Most Americans are not concerned with legislation around transgender issues and harbor doubts about whether lawmakers are informed enough on matters related to trans lives to create fair policies about access to gender-affirming care, according to a survey released Monday.
In their second annual “The State of Our Nation” poll, The 19thandSurveyMonkey examined the state of women in America, with a particular focus on women of color and LGBTQ+ individuals. Respondents were asked about attitudes toward the economy, abortion, health care, guns and the workplace, as well as attitudes toward gender-affirming care and trans rights.
Transgender issues don’t feature prominently in most Americans’ political priorities, according to the online survey of more than 20,000 adults conducted in late August. Just 17 percent believed politicians should focus on restricting gender-affirming care, while 33 percent thought they should protect transgender individuals.
While Republicans were more likely to support limiting trans rights, they opposed politicians focusing on transgender issues; 58 percent of Republicans oppose a focus on transgender issues compared to 49 percent of Independents and 32 percent of Democrats.
Republican ‘bullies’ and trans issues
Out California Rep. Robert Garcia, who has the distinction of being the only Democrat who sits on three committees with Georgia firebrand and MAGA Republican Rep. Marjorie Taylor Greene, was blunt about why Republicans continue to use a losing issue to push hate.
“It’s because the Republican caucus here in Congress is a bunch of bullies. They are willing and happy to attack folks who are the most marginalized, who are such a small part of the population, and who don’t always have the ability or the resources to fight back,” Garcia said in an interview with The Advocate. “They view the trans community and trans families as an opportunity to reignite and continue their cultural wars.”
The survey drew parallels between public opinion on gender-affirming care and abortion. Most respondents — 72 percent — believed politicians lacked sufficient knowledge about gender-affirming care for minors to create fair policies.
Similarly, approximately 63 percent of Americans support the idea that abortion should be legally permissible in most or all cases, while over 70 percent of Americans expressed doubts about the ability of politicians to craft fair abortion policies due to their perceived lack of expertise on the matter.
“Now that they’ve realized that all their attacks on women’s health and abortion have backfired on them, they’re now turning to the trans community and the broader LGBTQ+ community because it’s both issues as their favorite kind of bullying tactic, and it’s shameful,” Garcia explained.
He added, “It’s also important to remember that they’re also trying to separate trans people from the broader LGBTQ+ community. We’re all in this fight together, and so we’re not going to allow it to happen.”
Republicans have added dozens of anti-LGBTQ provisions to must-pass spending bills and voted to strip funding from LGBTQ community programs in Democratic districts. The GOP’s far-right wing has made it clear they’re willing to shut down the government to get spending cuts and other demands.
Ranking member of the House Appropriations Committee, Rep. Rosa DeLauro (D-Connecticut), told The Advocate that while she’s mindful of the importance of LGBTQ+ issues, the public is consumed with economic issues that relate to their families, and House Republicans’ focus on stripping funding from LGBTQ-related programs shows that the GOP is only interested in tribalism.
“What the Republicans are trying to do is to create division and hate in our society and deal in a cultural way, which plays to people’s fears, and that flies in the face of what our responsibilities are as legislators,” she said.
People need resources to be able to survive and succeed and should have access to medical care, DeLauro said. “The bottom line is that this hate has no place in our funding bills. Hate is not the underlying principle of passing a budget.”
Divided on care for transgender adults, children
When it comes to gender-affirming care, Americans are divided.
More than 57 percent of survey respondents expressed their support for the rights of transgender adults to access gender-affirming care. However, a significantly smaller percentage (39 percent) indicated their support for gender-affirming care for minors, revealing a complex public opinion landscape on this critical issue.
As a doctor who sees and provides gender-affirming care for children with gender dysphoria, Angela Kade Goepferd understands the complexities of the science and the political landscape surrounding this treatment.
Goepferd is the medical director of the Children’s Minnesota Gender Health Program in Minneapolis.
Goepferd told The Advocate that there is a misconception that medical care for transgender young people involves secret conversations behind parents’ backs, or kids who are seen and immediately prescribed puberty blockers and hormones. Extremists also claim that doctors are performing gender-confirmation surgeries on children when, in reality, none of those things are the case.
Gender-affirming care has been a part of medical education and treatment for decades. It is based on established standards of care shown to have positive mental health and well-being outcomes.
It’s important to understand that gender-affirming care is “regular” medical care, Goepferd noted.
The survey also revealed a stark partisan divide on the subject of trans health care.
Republicans were significantly less likely than Democrats to support gender-affirming care, the survey found. Democratic support for such care for adults stands at 83 percent, while Republican support is only 33 percent. Access to care for minors showed an even wider gap, with 68 percent of Democrats supporting it compared to just 12 percent of Republicans.
“Those who oppose transgender rights and the rights of people in general in this country have done a really effective job at framing the national conversation around gender-affirming care and around gender-affirming care for kids. (They) have made it very scary and have put out a lot of false information that is just simply not true,” Goepferd said.
Knowing transgender people can lead to a higher level of support for gender-affirming healthcare, according to the survey.
Of those who personally know someone who is transgender, 67 percent support gender-affirming care for adults and 48 percent support it for minors, while those who have no personal connection with transgender people support it at 48 percent and 33 percent, respectively. Of those who identify as part of the LGBTQ+ community, 84 percent supported gender-affirming care for adults, while 70 percent supported it for minors.
What is gender-affirming health care?
This debate over essential medical care is complicated because many Americans don’t understand what it involves.
There is broad support and recommendations for treating gender dysphoria by all major U.S. medical associations, including the American Medical Association and the American Academy of Pediatrics. Goepferd said there have been standards of care in place in the United States through the Pediatric Endocrine Society and internationally through the World Professional Association for Transgender Health, or WPATH.
Goepferd said that there are several misconceptions about gender-affirming care.
“The first misconception is that somehow this care is new or experimental,” they said. “I’m a pediatrician who has been in practice for almost 20 years, and I was taught about caring for transgender adolescents and young people as part of my education.”
Goepferd explained that when young people have access to gender-affirming care, they benefit in many ways, including having a better sense of self and self-esteem.
“So the only reason that we provide access to care and support and medications for youth is that the outcomes have shown us over and over and over again that they do better,” Goepferd said. “So that’s why we do it in the first place.”
Another misconception is that kids go to hospitals for gender-confirmation surgeries, which is false. Goepferd said that opponents of this care conflate the standard of care for adults with the care for minors.
“[Republicans are] talking about adult transgender care, particularly surgical care, and leading people to believe that that care happens for children, which is absolutely not the case,” they said.
Goepferd said that in rare cases, some transgender boys, when they are 16 or 17, may seek out and get approved for chest surgery.
They said those procedures account for less than 0.5 percent of all transgender adolescents and only after extensive consultation, counseling, and consent from parents and the patient.
In fact, far more cisgender teen girls get cosmetic breast implants or breast reduction surgery, according to a recent study. In 2021, 203 minors had gender-affirming chest surgery, compared to 3,200 who received cosmetic breast implants in 2021.
“I think there’s a big misperception that someone wakes up one day when they’re 13 and tells their parents that they’re transgender, and by the end of the week, they’re on testosterone, and that’s just like simply not how it works,” Goepferd said. “The diagnosis, gender dysphoria, relies on six months of persistent identity and symptoms, and the standards recommend waiting for a year or longer of onset of symptoms. So, again, this is a very long, thoughtful process involving multiple visits involving mental health and medical providers, and first and foremost involving parents.”
Despite the disparities in public opinion, a substantial number of Americans (47 percent) believed that gender-affirming care would become more accessible in their lifetime. Republicans and Democrats share this optimism, with 57 percent of each agreeing.
A timeline for transition care
Goepferd laid out some basics to understand about gender-affirming care.
Recognition of Gender Identity: Gender identity typically develops in early childhood, around ages three to five. Transgender children may need support in understanding and expressing their gender identity.
Creating Safe Spaces: Many transgender children face challenges openly discussing their gender identity due to unsafe environments. Creating safe and supportive spaces is crucial.
Supporting Families: Parents of transgender children often have questions and concerns about how to support their child’s gender identity best. This includes discussing topics like talking to schools and relatives and understanding one’s rights.
Social Transition: For pre-pubertal children, the primary focus is on social transition, allowing them to express their gender identity in various aspects of life. This might include using different names and pronouns or wearing different outfits or haircuts. There are no medical interventions for these children.
Mental Health and Medical Care Integration: A holistic approach combines mental health and medical care to provide comprehensive support to transgender youth and their families.
Puberty Suppression: As children approach puberty (around ages 11 to 14), discussions about the option of puberty suppression may arise. This reversible treatment can help align their bodies with their gender identity. Because everybody must go through one puberty or another to become an adult, this gives trans people time to go through puberty in line with their gender identity.
Hormone Therapy: In late adolescence (typically 15 and older), discussions may involve hormone therapy (testosterone or estrogen) to ensure that puberty aligns with their gender identity. This treatment is partially reversible.
Thorough Assessment and Consent: Before any medical interventions, a comprehensive assessment, including mental health evaluations and medical history, is conducted. Informed consent is an essential part of the process.
Surgical Considerations: Surgery is generally not a part of care for transgender youth, except for chest surgeries for trans males, sometimes considered at 16, 17, or 18 years old. These are rare procedures.
Parental Involvement: Throughout the entire process, parental involvement is crucial and required for transgender youth to access care.
