Transgender youth and their families struggle to find gender-affirming care – even in states where it’s still legal

Imagine this scenario: In late 2025, a social worker sits down with a transgender teenager and his parents. The family is trying to decide whether, and when, to begin gender-affirming hormone treatment.

No one in the family was questioning this young person’s gender identity. The teen had been living as a boy for years. By all accounts, he was thriving: emotionally, academically and socially.

He felt ready for this next step, and so did his parents – at first.

What gave them pause was not a wavering in the parents’ support of their child’s identity, or a change in the teen’s needs. Instead, they felt unsure whether starting hormone therapy was still legal – or even safe.

As a clinical social worker^[1] who works extensively with children and families navigating gender‑affirming care – and as someone whose trans child is now an adult – I have encountered several families facing similar questions about their options. These concerns have grown in recent years, especially as more states have moved to restrict gender-affirming care for minors.

In states like Michigan, gender-affirming care for minors remains legal as of May 2026^[2]. Yet news coverage and political rhetoric^[3] have left many families uncertain about what care doctors are still permitted to offer.

In response to evolving federal legal and regulatory pressures, several Michigan health systems have limited or discontinued certain forms^[4] of gender-affirming medical care for minors. This includes puberty blockers and gender-affirming hormone therapy. These limitations have increased confusion^[5] among families about what care remains available.

Families are flooded with disinformation and misinformation suggesting the science on gender-affirming care^[6] has changed. It has not. But a growing gap exists between what the law permits and what families believe possible, shaping how parents make medical decisions for their children.

What the law says – and what families hear

As of May 2026, gender-affirming care for minors remains legal in 23 states^[7], with shield laws that protect against prosecution in other states. Around 27 states have enacted laws restricting or banning gender-affirming care^[8] for transgender youth.

Regardless of legality, gender-affirming care is endorsed by every major medical association^[9], including the American Medical Association^[10], the American Academy of Pediatrics^[11] and the Endocrine Society^[12].

In states where gender‑affirming care is banned, the effects on youth and families^[13] are often immediate and far‑reaching. Patients may be forced to stop care, and these unplanned treatment disruptions can negatively affect mental health^[14]. Research shows that transgender youth experience increased anxiety, depression and suicidality^[15] when they’re exposed to restrictive policies, and a majority have reported that these policies have negatively affected their well‑being.

When care is banned, families shoulder added burdens^[16]. They must take time away from work and school and travel long distances^[17] – sometimes crossing state lines – to access care. One national study found that more than 1 in 4 transgender youth were living over four hours from the nearest clinic^[18] after state legislators enacted restrictions. Many faced even longer travel times. For young people, having to retell their story to a new care team can feel exhausting and traumatizing.

Even in states where care is legal, there are longer wait times and reduced access as providers and families pivot to navigate evolving legal risks. These pressures compound the emotional, logistical and financial toll^[19] on families trying to maintain stable care. Parents and young people are also concerned that their care may be abruptly withdrawn once started.

Additionally, parents worry that supporting their child’s gender transition could bring unwanted government scrutiny^[20]. In July 2025, the Department of Justice issued subpoenas to doctors and clinics^[21] to obtain the private medical records of transgender minors as part of an effort to end pediatric gender-affirming care.

This heightened scrutiny has had a chilling effect on patients and providers^[22], undermining patient privacy and trust in care.

What gender-affirming care actually involves

Much of the pushback concerning gender‑affirming care arises from misunderstandings about what it actually involves.

Gender-affirming care^[23] is an individualized approach to supporting young people whose gender identity differs from their sex assigned at birth. It includes social support, mental health assessment and, for some patients, medical treatment.

Care begins with a comprehensive, thorough assessment^[24] of the patient, including their mental and physical health and social relationships. Clinicians interview patients about significant aspects of their life, including their gender identity, trauma history, educational status and overall well-being. The parents’ perspectives are incorporated into the assessment as well, along with religious or cultural barriers to care.

To initiate any medical care, consent from the parent and assent from the patient is required. Each patient’s plan is grounded in a full understanding of the child’s needs, and this may or may not involve medical transition.

Access to gender‑affirming care has been consistently associated with improved mental health outcomes^[25], including reductions in depression, anxiety and suicidal thoughts among transgender youth. While some research has reported regret after transitioning^[26], many of these studies tend to discount positive outcomes, minimize the harms of restricting care or apply standards of evidence unevenly for transgender and cisgender children.

For example, the National Health Service England’s 2020 Cass Review^[27] has influenced public discourse about gender-affirming care in the U.S. and the U.K. It concluded that there is limited and uncertain evidence supporting medical interventions for transgender youth and recommended a more cautious approach to care. However, scholars across medicine, mental health and law have criticized the Cass Review’s^[28] methodology and conclusions^[29], noting that the authors misused or misrepresented parts of the available data and applied inconsistent standards when evaluating research.

Critics caution against applying^[30] the review’s findings to patient care. Doing so risks harming young patients by treating transgender identities as a disease and making blanket recommendations against care.

Even where care is legal, accessing it is harder

Together, misinformation, legal threats and evolving policies have made accessing evidence‑based care more difficult. This has resulted in the weakening of the safeguards supporting comprehensive care^[31] and ongoing monitoring of young patients’ physical and mental health. Some families have been forced to navigate fragmented access to care^[32], rely on less experienced providers or attempt to piece together care on their own.

Some politicians frame restrictive policies as protecting young people. But these restrictions in fact have the opposite effect^[33] by limiting access to care and destabilizing established treatment plans.