Public opinion about gender-affirming care for young people experiencing gender dysphoria is divided, with many Americans expressing uncertainty about the issue.
An issue that has occupied increasing attention at the state level in recent years is care for young people who are experiencing gender dysphoria. According to a report from the Kaiser Family Foundation, 26 states have passed laws limiting access to gender-affirming care for transgender and nonbinary young people, and 24 states impose penalties on medical professionals who provide such care. (About half of our respondents live in a state that has passed a ban.) All of these state-level laws have been adopted since 2021, though the specific details vary from state to state. Currently, 17 states face lawsuits challenging their policies. Our aim in the American Family Survey is not to comment on the wisdom or efficacy of any specific state-level policy, but rather to better understand public opinion about this issue, which affects both transgender children and their families.
We asked respondents whether they support or oppose their state “passing laws preventing hormone therapy that delays puberty for minors experiencing gender dysphoria.” Opinion on this issue is divided. Overall, 40% support such a ban, but 36% oppose. One-quarter of respondents say they don’t know. Notably, the distribution of opinion is roughly similar whether or not the respondent lives in a state that has passed a ban on gender-affirming care, and even in those states, nearly one-quarter of respondents say they don’t know.
The high level of uncertainty in the responses could be partly because respondents don’t understand the term “gender dysphoria,” which we did not define for them, or don’t know enough about the issue to have a meaningful opinion. “Don’t know” responses could also occur because respondents are genuinely ambivalent, seeing both reasons to support and reasons to oppose such laws. Another possibility is that respondents are hesitant to disclose their attitudes about this sensitive issue. In addition, we asked about only one type of gender-affirming care: hormone therapy that delays puberty for minors. The broader category of gender-affirming care includes a spectrum of “medical, surgical, mental health, and non-medical services,” according to the Kaiser Family Foundation. It is possible that opinions about other aspects of gender-affirming care would be different or include more definitive views.
Though young people are sometimes assumed to be more supportive of transgender rights, we find few differences in attitudes about this policy by age. Young people between the ages of 18-30 express the lowest levels of support for laws banning hormone therapy for minors (36%), but that is not much different from the level of support among those 51-64 (37%) or those over 65 (39%). The age group with the highest support level turns out to be people between 31 and 50, of whom 44% express support for hormone therapy bans. This group is also the set of respondents who are the most likely to be parents of children under the age of 18, with more than half the respondents in that age group currently parenting minor children. Among respondents between 31-50 years old, 48% of parents with minor children support the ban, while 40% of respondents who do not have children under 18 favor such a ban. Of all parents with minor children, no matter what their age, 46% support state-level bans, compared to 37% of respondents with no minor children. Thus, while support does not quite reach a majority, the group most friendly toward a state ban on hormone therapy is parents of children under 18. We do not have an indicator of whether or not these respondents have children who are experiencing gender dysphoria, so we cannot say how parents whose families might be directly affected by such a ban view the policy.
We find some evidence of racial or ethnic differences in attitudes about this issue, though again across all groups, support for hormone therapy bans is highest among parents. Whites are considerably more supportive of bans than Black or Hispanic respondents, and half of white parents of minor children support such policies. Among Black and Hispanic respondents not currently parenting minor children, we find especially high levels of uncertainty. About 45% of Hispanics and 40% of Blacks who are not parenting minor children say they don’t know.
Not surprisingly, given the ways in which this issue has been politicized, with nearly all the state-level bans occurring in red states, we also find a substantial partisan divide. Nearly 6 in 10 Republicans support the bans, compared to 23% of Democrats. By contrast, a little over one-quarter of Republicans and a little less than one-quarter of independents oppose banning hormone therapy treatments for minors, while close to half of Democrats oppose them. Still, among both independents and Democrats, about one in three respondents say they do not know. A far smaller percentage of Republicans choose the “don’t know” option.
Parental status also interacts with partisanship to shape opinions about this issue, but primarily among Democrats. While parents of children under 18 are consistently more supportive than non-parents, the gap among Democrats is substantially larger than for the other partisan categories. Support among Democrats with minor children is double that of Democrats who do not have minor children. By contrast, parental status makes a much smaller difference among both independents and Republicans.
Both partisanship and parental status shape attitudes about hormone therapy policy. It is not surprising that legal bans on gender-affirming care can be found primarily in red states, because the highest levels of support are found among Republicans. In this sense, Republican legislators are responding to the preferences of those most likely to vote for them and not to the broad distribution of public opinion, where support never reaches a majority, even in states that have already enacted a ban. At the same time, large percentages of Americans are not yet ready to take a stand on the issue one way or the other.
A great deal remains to be learned about this issue. How do Americans view other aspects of gender-affirming care? Are the high levels of “don’t know” responses a function of lack of information, unwillingness to weigh in on a sensitive issue, or genuine ambivalence? How should we interpret the comparatively higher level of opposition among parents who are currently parenting minor children? And how might opinion change as medical experts study these issues more? Our data provide just a glimpse at the contours of public opinion on an issue that has only recently emerged onto the political scene.
By Christopher F. Karpowitz and Jeremy C. Pope
METHODOLOGY NOTE
Between August 22-29, 2024, YouGov interviewed 3,245 respondents who were then matched down to a sample of 3,000 to produce the final dataset. The respondents were matched to a sampling frame on gender, age, race, and education. The matched cases were weighted to the sampling frame using propensity scores. The matched cases and the frame were combined, and a logistic regression was estimated for inclusion in the frame. The weights were then post-stratified on 2020 presidential vote choice as well as a four-way stratification of gender, age (4 categories), race (4 categories), and education (4 categories), to produce the final weight. The overall margin of error is +/- 2%.