- Introduction
The mental health of transgender youth has become a pressing issue in both legal and public discourse. Studies consistently show that transgender youth face significantly higher rates of depression, anxiety, and suicidality compared to their cisgender peers.[i] The role of statutory and case law, as well as public opinion and societal treatment, in shaping these mental health outcomes is critical to understanding the challenges transgender youth face today. This article examines the legal landscape affecting transgender youth, the intersection of public policy and mental health, and the implications of societal attitudes on their well-being.
- Legal Framework and Its Impact on Mental Health
- State and Federal Legislation
Legislation targeting transgender youth has proliferated in recent years, with laws restricting access to gender-affirming care, barring participation in sports, and limiting the ability to change gender markers on official documents. For example, in 2023, Tennessee enacted a law banning gender-affirming medical care for minors, arguing a compelling state interest in preventing “irreversible” medical procedures.[ii] The law was challenged in L.W. v. Skrmetti, where the Sixth Circuit upheld the ban, marking a significant judicial endorsement of legislative authority over transgender healthcare.[iii] Similar laws have been enacted in Alabama, Arkansas, and Texas, each facing legal challenges that could set national precedents.
Similarly, in 2024, Tennessee courts heard a case involving Florida’s prohibition of Medicaid coverage for gender-affirming treatments.[iv] The ruling upheld the state’s restrictions pending appeal, significantly impacting low-income transgender youth dependent on Medicaid for healthcare access. This decision reflects a growing legal divide over the accessibility of gender-affirming care, as other states, such as California and New York, have enacted laws ensuring coverage for such treatments under their public health programs.
- Federal Executive and Administrative Actions
In contrast to state restrictions, federal actions have aimed to protect transgender rights. The Biden Administration issued executive orders expanding protections under Title IX, explicitly including gender identity as a protected category against discrimination.[v] However, states have challenged these policies in court, leading to an ongoing legal battle over federal authority in civil rights protections for transgender individuals.
The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have also issued guidance asserting that bans on gender-affirming care violate constitutional rights under the Equal Protection Clause of the Fourteenth Amendment. The DOJ has intervened in lawsuits challenging state bans, arguing that these laws unlawfully discriminate against transgender youth.[vi] Despite federal efforts to secure protections, ongoing litigation and shifting political landscapes threaten their permanence.
III. Public Opinion and Societal Treatment of Transgender Youth
- The Role of Public Perception in Mental Health Outcomes
Public opinion has a profound impact on transgender youth mental health. Studies show that transgender youth living in affirming environments experience significantly lower rates of depression and suicide. According to a 2023 report by The Trevor Project, 45% of transgender youth considered suicide in the past year, but those with supportive families saw a 60% decrease in suicidal ideation.[vii]
In contrast, when transgender youth experience familial rejection, discrimination, or bullying, their risk of experiencing severe mental health challenges increases exponentially. Research published in JAMA Pediatrics found that transgender youth facing significant societal rejection were four times more likely to develop major depressive disorders compared to their cisgender peers.[viii]
- Discrimination and Social Stigma
Negative societal attitudes also manifest in harmful policies. Many school districts have implemented policies requiring parental notification before a student can use their preferred name or pronouns, even if disclosure could place the student in harm’s way.[ix] Courts remain divided on whether such policies constitute discrimination or a legitimate interest in parental rights.
Additionally, “bathroom bills” restricting access to gender-appropriate restrooms have been shown to significantly impact transgender youth’s mental well-being. Research from the UCLA Williams Institute found that students subject to restrictive bathroom policies reported higher rates of anxiety and school absenteeism due to fear of harassment.[x]
- The Trump Administration and the Erosion of LGBTQ Protections
During the Trump Administration, multiple rollbacks of LGBTQ rights and protections heightened risks for transgender individuals. The administration rescinded Obama-era guidelines that protected transgender students’ rights to use facilities corresponding to their gender identity.[xi] This decision led to increased discrimination in schools, forcing transgender youth into hostile environments.
The Trump Administration also attempted to define gender strictly based on biological sex at birth, effectively erasing federal recognition of transgender individuals.[xii] Although never publicly released, the contents of this memorandum were disclosed through investigative reporting by The New York Times. The report revealed that HHS aimed to establish a federal definition of gender based strictly on biological sex assigned at birth.
Additionally, in 2020, the administration finalized a rule under the Affordable Care Act removing protections for transgender patients in healthcare settings, permitting discrimination based on gender identity.[xiii] This policy resulted in increased denial of healthcare services, worsening health outcomes for transgender individuals.
The cumulative impact of these policies fostered an environment of hostility and eroded previously established protections, amplifying risks for transgender and broader LGBTQ communities. The 2018 leaked HHS memorandum served as an early indicator of the policies that would later become central to Trump’s second-term agenda. While legal challenges and administrative pushback slowed the implementation of such policies in his first term, his return to office in 2025 enabled a renewed and more expansive effort to codify these views into federal law. The executive orders signed in early 2025, particularly those restricting gender recognition and access to medical care, reflect the same underlying philosophy of defining gender solely based on biological sex, effectively erasing legal recognition for transgender individuals.
- The Second Trump Administration: Escalation of Anti-Transgender Policies
Upon returning to office in January 2025, President Donald Trump intensified efforts to curtail transgender rights through a series of executive orders and policy directives.
- Executive Order: “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”
Signed on January 20, 2025, this order mandates that all federal agencies define sex strictly based on biological attributes identified at birth, effectively eliminating recognition of transgender and non-binary identities within federal policies.[xiv] The order also directs agencies to remove materials promoting “gender ideology” and cease funding for gender-affirming care.[xv] This redefinition has profound implications, including the invalidation of gender markers on federal identification documents and the exclusion of transgender individuals from facilities aligning with their gender identity.
- Executive Order: “Protecting Children from Chemical and Surgical Mutilation”
Issued on January 28, 2025, this order prohibits the use of federal funds for gender-affirming medical treatments for individuals under 19, labeling such procedures as “mutilation.[xvi]” It also restricts insurance coverage for gender-affirming care under Medicaid and TRICARE, and directs the Department of Justice to oppose these treatments through litigation and legislation.[xvii] Legal challenges have emerged, with federal judges temporarily blocking the order’s enforcement, citing potential violations of constitutional rights.
- Executive Order: “Keeping Men Out of Women’s Sports”
Signed on February 5, 2025, this order bans transgender women and girls from participating in female sports teams at federally funded educational institutions.[xviii] It threatens to revoke federal funding from institutions that allow transgender females to compete in women’s sports, arguing a violation of Title IX protections.[xix] The National Collegiate Athletic Association (NCAA) has stated its compliance with the order, leading to policy changes that exclude transgender athletes from women’s competitions.
- Redefinition of Gender Terminology
The Department of Health and Human Services (HHS), following executive directives, updated official definitions to assert that sex is immutable and strictly binary.[xx] This action, led by Secretary Robert F. Kennedy Jr., aims to eliminate recognition of transgender identities in healthcare policies, potentially denying transgender individuals access to necessary medical services.
- Impact on the LGBTQ+ Community
These executive actions have prompted widespread concern among LGBTQ+ rights advocates, healthcare providers, and legal experts. The policies not only undermine existing protections but also exacerbate stigma and discrimination against transgender individuals. Legal challenges are underway, with courts examining the constitutionality of these orders and their alignment with federal civil rights laws. The outcomes of these legal battles will significantly influence the future of transgender rights in the United States.
- Conclusion
The mental health of transgender youth is inextricably linked to legal protections, public attitudes, and societal treatment. The growing wave of restrictive legislation and judicial decisions upholding these laws have placed significant barriers to healthcare and personal autonomy, leading to worsened mental health outcomes. Conversely, policies that affirm transgender identities correlate with improved well-being and lower suicide rates.
As legal battles continue to shape the rights and futures of transgender youth, it is imperative to consider the tangible impacts these policies have on their mental health and overall well-being. Federal protections, affirming state policies, and public advocacy remain crucial in counteracting the harmful effects of discrimination and ensuring transgender youth receive the support and resources necessary to thrive.
[i] Jack L. Turbin et al., Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. 145 Vol. 2 Pediatrics 1, 1 (2020).
[ii] See Tenn. Code Ann. § 68-33-101 (2023).
[iii] L.W. v. Skrmetti, 73 F.4th 408 (6th Cir. 2023).
[iv] See Doe v. Ladapo, 88 F.4th 721 (11th Cir. 2024).
[v] See Exec. Order No. 14075, 87 Fed. Reg. 37,189 (2022).
[vi] Justice Department Files Complaint Challenging Tennessee Law Banning Gender-Affirming Care for Transgender Youth, U.S. Dep’t of Justice (April 26, 2023), https://www.justice.gov/archives/opa/pr/justice-department-challenges-tennessee-law-bans-critical-medically-necessary-care.
[vii] See The Trevor Project, 2023 National Survey on LGBTQ Youth Mental Health, https://thetrevorproject.org/survey-2023/ (Last Visited Feb. 22, 2025).
[viii] See Natalie M. Wittlin et al., Mental Health of Transgender and Gender Diverse Youth, 19 Ann. Rev. Clin. Psychol. 207 (2023).
[ix] See Doe v. Madison Metro. Sch. Dist., 976 N.W.2d 584 (Wis. 2022).
[x] See Christie Mallory, et al., Williams Inst., The Impact of 2023 Legislation on Transgender Youth (2023); Jody L. Herman, Williams Inst., Gendered Restrooms and Minority Stress: The Public Regulation of Gender and its Impact on Transgender People’s Lives (2013).
[xi] See Dear Colleague Letter, U.S. Dep’t of Educ. & U.S. Dep’t of Justice (Feb. 22, 2017), https://www.ed.gov/sites/ed/files/about/offices/list/ocr/letters/colleague-201702-title-ix.pdf.
[xii] Green, E. L., Benner, K., & Pear, R., ‘Transgender’ Could Be Defined Out of Existence Under Trump Administration, N.Y. Times (Oct. 21, 2018).
[xiii] See Nondiscrimination in Health and Health Education Programs or Activities, 85 Fed. Reg. 37,160 (June 19, 2020).
[xiv] Exec. Order No. 14168, 90 FR 8615, 2025
[xv]Id.
[xvi] Exec. Order No. 14187, 90 FR 8771, 2025
[xvii] Id.
[xviii] Exec. Order No. 14201, 90 FR 9279, 2025
[xix] Id.
[xx] HHS Takes Action on President Trump’s Executive Orders Defending Women and Children, U.S. Dep’t of Health & Human Services (Feb. 19, 2025), https://www.hhs.gov/about/news/2025/02/19/hhs-takes-action-president-trumps-executive-orders-defending-women-children.html.
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