Anti-Transgender Legislation and Its Implications for Social Work: A Systematic Review

Background and Purpose: Within the first 14 weeks of 2025, a staggering 70 anti-transgender bills were introduced across 21 states, and 5 federal Executive Orders (EOs) restricting the rights of transgender people were signed. These policies have significant adverse effects; they are linked to increased rates of homicide and poor physical and mental health outcomes for transgender people. Notably, they exacerbate the mental health inequities experienced by transgender (vs. cisgender) people. Most anti-transgender policies target youth; however, little is known about how these policies affect the 5.5% of youth who are transgender or questioning their gender. Additionally, we are unaware of studies exploring the recent EOs' immediate impact.

To fill this gap, this study integrates findings from (a) a systematic review and (b) a qualitative study of transgender youth, parents of transgender youth, and mental health providers just 2 months after the first anti-transgender EO was signed.

Methods: We conducted a systematic review following PRISMA guidelines to search APA PsycINFO, ERIC, Proquest Political Science, PubMed, Scopus, Social Services Abstracts, and Sociological Abstracts for peer-reviewed journal articles published in English testing the association between state-level anti-transgender policies and transgender youth mental health. Papers were screened for eligibility, assessed for their risk of bias, and synthesized. To better understand the distinct effects of the 2025 anti-transgender EOs, we conducted a self-administered online survey of transgender youth (N=5), the parents of transgender youth (N=4), and mental health providers of transgender youth (N=31). The measure assessed how the sociopolitical climate of the first quarter of 2025 affected transgender youth, their parents, and their mental health providers, along with what supports were necessary. We qualitatively coded the results and conducted a thematic analysis to identify the effects of anti-transgender legislation and desired support.

Results: The systematic review yielded 5,842 records, 14 of which were included in the final sample. The records were published between 2020 and 2025, with half of them published between 2024 and 2025, reflecting the recent exponential growth of proposed and enacted anti-transgender policies. Six of the records utilized qualitative methods, 5 used quantitative methods, and 3 used mixed methods. Anti-transgender policies were consistently found to be associated with negative mental health outcomes, with depression and suicidality being the most commonly assessed outcomes.

The qualitative survey enriched this study by providing vital insight into the concerns and needs of transgender youth, their parents, and their mental health providers as they navigate the recent and rapid anti-transgender policy changes at the federal level. For example, as a result of the EOs, previously supportive parents shifted their stance on their child’s gender-affirming goals, and providers worried about the legal ramifications of providing gender-affirming care.

Conclusions and Implications: Anti-transgender policies adversely affect transgender youth, their parents, and their providers. Social workers can lead transformative change by leaning on their ethics and values to integrate research, practice, and policy work to challenge anti-transgender legislation and mitigate the harm they cause.