Recently, lesbian, gay, bisexual, transgender and queer (LGBTQ+) communities have increasingly been a target of actions to further disenfranchise, harm and remove civil rights and protections. These actions are particularly focused on transgender and gender diverse communities with most of the attacks concentrated on the health and wellness of transgender youth, including participation in sports, representation in K-12 and higher education curriculum, and access to gender-affirming care. Federal Medicaid dollars have been explicitly stripped from covering gender-affirming care for youth as of April 11, 2025; Colorado Medicaid funds are still available (as of publication). Additionally, researchers at universities across the country have had their research grants from federal agencies canceled for LGBTQ+ health research including specifically for studies that examine the efficacy and effectiveness of gender-affirming care.
The amount of misinformation and disinformation about transgender health and gender-affirming care is vast and includes a misleading report released by the Department of Health and Human Services on May 1, 2025. While many Coloradans have been introduced to gender-affirming care through political discourse in the past few years, modern health care related to transgender health has been around for over a century. Just because something is receiving greater public attention in the current moment, doesn’t mean there isn’t history and research behind it. Remaining curious and asking questions is important, as is having access to accurate and credible sources of information so that health care decisions are made based on facts and not assumptions.
Transgender and Gender Diverse Definitions
Language around gender is imperfect and always evolving. Different terms may mean different things to different people, however, for the purpose of this post we are defining these terms in the following ways:
- Transgender: an umbrella terms for persons whose gender identity, gender expression or behavior does not conform to that typically associated with the sex to which they were assigned at birth.
- Gender Diverse: Having a gender identity that is not strictly male or female, which may include non-binary identities.
- Cisgender: a person whose gender identity corresponds to their sex assigned at birth or a person who is not transgender or gender diverse.
The Facts About Gender-Affirming Care
Gender-affirming care includes social services, legal services and medical care that aim to align someone’s physical and social experiences with their gender identity.
- Social gender-affirming care may include things like the name you go by, the pronouns you use, the clothing you wear and even how you style your hair.
- Legal gender-affirming care may include things like having identity documents such as a driver’s license that align with your gender identity and chosen name.
- Medical gender-affirming care may include things like puberty blockers, hormone therapy or surgeries.
There’s no one “right” way to be transgender.
- Every transgender and gender diverse person has their own wants and needs for gender-affirming care that could include a mix of all, some or no social, legal and medical services and care. Access to gender-affirming care is essential for the overall health and wellbeing of transgender and gender diverse Coloradans.
- Gender-affirming care is a vital form of primary care because it is a holistic approach that includes physical health, mental health, behavioral health and social determinants of health.
- Yet, many barriers exist including a lack of culturally responsive providers, anti-transgender discrimination and policies, and disparate gender-affirming health insurance coverage.
Gender-affirming care is safe and effective for transgender and gender diverse people of all ages.
- Modern day gender-affirming care dates back to the early 20th century, when Dr. Magnus Hirschfield performed the first gender-affirming surgery in 1930. Unfortunately, much of Dr. Hirschfield’s research and documentation was destroyed during the Holocaust in Germany.
- Dr. Harry Benjamin worked under Dr. Hirschfield and started practicing the earlier iterations of gender-affirming care in the United States in the mid-20th century. In the 1960’s he developed the “Benjamin Model,” the framework that led to the first international standards of care for providing gender-affirming care that has since evolved into today’s World Professional Association for Transgender Health (WPATH).
- Health care providers follow rigorous and evidence-based practices when working with transgender and gender diverse patients of all ages that involve interdisciplinary health care teams to assess mental and physical health, following the universally accepted WPATH standards of care.
- All credible professional health care associations and societies have published statements stating that gender-affirming care is both evidence-based and medically necessary.
- Over the last half century, study after study demonstrates that gender-affirming care is associated with improved mental health for transgender and gender diverse people, and in particular transgender and gender diverse youth.
- Gender-affirming care is the strongest protective factor for the mental health of transgender and gender diverse young people decreasing rates of depression, anxiety, and suicidality, sometimes experiencing even lower rates compared to their cisgender peers.
- It is quite rare that transgender and gender diverse youth have gender-affirming surgery. Among those that do, a mastectomy is by far the most common.
- Cisgender minors and adults are more likely to have gender-affirming top surgery compared to transgender and gender diverse minors and adults.
- Gender-affirming care has very low rates of regret, including among transgender and gender diverse youth.
- Gender-affirming surgeries have a very low regret rate compared to other plastic surgeries and life decisions including body contouring, gastric bypass surgery and getting a tattoo.
Access to Gender-Affirming Care is Essential for Health Equity
Despite the evidence that gender-affirming care is safe and saves lives, there’s been increasing attacks on access to gender-affirming care at local, state and national levels. Colorado has some of the strongest non-discrimination protections and gender-affirming care policies in the country. Decades of labor, leadership and advocacy of transgender and gender diverse Coloradans and allies went into securing these protections. While Colorado is considered a safe haven for transgender and gender diverse youth and families, that reputation has come into question as national level political attacks on gender-affirming care become more and more dangerous at the state level – spreading disinformation as well as dehumanizing and criminalizing transgender people and those who care about them.
The Colorado Health Foundation is committed to achieving health equity, and to do so it’s imperative for Coloradans to have access to medically necessary and evidence-based care. This includes gender-affirming care. We believe that health care decisions should be between patients, families and their health care providers. Harmful policy decisions that invoke fear, go against rigorous and reliable research, and restrict access to health care for Coloradans have no place in our state. We stand firm in our support of inclusive and comprehensive gender-affirming care.