Improving Access to Gender-Affirming Care for Two-Spirit, Transgender, and Nonbinary (TTNB) Youth

Executive Summary

Access to gender-affirming care is vital for the physical and mental health of Two-Spirit, transgender, and nonbinary (TTNB) youth. Research consistently shows that affirming primary care, mental-health supports, and medical interventions (puberty blockers, hormone therapy, surgeries) dramatically reduce depression, anxiety, self-harm, and suicidality while boosting self-esteem and life satisfaction to levels comparable with cisgender peers. Yet TTNB youth face a web of barriers—few trained providers (especially outside urban centers), knowledge gaps among clinicians, outright denials or referral refusals, fear of discrimination, past negative experiences, and logistical or financial hurdles—that prevent timely access to care. To close these gaps, coordinated action is required across policy, education, clinical practice, community support, research, and public outreach to ensure every TTNB young person can receive respectful, comprehensive, and affordable gender-affirming health services.

Key Recommendations

• Adopt Equitable Health Policies: Mandate full insurance coverage for puberty blockers, hormone therapy, surgeries, and related mental-health supports for TTNB youth without discriminatory prerequisites.
• Enhance Provider Education & Training: Require all medical and allied-health programs (and their continuing education curricula) to include evidence-based modules on gender diversity, affirming language, and TTNB care pathways.
• Expand Service Availability: Establish incentive programs and telehealth networks to increase the number of trained gender-affirming clinicians—especially in underserved regions—and reduce travel and wait-time burdens. 
• Strengthen Community Engagement & Support: Fund community-based TTNB peer-support and caregiver education initiatives that are guided by youth advisory councils to ensure culturally relevant, affirming services.
• Invest in System Improvements & Data: Allocate dedicated health-system resources for real-time monitoring of TTNB care pathways and commission longitudinal research to refine best practices and inform policy evolution.
• Lead Public Awareness Campaigns: Roll out multi-channel, youth-driven education initiatives to dispel myths about TTNB identities, normalize gender diversity, and reduce stigma across schools, clinics, and communities.