[Transgender care in the USA, advances and setbacks, and how it impacts Europe]

What is happening in the United States in terms of support for trans people, as in other areas, is regularly observed and a source of inspiration at the international level; the recent political turmoil around affirmative trans care in some States, especially for minors, has a tremendous impact in Europe, being regularly used by the "camps" that argue today on this issue. However, the political context and the organization of the health and health insurance system color this support in a very specific way in the United States, and omitting these aspects or simplifying them is a source of erroneous interpretations and misinformation. Understanding these determinants is essential to define what belongs to the medical field, and to put back at the center of the discussions the interest of the people concerned, the principles of beneficence, non-maleficence and equity. In this article, we will therefore discuss the organization of care and recommendations for good practice, but also, from "non-scientific" articles and references, the political and social climate and its impact on trans health and care, including in Europe.