Half of US youths lack nearby access to gender-confirming care due to state restrictions
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Key takeaways:
- Twenty states in the U.S. have passed laws limiting or prohibiting gender-confirming care for youths.
- More than 25% of youths in the U.S. live more than 4 hours from a gender-confirming care clinic.
Government-enacted restrictions have resulted in about half of U.S. children and adolescents aged 10 to 17 years living more than 1 hour from a clinic offering gender-confirming care, according to a research letter published in JAMA.
“Since 2021, 20 states have passed laws limiting or banning gender-affirming care for transgender youth,” Luca Borah, BA, a medical student at the University of Michigan Medical School, told Healio. “We find that these restrictions — some of which have yet to take effect — are associated with significant reductions in geographic access and affect nearly a quarter of gender clinics in the U.S. Our study demonstrates significantly increased drive times to the nearest clinic providing puberty-suppressing medications and hormones.”
Borah and colleagues conducted online searches and queried public directories, resource lists, news articles and archived clinical websites to identify clinics offering gender-confirming care for youths in the U.S. Clinics were included if they provided puberty-suppressing medications and hormones. States with restrictions on gender-confirming care for people younger than 18 years were identified through enacted legislation, executive actions, funding provisions and other policies that were in effect as of May 22. Drive times were determined using the drive time from the population-weighted U.S. Census Bureau center of each county to the nearest gender-confirming clinic. Researchers calculated the percentage of youths living more than 1 hour and more than 4 hours away from a clinic prior to gender-confirming care restrictions and after restrictions went into effect. The percentage of transgender youths aged 13 to 17 years in each state was calculated using estimates from the Williams Institute at the UCLA School of Law.
There were 271 gender-confirming clinics identified by the researchers, of which 25.8% were located in states with restrictions. The states with gender-confirming restrictions were Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia. An estimated 89,100 transgender adolescents live in those states, representing about 30% of all transgender youths in the U.S.
Before restrictions, the median drive time to a gender-confirming clinic was 0.51 hours. The drive time increased to 0.99 hours after restrictions were implemented (P < .001). The percentage of youths aged 10 to 17 years living more than a 1-hour drive from a gender-confirming clinic increased from 27.2% before restrictions to 50% after restrictions (P < .001). The proportion of U.S. youths living more than 4 hours from a gender-confirming clinic increased from 1.4% before restrictions to 25.3% after restrictions were put in place. (P < .001). The states with the largest increase in median drive times were Florida with an 8.5-hour increase, Texas with a 6.7-hour increase and Utah with a 5-hour increase.
“Increased travel times to gender-affirming care may further exacerbate barriers to care,” Borah said. “It is unknown whether transgender youth and their families will be able to overcome the cost and time barriers associated with further travel, resulting in delayed treatments or inability to access care. Previous studies have shown that lack of access to gender-affirming care is associated with worsened mental health.”
Borah said increased access to telehealth services and the opening of clinics near the borders of states may help youths living in a state with gender-confirming care restrictions. Borah added that more research is needed to assess how the increased distance to clinics impacts health outcomes.
“Access to gender-affirming care is associated with lower odds of depression, anxiety and suicidality,” Borah said. “As such, further research is needed to understand and support mental health outcomes of youth living in states that have restricted or banned gender-affirming care.”
For more information:
Luca Borah, BA, can be reached at lucab@med.umich.edu.
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