Beyond Misconceptions: Understanding Gender-Affirming Care

What Gender-Affirming Care Actually Means

Gender-affirming care encompasses a spectrum of medical, social, and psychological support designed to help individuals live in alignment with their gender identity. Contrary to common misconceptions, it is not a single procedure, a radical “agenda,” or a uniform path. It is about supporting people to feel safe, seen, and affirmed in their bodies and lives.

This type of care can include social interventions such as changing names, pronouns, hairstyles, or clothing; legal updates to identification documents; therapy to explore identity or cope with dysphoria; and medical treatments like hormone therapy, puberty blockers, or surgical procedures. Importantly, not every person pursuing gender-affirming care undergoes surgery or hormones; some interventions are subtle, like a hairstyle change, while others are more significant.

Additionally, gender-affirming care is not exclusive to transgender individuals. Many services, such as cosmetic procedures, hormone treatments, or hair restoration, are used by cisgender people for similar purposes: aligning the body with their sense of self. The unifying goal is simple: helping individuals feel authentic and affirmed.

A Historical Perspective

Supporting personal or social gender expression is not new. Across centuries, societies have shaped standards of masculinity and femininity, from women wearing corsets during the Renaissance to men donning heels and makeup in the 17th century. These historical practices illustrate a long-standing human desire to align one’s appearance with identity and societal roles.

Modern gender-affirming care began taking shape in the early 20th century. In 1920s Germany, Magnus Hirschfeld and his colleagues pioneered research and treatment for individuals experiencing gender dysphoria, the distress that arises when gender identity differs from assigned sex at birth. Hirschfeld emphasized that gender identity is distinct from sexual orientation and advocated for the rights of marginalized communities, including transgender people.

In the United States, early gender-affirming surgeries were performed in the 1950s, often in secrecy. The establishment of the Johns Hopkins Gender Clinic in 1966 marked a milestone, offering counseling, hormone therapy, and surgery while introducing the “Real-Life Test” for patients before surgical intervention.

Setbacks occurred in the decades that followed, including the closure of the Johns Hopkins Gender Clinic and severe federal funding restrictions during the Reagan administration, which limited access to care for many who needed it.

Significant progress did not come until the Obama administration, when protections for transgender patients expanded: the Affordable Care Act prohibited discrimination based on gender identity in federally funded health programs, and federal agencies removed the “experimental” designation for gender-affirming care, improving access to insurance coverage and encouraging further research.

Despite these wins, policy reversals in subsequent years have kept gender-affirming care a politically charged and contested issue.

Medical Interventions: Puberty Blockers and Hormone Therapy

Medical interventions are a key component of gender-affirming care, providing transgender and gender-diverse youth and adults with tools, such as puberty blockers and hormone therapy, to align their physical development with their gender identity.

Puberty blockers temporarily pause the physical changes of puberty for adolescents experiencing gender dysphoria. These medications, often gonadotropin-releasing hormone (GnRH) agonists, delay the development of secondary sex characteristics, giving young people time to explore their identities before permanent changes occur. Effects are closely monitored by healthcare professionals, and treatment is reversible, with puberty resuming once the medication is discontinued.

Hormone therapy helps individuals develop physical traits that align with their gender identity. Estrogen and testosterone can feminize or masculinize the body, impacting features such as breast growth, voice depth, and hair distribution. Hormone therapy may also bring emotional changes, requiring supportive monitoring. Together with social and psychological interventions, these treatments form a comprehensive approach to aligning body, identity, and well-being.

Cost and Access: Separating Fact from Perception

Concerns about cost often dominate discussions of gender-affirming care. Available data indicate that expenses are relatively modest. A 2019 study estimated that the annual cost of providing gender-affirming care to an insured individual was $1,776, roughly six cents per member per month. Additionally, not all transgender individuals pursue these services, with the 2022 US Transgender Survey finding that about 60% of adults access care.

Data from Medicaid and CHIP in 2023 show approximately $31 million spent on gender-affirming care for youth ages 6 to 18, primarily for hormone therapy. Surgery accounted for a small portion of the total, with just over $2 million used for outpatient procedures and less than $200,000 for inpatient surgeries. Notably, no inpatient surgical spending was reported for youth under 15.

Putting these numbers in context, total Medicaid and CHIP spending in 2023 reached approximately $924 billion. While no official numbers exist for adult spending, estimates can be made using available data. In 2025, roughly 2.1 million adults identified as transgender. Assuming 60% of them access gender-affirming care, as reported in the 2022 U.S. Transgender Survey, that would represent about 1.6 million people. Using the 2019 annual cost estimate of $1,776 per person, adult gender-affirming care could cost roughly $2.2 billion per year. Combined with youth spending, total estimated expenditures could reach around $2.3 billion, or about 0.25% of overall Medicaid and CHIP spending.

These figures highlight that, despite political claims of high costs, gender-affirming care represents a very small fraction of total healthcare spending. The focus, therefore, should remain on ensuring access to medically necessary, evidence-based services.

Navigating the Political Landscape

Recent years have seen a surge in laws restricting access to gender-affirming care, particularly for minors. As of early 2025, roughly half of transgender youth ages 13 to 17 live in states with limitations, including professional penalties for healthcare providers. Some states have also introduced restrictions affecting adults, particularly regarding Medicaid coverage and access to hormone therapy.

At the federal level, proposed rule changes and executive actions continue to influence access to care, creating a complex and evolving legal environment. These developments underscore the challenges faced by transgender individuals in obtaining medically necessary services and the importance of public understanding and advocacy.

Moving Toward Understanding

In the midst of political debate and widespread misconceptions, it is more important than ever to understand what gender-affirming care actually entails. It is not a one-size-fits-all approach, nor is it about “transgender for everyone.” In actuality, it is a spectrum of medical, social, and psychological support designed to help individuals live authentically.

Educating ourselves, examining our assumptions, and grounding opinions in facts allows for more thoughtful engagement and compassion. Beyond policy and politics, this process is ultimately about living authentically, respecting the experiences of others, and recognizing that progress often begins within. By approaching gender-affirming care with clarity and understanding, society can move toward a more informed, empathetic, and equitable future.

And remember: every day is all we have, so you've got to make your own happiness.

For more information on this topic, listen to Episode 175. What is Gender-Affirming Care?

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