22.1 Standards of Care and Legal Landscape of Gender-Affirming Care Bans in the United States

Objectives: Gender-affirming medical interventions (GAMIs) are evidencebased tools to treat youth with gender dysphoria.Despite these standards of care, many states in the United States are banning GAMIs for minors.Transgender youth experience mental health conditions at higher rates than their cisgender peers due to stigma.Clinicians in states with gender-affirming care (GAC) bans need to be equipped to support this population despite a lack of access to all available treatments.This presentation will outline the standards of care, discuss nonmedical interventions to support transgender youth in states where GAMIs are banned, and describe the experience of clinicians and trainees in states with bans.Methods: Presenters will outline the current standards of care for treating gender dysphoria in youth followed by an overview of state laws in the United States that have banned GAMIs for minors.Nonmedical interventions to support transgender youth will be presented in order to help clinicians provide useful care even when gold-standard treatment is banned in their state.The experience of clinicians and patients in states with bans will also be presented.Implications for training and education will be discussed by a child and adolescent fellow with lived experience as a resident in a state enacting GAC bans and as a transgender psychiatrist.A discussion panel will follow these presentations in order to deepen the learner's understanding of this topic area.Results: GAC bans are changing the landscape of what care is available to transgender youth in the United States.Given the vulnerability of this population, it is necessary for clinicians to understand how they can support these youth even in the absence of GAMIs.These bans are also changing the landscape of medical training in the care of transgender youth, which could result in fewer emerging child and adolescent psychiatrists who have the knowledge and experience to treat this population effectively.Conclusions: GAC bans are reinforcing stigma for transgender youth while at the same time limiting access to evidence-based interventions that can alleviate gender dysphoria.Clinicians must understand all the ways they can support these youth when GAC bans are enacted in their state.Serious ethical considerations emerge in this landscape where a lack of access to care and comprehensive medical training exacerbate systemic inequity.