Editor’s note: This article has been revised to more clearly describe who is affected by state laws on gender-affirming care. It has also been edited to clarify that The Economist’s reporting relied on emails and multiple court documents rather than solely on an amicus brief. Additionally, the characterization of the impact of the Cass Review has also been revised to reflect its defense of its methodology.
A recent editorial in Science highlighted the critical need for more transgender health research, especially community-led studies that can help improve care and inform policies that protect the rights of transgender and gender-diverse people. Even some of the most robust studies on high risk diseases among transgender and people who express their gender identity beyond the binary framework do not consistently collect data on gender identity. Lack of demographic data may result in missed opportunities to tailor care to specific groups. National surveys, such as the U.S. Census, also do not accurately represent LGBTQ+ people.
Meanwhile, as many as 26 states have enacted laws that have restricted or banned gender-affirming care for youth; as many as a dozen states ban Medicaid from covering some forms of gender-affirming care for any age. This is notable because transgender adults are more likely to rely on Medicaid coverage than cisgender people. The American College of Physicians, among other physician organizations, has joined in supporting lawsuits that have challenged the laws in more than a dozen of the restrictive states.
The issue is no less politicized in Europe, where a patchwork of varying policies have complicated access to different types of gender-affirming care.
Limited solid research has led to less informed policies. For journalists, it has also contributed to the challenge of reporting stories on transgender health. We typically don’t report on what we don’t know. But the studies that do exist provide an opportunity to advance public understanding and support evidence-based care for transgender and gender-diverse people.
Here are some major themes in transgender health research so journalists can contribute to more accurate and informative coverage of transgender health issues.
Gender-affirming care is personal(ized).
Gender-affirming care is personalized and may include social interventions (such as affirmation of gender, name, dress, etc.), hormone therapy, surgeries, and mental health services. While the term is used holistically to encompass all forms of health care delivery, some individuals may seek one or all of these interventions. (In fact, only about 31% of trans adults have used hormone therapy, and just 16% have undergone any form of gender-affirming surgery.) Its aim is to decrease gender dysphoria and increase gender euphoria, in whatever form it takes for an individual. Recent studies have shown that accessing gender-affirming care is associated with improved quality of life and lower rates of anxiety, depression, and addiction. One study in adolescents and young adults has found it to be associated with reductions in suicidality.
Research has shown evidence of mental health benefits of gender-affirming care, but some medical interventions may pose some risks to physical health. One study suggests the need for more research on cardiovascular outcomes in transgender people undergoing hormone therapy since current data shows mixed results on risks of blood clots and heart disease. Another review highlights the need for more research on bone health in transgender people, particularly those undergoing long-term hormone therapy.
That’s why it’s so important for reporters to acknowledge areas where more research is needed, such as optimizing hormone therapy and surgical techniques. Be cautious not to overstate or understate what is currently known based on what research does exist. Consider also communicating uncertainty — that is, point out where research does not exist or what it has not shown.
Gender-affirming research methods are complex and may confuse the public’s understanding of what’s actually happening in health care.
One of the most controversial and politically charged areas of research in trans health centers on gender-affirming care for minors. Legitimate questions have been raised about the methodology and impartiality of research that has been used both to support and to oppose certain interventions in gender-affirming care. Some of the coverage about the need for additional research, however, has mischaracterized what controversies actually exist in the medical literature.
For example, a June article in The Economist reports on court documents and emails that suggest that an international trans health organization interfered with systematic reviews of evidence on transgender medicine that it had commissioned from Johns Hopkins University. The article does not show evidence of data manipulation as the headline suggests; it reports on the organization’s attempts to influence the research.
Similarly, some news outlets have reported uncritically on an extensive review of the evidence commissioned by the U.K.’s National Health Service. But the Cass Review, which has been used to justify legal action against certain types of gender-affirming care, has come under fire for poor methodology. The Cass Review team has defended its work, stating it was based on extensive research and peer review. The review itself acknowledges limitations in the existing evidence base for gender-affirming care. The British Medical Association has announced it has assembled a task force to review the evidence.
When reporting on the research, it’s important to include caveats about research methods, to provide context about what “gender-affirming care” for minors encompasses, and what the medical intervention utilization rates are in people under age 18. The vast majority of gender-affirming care for minors focuses primarily on social affirmation of the minor’s identity, such as their name or pronouns, or allowing them to experiment with different styles of dress.
One of the most common forms of medical intervention in trans or nonbinary minors is the use of puberty blockers, medications that temporarily halt the process of puberty and whose effects are reversible, according to research cited in The Endocrine Society practice guidelines. However, one of the largest, most recent studies of trans adults revealed that only 17% had an interest in puberty blockers in their youth, and only 2.5% received them.
It’s difficult to get more recent data on puberty blocker utilization in current trans youth due to underreporting and inconsistent insurance coverage for it. But one of the stronger data sets — albeit not peer reviewed — is an analysis of insurance claims that included 121,882 new diagnoses of gender dysphoria in youth for a five-year period. Among those youth, only 3.9% received puberty blockers and 12.1% began hormone treatment (those numbers may include youth who received both). Despite being commonly invoked in political football, any form of gender-affirming surgery is far rarer. While it remains important to understand the benefits, risks and long-term effects of these interventions, it’s equally important to highlight that they represent only a small proportion of overall gender-affirming care for youth.
Distinguishing research and rhetoric can improve disparities
Mischaracterization of transgender and gender diverse health science by non-experts can impact health care access. A 2023 study in JAMA Surgery found significant disparities in access to gender-affirming surgeries, with factors like race, income, and geographic location playing major roles in who receives these procedures. Since health care is a vote-moving issue, it can be easy to report solely on claims or stances of politicians on transgender and gender-diverse people and their right to health care. Rhetoric can also increase stigma and the reluctance to seek care when transgender and gender-diverse people already face medical discrimination and other barriers to standard medical care of any kind.
One study analyzing social media posts about the experiences of self-identified transgender people assigned female at birth highlights the reluctance and stigma some face to seek care for breast and gynecological cancers. Another substantial barrier to cancer care in transgender and gender-diverse people is the lack of data on risk of specific cancers and inadequate evidence for reliable cancer screening guidelines in the trans population.
Cite reputable medical organizations and peer-reviewed studies to contextualize – even refute – political rhetoric on transgender and gender-diverse people and their care.
Care is a lifelong consideration.
While much of the current rhetoric and political focus on transgender health care focuses primarily on youths, research suggests older transgender adults face unique health challenges compared to cisgender peers. Transgender adults have higher rates of disability and chronic health conditions.
A comprehensive approach to transgender health research should consider the entire lifespan, from childhood through older adulthood. Journalists can help highlight the importance of long-term studies and the need for age-specific health interventions for transgender and gender-diverse people.
Additional resources
- Kaiser Family Foundation Policy Tracker: Youth Access to Gender Affirming Care and State Policy Restrictions
- Getting it right: Reporting on laws that prohibit gender-affirming care for minors from AHCJ
- Covering LGBTQ+ health and health care: Reporting tips and story ideas from The Journalist’s Resource
- Five tips for journalists on covering trans and nonbinary people from Columbia Journalism Review
- The complexities and nuances of transgender coverage from Columbia Journalism Review
- Reporting on the transgender community from NBCU Academy
- How journalists can improve their coverage of the trans community from NBCU Academy
- Transgender Coverage Topical Guide from The Associated Press
- Making Your Writing and Reporting Transgender-Inclusive from The Open Notebook
- Trans Journalists Association Stylebook and Coverage Guide by the Trans Journalists Association
