Across the country, at least 22 states have passed legislation banning gender-affirming care for certain segments of their population. While in most instances the target of the bans has been youth (13-17 year-olds), Idaho legislators are trying to stop the use of public funds to pay for gender-affirming care for adults who are either state employees or Medicaid recipients. What is gender-affirming care and why does this legislation matter? Let’s use sociology to help us better understand this issue.
According to the World Health Organization (WHO), gender-affirming care refers to a “single or combination of a number of social, psychological, behavioral or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.” Gender identity is defined as an individual’s inner sense of identification of being masculine or feminine. People develop their own gender identity based on interactions and their social environment. All societies have gender norms, behaviors, or traits that society attributes to a particular sex, but not everyone’s inner sense of who they are matches perfectly with the assumed gender norms in their society. For example, in Western society, traditional femininity, behaviors, and traits associated with women, has expected women to be timid, sensitive, accepting, and passive. On the other hand, traditional masculinity, behaviors, and traits associated with men, has expected men to be tough, aggressive, and stoic. Yet, we know that not all women are timid, and not all men are aggressive. Gender-affirming care is designed to help those who experience an incongruence between how they see themselves and how they are perceived by society.
The segment of society most impacted by gender-affirming care legislation includes members of the LGBTQ+ (lesbian, gay, bisexual, transgender, queer) community. Focusing specifically on people who are transgender, a person who identifies with a gender different from their biological sex, 2022 research indicated that 0.5 percent of adults in the U.S. are transgender. That comes out to about 1.3 million people out of a total population of 334 million. The number of youth is even smaller, with 300,000 identifying as transgender. Regardless of the numbers, many people who are transgender seek gender-affirming care to help align themselves physically and emotionally with how they perceive themselves.
States are choosing to ban gender-affirming care for a variety of reasons. When it comes to young adults, proponents of bans contend that they have concerns about the long-term consequences of gender-affirming treatments, such as hormone therapy, on minors. Other people oppose gender-affirming care for religious reasons, while others voice concerns about whether changes done to a young person’s body, even at the request of that person, qualify as child abuse.
When it comes to adults, as in the case of Idaho, legislation is being designed to prevent public funds from being used to pay for the care of state employees and Medicaid recipients. To put this into perspective the cost of gender-affirming psychological care generally starts with therapy at $65 plus per hour, while surgery can run anywhere from $7,000 to $63,000, depending on the procedure. Most insurance companies do not cover the cost of surgery because it is not deemed medically necessary. The result is that people generally pay for treatment out of pocket, on credit, or with a loan.
Fundamentally, the question of gender-affirming care is about sex reassignment, the process of having surgery and taking hormone medications to become the opposite sex. It is worth noting that the U.S. isn’t the only country grappling with this issue. Across Europe, countries that had once been very much in favor of providing gender-affirming care to minors are starting to reverse their decisions because there isn’t enough data on the long-term consequences of such treatments. When it comes to adults, European countries take a “medicalized” approach to the process, requiring a psychiatric diagnosis before covering the cost of treatment with state funds.
As the issue of gender-affirming care makes its way through state legislators and federal courts, the U.S. Supreme Court may have to take up the topic to determine the law of the land. Only time will tell if they do and whether the decision they make helps or hurts.
Thompson is a co-owner of UITAC Publishing. UITAC’s mission is to provide high-quality, affordable, and socially responsible online course materials.
Images in this blog:
- Welcome to Idaho” sign along I-90 at the border with Montana, by Sebastian Bergmann. October 3, 2008. This file is licensed under the Creative CommonsAttribution-Share Alike 2.0 Generic The image is unaltered.
- Pride Flag, by SatyaPrem. Free for use under the Pixabay Content License. The image is unaltered.
- Surgery, Hospital, Medical Professionals by Sasint. Free for use under the Pixabay Content License. The image is unaltered.
- Supreme Court Of The United States by Jesse Collins. January 4, 2017. This file is licensed under the Creative CommonsAttribution 3.0 Unported The image is unaltered.
