27 September, Lisbon, Portugal—At the 28th WPATH Scientific Symposium, a session reviewing policies regulating access to gender-affirming healthcare highlighted the global inconsistencies and inequities in this critical area of care. Experts presented research and insights that highlighted the urgent need for more standardized and inclusive policies, as the gaps in care continue to affect trans and gender diverse individuals worldwide.
Gender-affirming healthcare plays a crucial role in improving the mental and physical wellbeing of trans and gender diverse individuals seeking transition-related services. However, worldwide, gender-affirming healthcare guidelines are inconsistent and inequitable, with varying priorities leading to unequal access. Different countries emphasize different aspects of care, further complicating access. Additionally, the role of parental consent or authority in determining youth access to gender-affirming healthcare varies widely, highlighting the inconsistent and often inadequate implementation of these critical services.
Led by Dr. Meredithe McNamara and co-hosted by Rasha Younes and Yasemin Smallens from Human Rights Watch, this session focused on the global discrepancies in gender-affirming healthcare access. The panel underscored how different countries apply healthcare guidelines in inconsistent ways, resulting in unequal access to these services. They emphasized that international law obliges States to provide gender-affirming care to both adults and youth, citing the United Nations Convention on the Rights of the Child. However, the panel noted that this obligation is far from being universally upheld, as evidenced by the varying levels of support and resources allocated to gender affirming care across different jurisdictions.
A forthcoming study by the Van Center for International Justice, examining data from July 2023 to July 2024, revealed striking disparities across countries in the policies and language used in gender-affirming care guidelines worldwide. For instance, while some nations, such as Australia and Italy, require parental consent or authorization for youth to access gender-affirming healthcare—ranging from one to two parents, respectively—elsewhere, certain U.S. States allow individuals aged 16 years or older to receive care without parental approval. In contrast, countries like Russia outright prohibit gender-affirming care, while the United Kingdom has recently banned youth access to puberty blockers following the Cass Review, citing “concerns” over inadequate evidence for long-term impacts.
Another key topic examined was insurance coverage for gender-affirming healthcare. Panelists highlighted that while countries such as Argentina, Belgium, and Mexico appear to have progressive policies on paper, healthcare coverage is often partial or requires upfront out-of-pocket payments that are only reimbursed later, exacerbating access inequalities. In France, it was noted that while some procedures, such as top surgery, are covered for trans women, trans men often face significant barriers, as such procedures may not be covered under the same policies, further complicating access. This discrepancy raises concerns about fairness and equity in access to necessary healthcare services.
Speakers emphasized the critical need to address these disparities by acknowledging cultural and policy differences while advocating for more equitable access to gender-affirming healthcare. The session stressed that inconsistent policies around parental consent, age restrictions, and healthcare coverage continue to create barriers for trans and gender diverse individuals worldwide. As the session drew to a close, experts called for a collaborative approach to reform policies, ensuring that all individuals can access the care they need, regardless of their geographic or socio-political context.