is a medical necessity that is supported by medical professionals and is essential for the physical and mental health of transgender youth.
Denying youth access to necessary medical treatments can be harmful and even deadly. The evidence is clear that social transitions, puberty blockers, hormone therapy, and other treatments can be safe and effective for gender dysphoria in minors.
It is important to support and advocate for transgender youth, so that they can access the medical care they need to live happy, healthy lives.
As child welfare legal professionals, we must reject the harmful and dangerous rhetoric that portrays gender-affirming health care as child abuse and work toward a more inclusive and accepting society. As a society, we have a responsibility to support and care for all of our youth, including those who are transgender.
This article was originally published on the State Bar of Wisconsin’s Children & the Law Section Blog. Visit the State Bar sections or the Children & the Law Section webpages to learn more about the benefits of section membership.
Endnotes
1 Nakajima, Koko, and Connie Hanzhang Jin, “Bills Targeting Trans Youth Are Growing More Common – and Radically Reshaping Lives,” NPR, Nov. 28, 2022.
2 Wylie C. Hembree, “Gender Dysphoria/Gender Incongruence Guideline Resources,” Endocrine Society, Dec. 8, 2022.
3> Texas Attorney General Ken Paxton, “Re: Whether Certain Medical Procedures Performed on Children Constitute Child Abuse (RQ-0426-KP),” received by Matt Krause, Chair, House Committee on General Investigating, Feb. 18, 2022.
4 AAP Continues to Support Care of Transgender Youths as More States Push Restrictions, American Academy of Pediatrics News, Jan. 6, 2022.
5 J. Olson-Kennedy, et al., “Impact of Early Medical Treatment for Transgender Youth: Protocol for the Longitudinal, Observational Trans Youth Care Study,” Journal of Medical Internet Research, July 9, 2019.
6 Id.
7 Id.
8 Id.
9 E. Coleman, et al., “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8,” International Journal of Transgender Health, 23(S1), S1-S260.
10 Cf. n. 4.
11 Id.
12 Id.
13 E. Coleman, et. al, “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8,” International Journal of Transgender Health, 23(S1), S1-S260.
14 J. Olson-Kennedy, et al.
15 Augustus Klein and Sarit A. Golub, “Family Rejection as a Predictor of Suicide Attempts and Substance Misuse Among Transgender and Gender Nonconforming Adults,” LGBT Health, May 25, 2016.
16 Myeshia N. Price and Amy E. Green, Association of Gender Identity Acceptance with Fewer Suicide Attempts Among Transgender and Nonbinary Youth, Transgender Health, February 2023.
