Skip to main content

Attitudes in the U.S. Toward Hormonal and/or Surgical Interventions for Adolescents Experiencing Gender Dysphoria


In order to align with their inner sense of gender identity, adolescents suffering from gender dysphoria are increasingly being treated with cross-sex hormones and irreversible surgeries to alter their bodies. The present study is the first to examine attitudes about these recently emergent medical practices in a national population. We used data from the 2018 Post-Midterm Election Study, a survey representative of adults in the USA ages 20 to 65 years (N = 5285), to examine the social factors associated with approval or disapproval of hormonal and/or surgical interventions for adolescents seeking medical treatment for gender dysphoria. Higher fertility, race/ethnicity (in this case, black), sex (male), and heterosexual self-identity were each robustly associated with disapproval. Nested regression models revealed that a range of religion measures were statistically significant (toward disapproval). However, all but evangelical self-identification were no longer significant after accounting for support for abortion rights, the spectrum of political self-identification, and voting behavior. These findings, prompted by a high percentage of variance explained, led us to consider perspectives on medical transitions for adolescents as fitting the “culture war” framework, largely polarized between a “progressive” worldview of bodily autonomy and an “orthodox” worldview of bodily integrity.

This is a preview of subscription content, access via your institution.


  1. Agreement that hormonal or surgical interventions for adolescents should be ok is conceptually the same as approval of said interventions for adolescents. We therefore use the two terms interchangeably throughout this paper. While “approval/disapproval” may sound more value-laden than “agreement/disagreement,” our survey respondents were in effect asked to make a value judgment. Our outcome variable does not indicate approval or disapproval of transgender people themselves as having human dignity, worthy of love and respect, etc.

  2. Knowledge Networks (now Ipsos) recruited the first online research panel that is representative of the US population. Dubbed the KnowledgePanel®, members are randomly recruited by telephone and mail surveys, and households are provided with access to the Internet and computer hardware if needed. Unlike other Internet research panels sampling only individuals with Internet access who volunteer for research, the KnowledgePanel® is based on a sampling frame which includes both listed and unlisted numbers as well as those without a landline telephone, is not limited to current Internet users or computer owners, and does not accept self-selected volunteers. As a result, it is a random, nationally representative sample of the American population. More information about Ipsos and the KnowledgePanel®, including panel recruitment, connection, retention, completion, and total response rates, is available from their Web site.

  3. We also realize the term “abortion rights” itself is contested in American public life. Our use of that term is not intended to signal any normative position, one way or another, on the proper scope of rights concerning abortion.

  4. A real type, as opposed to a Weberian ideal type, following Gorski, is a conceptual abstraction that helps social scientists to understand why particular structures/patterns of human social relations are the kind of structures they are by identifying some set of elements and interrelations without which those social structures would be something else and/or would not have the particular kinds of emergent causal powers we believe they have.


  • Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: Preliminary results. International Journal of Pediatric Endocrinology, 8.

  • Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C. L., Leef, J. H., Lishak, V., Reim, E., Takagi, A., Vinik, J., Wreford, J., Cohen-Kettenis, P. T., de Vries, A. L. C., Kreukels, B. P. C., & Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 756–763.

    PubMed  Article  Google Scholar 

  • Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology, 7, 302–311.

    Article  Google Scholar 

  • Anderson, R. T., & George, R. P. (2019). Physical interventions on the bodies of children to “affirm” their “gender identity” violate sound medical ethics and should be prohibited. Public Discourse.

  • Brown, A. (2017). Republicans, Democrats have starkly different views on transgender issues. Fact Tank. Pew Research Center.

  • Brunskell-Evans, H. (2019). The medico-legal “making” of “the transgender child.” Medical Law Review, 27, 640–657.

    PubMed  Article  Google Scholar 

  • Cole, D. (2021). Arkansas becomes first state to outlaw gender-affirming treatment for trans youth. CNN.

  • Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., … Zucker, K. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232.

    Article  Google Scholar 

  • D’Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D. T., & Clarke, P. (2021). One size does not fit all: In support of psychotherapy for gender dysphoria [Letter to the Editor]. Archives of Sexual Behavior, 50, 7–16.

    PubMed  Article  Google Scholar 

  • Davis, N. J., & Robinson, R. V. (1996). Are the rumors of war exaggerated? Religious orthodoxy and moral progressivism in America. American Journal of Sociology, 102, 756–787.

    Article  Google Scholar 

  • de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696–704.

    PubMed  Article  Google Scholar 

  • Dubin, S., Lane, M., Morrison, S., Radix, A., Belkind, U., Vercler, C., & Inwards-Breland, D. (2020). Medically assisted gender affirmation: When children and parents disagree. Journal of Medical Ethics, 46, 295–299.

    PubMed  Article  Google Scholar 

  • Ehrensaft, D. (2017). Gender nonconforming youth: Current perspectives. Adolescent Health, Medicine and Therapeutics, 8, 57–67.

    PubMed  PubMed Central  Article  Google Scholar 

  • Ehrensaft, D., Giammattei, S. V., Storck, K., Tishelman, A. C., & Keo-Meier, C. (2018). Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens. International Journal of Transgenderism, 19, 251–268.

    Article  Google Scholar 

  • Elischberger, H. B., Glazier, J. J., Hill, E. D., & Verduzco-Baker, L. (2016). “Boys don’t cry”—or do they? Adult attitudes toward and beliefs about transgender youth. Sex Roles, 75, 197–214.

    Article  Google Scholar 

  • Elischberger, H. B., Glazier, J. J., Hill, E. D., & Verduzco-Baker, L. (2018). Attitudes toward and beliefs about transgender youth: A cross-cultural comparison between the United States and India. Sex Roles, 78, 142–160.

    Article  Google Scholar 

  • Evans, M. (2021). Freedom to think: The need for thorough assessment and treatment of gender dysphoric children. BJPsych Bulletin, 45, 285–290.

    PubMed  PubMed Central  Article  Google Scholar 

  • Flores, A. R. (2015). Attitudes toward transgender rights: Perceived knowledge and secondary interpersonal contact. Politics, Groups, and Identities, 3, 398–416.

    Article  Google Scholar 

  • Flores, A. R., Haider-Markel, D. P., Lewis, D. C., Miller, P. R., Tadlock, B. L., & Taylor, J. K. (2018). Challenged expectations: Mere exposure effects on attitudes about transgender people and rights. Political Psychology, 39, 197–216.

    Article  Google Scholar 

  • Greenhalgh, H. (2021). UK court rules in favour of parental consent in trans treatment row. Reuters.

  • Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 102, 3869–3903.

    PubMed  Article  Google Scholar 

  • Hoffarth, M. R., & Hodson, G. (2018). When intergroup contact is uncommon and bias is strong: The case of anti-transgender bias. Psychology and Sexuality, 9, 237–250.

    Article  Google Scholar 

  • Hunter, J. D. (1991). Culture wars: The struggle to define America. Basic Books.

    Google Scholar 

  • Jeffreys, S. (2014). Gender hurts: A feminist analysis of the politics of transgenderism. Routledge.

    Book  Google Scholar 

  • Jones, A. (2020). How “conversion therapy” bans hurt kids. The Heritage Foundation.

  • Jones, P. E., Brewer, P. R., Young, D. G., Lambe, J. L., & Hoffman, L. H. (2018). Explaining public opinion toward transgender people, rights, and candidates. Public Opinion Quarterly, 82, 252–278.

    Article  Google Scholar 

  • Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 9, 31–41.

    PubMed  PubMed Central  Article  Google Scholar 

  • Kuper, L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics, 145, e20193006.

    Article  PubMed  Google Scholar 

  • Luhur, W., Brown, T. N. T., & Flores, A. R. (2019). Public opinion of transgender rights in the United States. The Williams Institute.

    Google Scholar 

  • Mahfouda, S., Moore, J. K., Siafarikas, A., Hewitt, T., Ganti, U., Lin, A., & Zepf, F. D. (2019). Gender-affirming hormones and surgery in transgender children and adolescents. The Lancet Diabetes and Endocrinology, 7, 484–498.

    PubMed  Article  Google Scholar 

  • Meadow, T. (2018). Trans kids: Being gendered in the twenty-first century. University of California Press.

    Book  Google Scholar 

  • Miller, P. R., Flores, A. R., Haider-Markel, D. P., Lewis, D. C., Tadlock, B. L., & Taylor, J. K. (2017). Transgender politics as body politics: Effects of disgust sensitivity and authoritarianism on transgender rights attitudes. Politics, Groups, and Identities, 5, 4–24.

    Article  Google Scholar 

  • Milrod, C. (2014). How young is too young: Ethical concerns in genital surgery of the transgender MTF adolescent. Journal of Sexual Medicine, 11, 338–346.

    PubMed  Article  Google Scholar 

  • Milrod, C., & Karasic, D. H. (2017). Age is just a number: WPATH-affiliated surgeons’ experiences and attitudes toward vaginoplasty in transgender females under 18 years of age in the United States. Journal of Sexual Medicine, 14, 624–634.

    PubMed  Article  Google Scholar 

  • Norton, A. T., & Herek, G. M. (2013). Heterosexuals’ attitudes toward transgender people: Findings from a national probability sample of U.S. adults. Sex Roles, 68, 738–753.

    Article  Google Scholar 

  • Olson-Kennedy, J., Streeter, L. H., Garofalo, R., Chan, Y. M., & Rosenthal, S. M. (2021). Histrelin implants for suppression of puberty in youth with gender dysphoria: A comparison of 50 mcg/day (Vantas) and 65 mcg/day (SupprelinLA). Transgender Health, 6, 36–42.

    PubMed  PubMed Central  Article  Google Scholar 

  • Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., & Clark, L. F. (2018). Chest reconstruction and chest dysphoria in transmasculine minors and young adults: Comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatrics, 172, 431–436.

    PubMed  PubMed Central  Article  Google Scholar 

  • Pang, K. C., de Graaf, N. M., Chew, D., Hoq, M., Keith, D. R., Carmichael, P., & Steensma, T. D. (2020). Association of media coverage of transgender and gender diverse issues with rates of referral of transgender children and adolescents to specialist gender clinics in the UK and Australia. JAMA Network Open, 3, e2011161.

    Article  PubMed  PubMed Central  Google Scholar 

  • Persinger, L. L., Persinger, J. D., & Abercrombie, S. (2020). The association between school policies, practices, and public perception of trans youth in the U.S. Journal of LGBT Youth, 17, 24–52.

    Article  Google Scholar 

  • Prusaczyk, E., & Hodson, G. (2020). The roles of political conservatism and binary gender beliefs in predicting prejudices toward gay men and people who are transgender. Sex Roles, 82, 438–446.

    Article  Google Scholar 

  • Pyne, J. (2014). Gender independent kids: A paradigm shift in approaches to gender non-conforming children. Canadian Journal of Human Sexuality, 23, 1–8.

    Article  Google Scholar 

  • Rafferty, J., AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142, e20182162.

  • Rahilly, E. (2020). Trans-affirmative parenting: Raising kids across the gender spectrum. New York University Press.

    Book  Google Scholar 

  • Richards, C., Maxwell, J., & McCune, N. (2019). Use of puberty blockers for gender dysphoria: A momentous step in the dark. Archives of Disease in Childhood, 104, 611–612.

    PubMed  Article  Google Scholar 

  • Shrier, A. (2020). Irreversible damage: The transgender craze seducing our daughters. Regnery Publishing.

    Google Scholar 

  • Shuster, S. M. (2021). Trans medicine: The emergence and practice of treating gender. New York University Press.

    Google Scholar 

  • Sopelsa, B. (2020). Virginia becomes 20th state to ban conversion therapy for minors. NBC News.

  • Steinmetz, G., & Gorski, P. (2017). Ideal types vs. real types. Critical Realism Network.

  • Stryker, S. ([2008] 2017). Transgender history: The roots of today’s revolution (rev. ed.). New York: Seal Press.

  • Turban, J. L., & Ehrensaft, D. (2018). Research review: Gender identity in youth: Treatment paradigms and controversies. Journal of Child Psychology and Psychiatry, 59, 1228–1243.

    PubMed  Article  Google Scholar 

  • Vrouenraets, L. J. J. J., Fredriks, A. M., Hannema, S. E., Cohen-Kettenis, P. T., & de Vries, M. C. (2015). Early medical treatment of children and adolescents with gender dysphoria: An empirical ethical study. Journal of Adolescent Health, 57, 367–373.

    Article  Google Scholar 

  • Williams, M. N., Gómez Grajales, C. A., & Kurkiewicz, D. (2013). Assumptions of multiple regression: Correcting two misconceptions. Practical Assessment, Research, and Evaluation, 18.

  • Zucker, K. J. (2019). Adolescents with gender dysphoria: Reflections on some contemporary clinical and research issues. Archives of Sexual Behavior, 48, 1983–1992.

    PubMed  Article  Google Scholar 

  • Zucker, K. J. (2020). Debate: Different strokes for different folks. Child and Adolescent Mental Health, 25, 36–37.

    PubMed  Article  Google Scholar 

Download references


The survey was underwritten by the Austin Institute.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Brad Vermurlen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The IRB at the University of Texas at Austin waived approval because the research used a de-identified dataset.

Informed Consent

Informed consent was obtained from all participants prior to their participation in the research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Regnerus, M., Vermurlen, B. Attitudes in the U.S. Toward Hormonal and/or Surgical Interventions for Adolescents Experiencing Gender Dysphoria. Arch Sex Behav 51, 1891–1902 (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Gender dysphoria
  • Gender identity
  • Cross-sex hormones
  • Surgery
  • Adolescents
  • Public opinion