How To Talk About Gender-Affirming Care

Political attacks on transgender youth have proliferated over the past few years, with a major focus being on their access to health care, also known as gender-affirming care. In 2019, no states had passed legislation restricting access to gender-affirming care for transgender youth. As of today, 22 states have banned best practice medical care for transgender youth, with some going as far as making it a felony to provide such care. And these attacks aren’t just isolated to the state level—anti-LGBT policymakers have introduced a bill in the US House of Representatives that would make it a felony to provide gender-affirming care to transgender youth with parental consent, punishable by 10 to 25 years in prison. These kinds of attacks are sure to ramp up as we head into a presidential election year, and pro-LGBT policymakers and candidates need to be prepared to push back in Congress and on the campaign trail.

In conjunction with Impact Research, Third Way conducted two rounds of qualitative and quantitative research in October 2023 to better understand Democratic and swing voters’ views around gender-affirming care for transgender youth. We conducted two virtual focus groups with swing voters in battleground states on Octgober 2nd, one with white men ages 30-55 who are parents and another among white women ages 30-55. We also conducted two in-person persuasion conversation groups in Detroit, Michigan on October 3rd, one with white men ages 30-60 who are parents and live in Wayne County and another among Black women ages 30-60 who live in Detroit. Finally, we conducted a nationwide online poll from October 25th to November 1st of 800 likely 2024 voters.

We found that voters have a range of personal views on gender-affirming care, but they do agree on one thing—the government should not categorically ban it. The framing of the issue has a major impact on support. Voters are split on banning gender-affirming care for transgender youth at the outset, but they are more supportive when it is framed as allowing parents to make medical decisions for their child with health care providers. When the debate is framed around whether transgender minors should have medical intervention, the opposition has the advantage. But when we shift the conversation to be about what the government versus parents should decide, we gain the advantage. When pushing back on attacks, we need to frame this as an attack on parents and their freedom to make medical decisions for their child.

Opinions on Issues Around Transgender Youth

Issues around transgender people are not top of mind for voters. When asked about their priorities, focus group participants brought up issues like the economy and rising costs, infrastructure, and homelessness. Yet voters are hearing a lot about transgender people–86% of voters said they had heard a lot or some about transgender issues in the past few months when asked directly, and most think it is due to politicians taking advantage of transgender people to score political points. Despite this oversaturation, voters don’t want to see more laws passed relating to transgender people in their state. Thirty-seven percent want fewer laws and 24% think they have the right number of laws already–only 19% say they want more laws relating to transgender people in their state. This sentiment was more pronounced among Independent voters, 42% of whom said they wanted fewer laws and only 12% of whom want to see more laws on this issue.

While voters are not eager for policymakers to legislate more in this area, they support the notion that transgender people, including young people, should be able to live their lives as they determine.

• Eighty-one percent supported allowing transgender youth to seek counseling from a therapist.
• Sixty-eight percent supported allowing transgender youth to dress in ways that align with their gender identity.
• Fifty-five percent supported allowing transgender youth to use pronouns that align with their gender identity.

But there are some issues on which voters are still divided. Only 39% supported transgender youth being able to use restrooms in public places designated for the gender with which they identify, and only 34% say the same about school restrooms and locker rooms.

Views on Gender-Affirming Care

Voters are split when it comes to gender-affirming care–they want to protect youth from making life-changing and permanent decisions they may later regret, but they don’t think the government should be getting involved. While focus group participants acknowledged that transgender kids could know from a very young age that they’re transgender, they were hesitant when it came to allowing them to make permanent, life-changing medical decisions before the age of 18.

I have the same kind of concerns about the long term implications. At age 16, it’s just, it’s a big decision to make. –White female swing voter.

Despite this, voters oppose banning health care professionals from providing gender-affirming care for trans youth by 4 points (49-45). They were even more supportive of protecting access to gender-affirming care when asked if they support allowing parents of a trans child and medical professionals to make decisions about it. Sixty percent said they were supportive of that proposition, 29 points higher than the number who opposed it. This framing was especially effective with Independent voters, who went from supporting a ban by three  points to supporting parents by 42 points.  

I’d like to be the decision maker for me and my kids. Not the government telling me what I can and can’t do. – White male swing voter.

However, when we got into the specifics of gender-affirming care, support dropped precipitously. Sixty-nine percent of voters supported making gender reassignment surgery illegal for a trans person under the age of 18. Opposition was less intense when framed as allowing parents to approve gender reassignment surgery for their child if a doctor agrees, with only 49% in opposition, a 20-point drop. But opposition still beat out support by six points even with that most persuasive framing. Fifty-eight percent of voters supported banning hormone therapy and puberty-delaying medication for transgender people under 18. Again, when we used the “allow” frame–allowing transgender youth to take doctor-prescribed medication with parental consent–opposition dropped by nine points to 49%, though it remained 12 points higher than support. Pro-LGBT policymakers and candidates should avoid litigating the specifics of gender-affirming care.

While voters had concerns about the implications of some kinds of health care for transgender youth, they also had concerns about the consequences of a ban.

• Seventy-one percent were bothered a great deal or some that a ban could prevent parents from getting their child mental health support and counseling.
• Sixty-five percent of voters opposed prohibiting doctors from providing health care to transgender people according to the expert standards of care.
• Sixty-four percent were bothered about the prospect of requiring parents to serve jail time if they help their child access gender-affirming care.
• Sixty-one percent were bothered about the prospect of requiring health care professionals to serve jail time if they help a patient under 18 access gender-affirming care with the permission of their parents.
• Fifty-six percent were bothered about the prospect of requiring Child Protective Services (CPS) to investigate parents for child abuse if they help their child access care.

Despite personally complex views on gender-affirming care, voters could agree on one thing–the government should not be passing laws to ban it. A total of 55% of voters said they didn’t believe the government should ban gender-affirming care. This includes both people who personally support access to gender affirming care for people under 18 (32%) and those who personally oppose it (23%). Only 40% of voters said they don’t support gender-affirming care for people under 18 and believe the government should pass laws to ban it.

Why does it have to be a law with you, your child, and your doctor to whatever you all decide with your child? Why does there have to be a law in place for your say as a parent overseeing your child? – Black female swing voter.

Electorally, this issue isn’t a potent political attack against pro-LGBT policymakers and candidates. Voters were less likely to support a candidate who wants to ban gender-affirming care for transgender youth by nine points (34-43). One-third of voters (34%) said they would only vote for a candidate who opposes criminalizing gender-affirming care for trans youth, while 27% said they wouldn’t consider it a major issue in their voting decision. Only 26% said they would only vote for a candidate who supports criminalization.

Messaging Recommendations

These issues are new to most voters, and both support and opposition messages resonated. Pro-LGBT messages that scored the highest focused on addressing voters’ concerns about gender affirming care by emphasizing that these kinds of health care decisions take time and that surgeries are very rarely performed on anyone below the age of 18. Messages emphasizing that the government should not be involved in these decisions were also compelling. Opposition messages that scored the highest highlighted that people under 18 are too young to make permanent decisions and questioned the research around the safety of gender-affirming care.

Pro-LGBT policymakers and candidates should not engage in a prolonged debate on gender-affirming care, but they shouldn’t ignore attacks either. When bills come up, they should frame this as a ban on parents being able to make medical decisions for their child. Messaging on gender affirming care should:

• Provide context. Gender-affirming care includes safe and age appropriate social, psychological, and medical treatments, including counseling. Surgery is not part of the routine standard of care for transgender youth.
• Dispel fears. The decision to seek gender-affirming care is not something that anyone—whether young or a legal adult—is able to rush into. It requires months of screenings, doctor’s visits, and counseling sessions. It would be impossible for a person to decide they want to transition one day and make an irreversible decision the next.
• Pivot to parents’ rights. Regardless of how you feel personally about the issue, transgender youth, their parents, and their doctors should have the right to make personal medical decisions without government interference or fear of facing jail time or investigations by Child Protective Services.
• Hit politicians who are pushing these laws for having the wrong priorities. They should be focusing on getting our country back on track, not changing laws to make life harder for parents and transgender youth.

Conclusion

As attacks against transgender youth continue, pro-LGBT policymakers and candidates need to feel comfortable to push back. While voters have some reservations about some kinds of gender-affirming care for transgender youth, they want parents to be able to make medical decisions for their children, not have the government passing laws to ban it. And that’s exactly how pro-LGBT policymakers should talk about this issue.