Provider Adaptations to Legislative Efforts to Ban Gender-Affirming Care for Adolescents

States have passed policies restricting gender-affirming care for adolescents (e.g., hormones, puberty blockers) forcing gender-affirming care providers to navigate new and complex political, legal, and interpersonal landscapes. Notably, there are no guidelines or competency trainings focused on helping providers to adapt and preserve clinical practice amidst evolving legal restrictions. We sought to explore how providers were adapting to the introduction of these restrictions.

From March to July 2022, we conducted in-depth qualitative interviews with 31 adolescent gender-affirming care providers who worked in states that had introduced or passed bans on gender-affirming care for adolescents. The interviews probed the adaptations providers were making in response to restrictions. We conducted thematic analyses using a combined inductive and deductive approach using MAXQDA Plus.

The thematic results were organized into 6 overarching themes: violence and intimidation, advocacy, consoling patients and families, adapting to institutional decisions, navigating where to focus efforts, and anticipatory adaptations. Providers discussed the steps they were taking to avoid violence, such as maintaining personal safety and negotiating workplace security with employers, such as removing public-facing personal and work information. Providers advocated against restrictive policies, which was described as necessary yet laborious and emotionally exhausting.

Proposed and enacted restrictions on gender-affirming care have forced providers to engage in safety and advocacy efforts that go beyond their clinical work. Providers want their employers and professional organizations to support their work by advocating for gender-affirming care and ensuring safe working conditions.