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More than 120 bills targeting transgender people have been introduced in state legislatures across the country since January, according to an analysis by the American Civil Liberties Union.
Among the proposed bills are adolescent restrictions on "gender-affirming care," or health care specific to trans people. More than two dozen states have either passed or introduced such legislation, according to the Associated Press.
While supporters of this legislation claim they are concerned about the wellbeing of minors, doctors and other medical professionals instead warn about the dangers of not providing gender-affirming care to those who need it.
Contrary to popular belief, gender-affirming care "encompasses a lot," said Dr. Kristen Frank-Dixon, a family medicine physician with Geisinger.
Care for trans/gender-nonconforming people, which certainly can include surgery and/or hormone therapy, can also be as simple as changing names and pronouns. Every trans person is different, so individual care is different from patient to patient, Frank-Dixon said.
For example, a patient who has yet to undergo puberty could be prescribed puberty blockers: medications that can suppress the release of certain hormones in pre-pubescent adolescents, dampening the effects of those hormones on developing secondary sex characteristics, like facial hair.
In essence, all those medications do is pause the onset of puberty, so the effects can be reversed if the medication is stopped.
Physicians at Geisinger help with adolescents and, for adults, can provide "limited" surgical services, like masculinizing "top" surgery, which removes breast tissue, Frank-Dixon said.
Geisinger workers who provide gender-affirming care follow the World Professional Association for Transgender Health standard of care, she said.
Local OB-GYN Dr. Natasha Aligood-Percoco also works with "gender-affirming hormone therapy," she said, along with some surgery, like hysterectomy, which removes the uterus from a patient.
"Hormone therapy is not necessary for (all) patients who identify outside their biological gender," Aligood-Percoco said.
Though, it can be medically necessary, she said, for those with gender dysphoria, or a feeling of distress caused by a mismatch between biological sex and gender identity.
That isn't to say that there aren't any risks associated with hormone therapy.
Across the health care field, a concept called "informed consent" is the rule of the land: going through all the possible risks and weighing the pros and cons of all forms of treatment.
Aligood-Percoco and other medical professionals who provide hormone therapy inform patients of the expected changes and adverse risks of the treatment. For example, patients undergoing masculinizing hormone therapy can expect the growth of facial hair, but the hormones could also lead to male-pattern baldness for some, she said.
She also only treats adults; younger people would be referred to pediatric specialists, she said.
There is also a "mental health prerequisite," Aligood-Percoco said.
After all, doctors want to make sure patients are stable before tweaking their hormones.
Fortunately, there is a "robust mental health care community" in the area, she said.
Trans and gender-nonconforming people have a much higher rate of depression and suicide compared to the general population, so doctors that treat trans patients want to make sure they're doing well before and during treatment.
That's not the only reason trans people seeking gender-affirming care might first seek out the help of a therapist.
Because some health care plans require letters from therapists in order to cover gender-affirming care, one place people in the area can turn to is Radiance Wellness Group in Williamsport.
Jamie Plocinski, a licensed clinical social worker and owner of Radiance Wellness Group, is well-versed in the process of writing letters for insurance purposes. In fact, she said, a number of trans people in the area who are otherwise happy with the therapy they receive elsewhere come her way for letters in case their therapist isn't familiar with the process.
Though, she said, she doesn't hand out letters willy-nilly.
She conducts an assessment of the patient and looks into their history and weighs other factors.
The process is "definitely based on age," she said.
For younger patients, parents/caregivers are involved in the process.
Beyond letters, Plocinski also offers therapy specific to trans patients, especially those struggling with gender dysphoria. She also stressed that her practice is certainly not the only one in the area offering gender-affirming care.
The human element
Frank-Dixon personally works with trans/gender-nonconforming patients and noted "very high rates of depression... in gender-diverse populations."
Though, she said, receiving gender-affirming care, even starting with pronouns, "dramatically" decreases depression.
She cited a study that reported a general depression/suicide rate among trans people at 41%; after gaining access to gender-affirming care, that rate dropped to just 2%.
Similar studies reported very similar results.
"It is critical care ... It saves more lives than mammograms," Frank-Dixon said.
Of course, she added, mammograms are still very important, and anyone who is recommended to get one should do so.
"Based on the number of lives saved ... it's a critical piece of health care," she said.
Frank-Dixon has seen first-hand the impact gender-affirming care has on her patients.
"Just seeing a dramatic improvement in people's lives has become an important part of my life," she said.
Depression and suicide attempts "melt away" in her patients when they receive the care they need, she said.
Frank-Dixon calls the experience "rewarding."
And it's not just doctors who get a lot out of providing a facet of care to the trans community.
Megan Bloom, marketing and public relations coordinator for AIDS Resource, said one of her favorite things to do at work is help with the Brian Spies Boutique.
The boutique offers free, gender-affirming clothes in a private environment. The address of the boutique is not publicized; interested parties have to contact AIDS Resource to set up an appointment to visit.
The boutique, which opened in June, sees people of all ages come through its doors, Bloom said. She lets the folks who come in talk about their experiences and how transitioning impacts their lives.
She said that one client asked her what kinds of clothes were appropriate for the workplace, seeing as how Bloom had the experience of being a woman in the workplace for much longer than the client had.
"She left feeling thankful that she came," Bloom said.
Having worked with AIDS Resource for three years, Bloom finds working at the boutique an "absolutely" rewarding experience.
She gets excited when there are new clients and loves to see them "walk out feeling more confident."
"Just wearing clothes that are affirming can do so much," Bloom said.
Advice for parents
Health care professionals across the field have the same recommendation for parents of young trans/gender-nonconforming people.
"Just love that person," Aligood-Percoco said.
Even adolescents who are straight and cisgender need loving environments, she said.
"Just be loving."
"It isn't a disease," Frank-Dixon said. "(Being transgender) doesn't need to be 'fixed.'"
"Being a parent is hard," she added.
"Just love and embrace your child," Frank-Dixon said.
After all, "gender identity is just a piece of who they are," she said.
Providing care at home gives trans youth the best outcome, Frank-Dixon continued.
"Love works."