Clinician Approaches to Research With Transgender and Gender-Diverse Youths

Importance: State legislative bans on gender-affirming care (GAC) for youths, along with federal executive orders focused on gender identity, have affected clinicians' approaches to research and care provision. While research has started to examine the number and types of studies assessing transgender and gender-diverse (TGD) populations that have been terminated, the impact of other sociopolitical factors remains underexplored. Objective: To understand how the current sociopolitical climate has changed the approach to research of clinicians caring for TGD youths. Design, Setting, and Participants: This qualitative study using national survey data was conducted at the University of Rochester in New York from June to August 2025. Participants included US clinicians (MD, DO, NP, PA, and PhD) who treated TGD youths from states with differing legislation: states with bans on GAC for minors, states with shield laws protecting GAC, and states without explicit legislation. Participants were recruited through snowball sampling using trusted networks and personal contacts via email primarily through professional listservs dedicated to varied disciplines of clinicians caring for TGD youths. Exposure: State legislation, federal executive orders, and institutional policies regarding GAC for minors enacted prior to June 2025. Main Outcomes and Measures: Clinicians' insights into changes to their approach to research in response to the sociopolitical climate surrounding care for TGD youths. Qualitative survey responses were analyzed thematically using inductive qualitative coding. Results: A total of 591 clinicians began the survey, and 443 clinicians completed the survey. Of them, 237 (93 [39.2%] in states with shield laws, 79 [33.3%] in states with legislative bans, 43 [18.1%] in states with no legislation, and 22 [9.3%] unsure of their state's legislation), completed the question: "How has the current sociopolitical landscape changed your approach to research?" A total of 193 respondents (81.4%) reported providing GAC, as defined by prescribing puberty pausers or gender-affirming hormone therapy, as part of their regular practice. Clinician responses were categorized into 4 key themes: barriers and structural challenges to research-including cuts to funding, institutional withdrawal, politically driven scrutiny of GAC evidence, and pressures to self-censor-change in research focus, ethical considerations, and emotional and psychological impact. Conclusions and Relevance: In this qualitative study of survey responses from clinicians caring for TGD youths, respondents reported barriers and structural challenges to research, shifts in research focus, and evolving ethical considerations and emotional and psychological impact. The findings suggest that restoration of federal funding for research focused on TGD populations' health alone cannot rebuild the fractured research landscape.