"If Not Me, then Who?": The Experiences of Mental Health Professionals Navigating Clinical Practice with Trans and Gender Expansive Youth in States with Restrictions or Bans on Gender Affirming Medical Care for Minors

Background and Purpose: The past several years have brought about a precipitous increase of legislation targeting trans people, trans youth especially. So far in 2025, 809 bills have already been introduced across 49 states and 40 have passed, already outpacing 2024, where 672 bills were introduced across 43 states and 50 passed. States that have introduced anti-LGBTQ legislation have seen hate crimes in schools quadruple over the past several years. Due to the pervasive marginalization by society, trans people are more likely than their cis counterparts to be diagnosed with a mental health condition, be the victims of harassment and discrimination, experience homelessness, abuse substances, and attempt suicide. These disparities underscore the need for, and importance of, clinicians who are effectively able to support trans youth as they attempt to traverse often hostile terrain. While there has been some research on the impact of gender-affirming care bans on trans and gender diverse youth, their caregivers, and medical care providers, there is a gap with respect to the experiences of mental health clinicians that this research study seeks to fill.

Methods: 68 semi-structured interviews were conducted with masters (63) and doctoral trained (5) mental health clinicians across 21 of the 25 states restricting gender-affirming medical care for trans youth at the time the interviews were conducted in summer 2024. Clinicians ranged in age from 24 to 74, with the average being 38. 88.1% (60) identified as white, 7.5% (5) as more than one race, 3% (2) as Lantinx, and 1.5% (1) as Indigenous. 55.9% (38) of people identified as cisgender and 44.1% (30) as transgender. 85.3% (58) of people identified as queer and 14.7% (10) as straight. 48.5% of participants (33 people) are mental health and professional counselors, 41.2% (28) are social workers, and 10.3% (7) are marriage and family therapists. Participants were recruited via email. Interviews explored the experiences, considerations, and choices of mental health clinicians providing therapeutic services for trans youth in states that have instituted bans on gender-affirming medical care for minors. Interviews were transcribed verbatim and coded thematically using Taguette qualitative software, guided by the principles of grounded theory and inductive analysis.

Findings: While the primary impact of these laws has been a constraint or total moratorium on care, the secondary and tertiary impacts have been creating confusion and fear for clients, clinicians, and physicians, which has deterred some providers from working with trans people and worsened the overall state of mental health for many trans youth. Other themes that emerged from data analysis include personal and professional values being in tension with the law, adjusting clinical approach, safety concerns, considerations surrounding participating in advocacy, legal involvement, fear of losing licensure (or not), and the importance of supportive community in sustaining clinicians in their work.

Conclusion and Implications: Findings indicate that clinicians are balancing taking on risk in working with trans youth and accordingly need to have more robust support from multiple sources–including professional organizations and peers–in navigating the implications of these laws.