Studying Clinicians’ Response to State Laws and Institutional Policies That Restrict Pediatric Gender-Affirming Care

Abstract: Pediatric gender-affirming care (GAC) is a matter of fierce public debate, and clinicians’ experiences with providing care for transgender and gender-diverse (TGD) youth are ever-changing. As we see with abortion care, the increasingly fragmented system of GAC will likely place strain on the physicians in states who permit GAC and moral distress for those in states that restrict it. Although the doctor-patient relationship is viewed as occurring within a private space, legislators and judges play a significant role in the delivery of medical care, and often have a variety of goals. Efforts to limit or ban GAC intensified in 2022 and have continued into 2024. When legislatures limit care options, many clinicians face a clash between state laws and their ability to provide appropriate care to all patients regardless of gender identity. This study asks: How do clinicians, whether they oppose or support GAC, respond to state laws and/or institutional policies that restrict GAC? How do changing state laws and/or institutional policies that restrict GAC impact clinicians’ practice, whether they oppose or support GAC? Through 50 semi-structured interviews with pediatricians, the project seeks to better understand how pediatricians’ practices have changed over the last two years, how providers across the country understand GAC and the impact of policy/legislation, and what providers need to provide GAC safely and comfortably. In this presentation, I will present preliminary findings of this work-in-progress.