What is gender affirming care, and why do conservatives want to destroy it?

Properly-informed professional care can lead to lives of dignity unless blocked by misinformation and political coercion.

Rarely has a group so small been the focus of so many large-scale political attacks as the transgender community — estimated at 0.8% of the Wisconsin population and 3.3% of those aged 13-17.

Still, the trans community has been targeted by a spate of attacks in recent years and Republican bills in Washington, DC. Now, lawmakers, through committee hearings last week in Madison, aim to restrict rights involving sports participation, bathroom access, workplace discrimination, military service, use of personal pronouns, and healthcare rights for minors. 

Transgender refers to people who feel their assigned sex is not how they naturally identify or express themselves. It does not inevitably mean transgender people seek surgical changes — sometimes a change in name, pronouns, clothing, hair, voice, or other factors will help someone live an authentic life more in keeping with their sense of identity. But that highly personal effort to simply live their lives is made harder by politicians who seek to force individuals to identify as whichever gender was written on their birth certificates.

“It just feels so out of touch to me that there are legislators who are really pushing such a disgusting agenda about a very small, very vulnerable, very loved population,” said Abigail Swetz, executive director of Fair Wisconsin. 

Swetz said members of Fair Wisconsin and other organizations showed up at legislative committee hearings to speak out against bills that would prohibit gender changes to birth certificates and target healthcare providers who provide gender affirming care — and she was encouraged at the turnout.

“Individuals are getting out there to say to trans Wisconsinites that we see you, you belong in this state, you belong in this country, you belong in this world,” she said. “And we’re going to fight for you to make sure the people in power realize that and change the way they are treating you — or we change them.”

Gender affirming care for minors: A conservative target

Conservative causes opposing civil rights date back to struggles over racial equality, women’s equality, and marriage equality for same-sex couples. Now the cause célèebre involves transgender individuals, with a forceful emphasis on minors who are wrestling with questions about gender identity. This most recent conservative campaign, however, has a champion in the White House prone to making outlandish, utterly unfounded claims.

“The transgender thing is incredible,” President Donald Trump said during the 2024 campaign. “Think of it, your kid goes to school and comes home a few days later with an operation. The school decides what’s going to happen with your child.”

That doesn’t happen.

But hyperbole notwithstanding, there are enough other examples of misinformation that make it necessary to clear up what gender affirming care for minors actually involves — and what it does not include.

“First of all,” Swetz said, “gender affirming care is medically necessary. It is highly individualized. It is also safe and effective, very strongly researched. And most importantly, it is life-affirming for trans youth. It makes it possible for our trans kids who need it to live full, healthy lives.”

The earliest form of gender affirming care, Swetz said, involves drugs known as puberty blockers, which have been safely used for decades by cisgender children whose bodies start puberty unusually early.  

“In terms of a trans kid,” Swetz said, “it would be able to pause puberty so that changes to the body would not be made that would feel discordant with their gender identity, so that they’re able to take the time to really figure out what is the next step.”

Swetz said hormone therapy may be that next step, but only after conversations “with medical professionals who understand the standards of care and the parents who are involved in every step of the process of providing a body “that feels like home.”

Bans proposed at state and federal levels

Last March, the state Assembly passed a bill that called for a ban on gender affirming care for minors. It has not passed out of a Senate committee. A similar bill was vetoed by Gov. Tony Evers two years ago.

The bill considered last week would take a backdoor approach to a ban, according to Swetz.

“It would create an entirely different version of medical malpractice that would create a horrible chilling effect and make it very difficult for providers to really provide this care.”

Another attack — at the federal level — has now led to diminished opportunities for care. Two of the state’s largest pediatric hospitals, Children’s Wisconsin of Milwaukee and UW Health in Madison, have stopped providing gender affirming care to minors because the Trump administration has vowed to block all Medicare and Medicaid funding for any services at any hospital where such care is provided.

“This would really decimate the ability of hospitals to provide this care,” Swetz said, “and really threaten everyone’s access to affordable care because this is just a very strong example of a government going after a small, vulnerable population, but not necessarily stopping there.”

The stakes were pointed out in a statement by four Democratic lawmakers: Sen. Melissa Ratcliff (D-Cottage Grove) Rep. Ryan Clancy (D-Milwaukee), Rep. Margaret Arney (D-Wauwatosa), and Rep. Lee Snodgrass (D-Appleton).

“Removing access to this care increases the risk of anxiety, depression, and suicidal thoughts among young people who already are facing disproportionate mental health challenges. These are real kids, real families and real consequences.”

Democrats have introduced legislation to target trans discrimination, but the bills are unlikely to see action in the Republican-controlled Legislature.