A transgender person's biological sex does not match their sense of being a man, woman, or non-binary. Gender dysphoria is when this difference causes persistent distress (Ahmad 2013).
HRT for transgender patients aims to match testosterone or estrogen levels with their gender identity. HRT is started after puberty and taken throughout life (Coleman 2022).
Testosterone HRT is a “masculinizing hormone therapy," leading to:
Estrogen HRT is a "feminizing therapy" causing:
There is not scientific consensus about the health risks of HRT due to small sample sizes, study inconsistencies, and short follow-up times.
Stopping HRT reverses most physical changes.
Among cisgender patients, stopping hormone therapy causes endocrine withdrawal symptoms (e.g., hot flashes, fatigue, anxiety, headaches, muscle and joint pain; Hochberg 2003).
Neither the physical nor psychological impact of involuntarily stopping HRT among transgender patients has been studied.
Puberty blockers stop hormones that initiate puberty and are approved for children who start puberty under the ages of 8 (female) and 9 (male). Medication is typically used for 1 to 5 years (Watson 2015).
No matter how long puberty blockers are used, puberty resumes once stopped (Coleman 2022). The health impact of delaying typically timed puberty or the impact of denying transgender youth this care has not been studied.
In a study of 70 transgender youth, puberty blockers decreased depression, behavioral and emotional problems, and improved general functioning (de Vries 2011).
A small study found no negative health effects of puberty blockers on kidney or liver function in transgender youth.
In the last two years, 16 states prohibited some or all medical care for transgender youth (Figure 1). How these policies impact families, youth mental health, healthcare professional liabilities, and healthcare costs is unclear.
Figure 1. State laws regarding transgender youth medical care. Dark orange states prohibit medication and surgical care, light orange prohibit surgical care, red triangles add felony provisions for medical professionals, and yellow triangles restrict care via executive action. Blue states have passed legal protections, access, and coverage for youth transgender care. Stars (*) indicate proposed policy.
Medical Professionals. Current legislation:
Families. Some legislation classifies guardians who seek gender-affirming care for their children as child abusers or classifies care as mutilation (UCLA 2023).
Financial Impacts. Some states restrict Medicaid from covering gender-affirming care or allow private insurance to opt out of coverage, requiring self-financing (UCLA 2023).
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