Hormone Care Is Healthcare: Addressing Access Gaps for Trans People in Maryland

Abstract

The Maryland Trans Survey is a community-based research project conducted by Trans Maryland. The Queer/Trans Collective for Research on Equity and Wellness examining experiences of trans people in the State of Maryland in areas such as health and healthcare, employment and economic well-being, and legal and policy experiences. To date, it is the largest survey of trans people in the State, with 750 trans people representing all 23 counties in Maryland and Baltimore City.

Data were collected from June to December 2023 through in-person and online community outreach. The project was approved by Towson University’s Institutional Review Board (Protocol #1897) and used Transgender Research Informed Consent (TRICON) Disclosures to provide trans community members with additional transparency on the project, recognizing long histories of harmful practices in trans research from scientific institutions.

Transgender and nonbinary people face disproportionately high rates of depression and suicidality compared to their cisgender and heterosexual peers (Rastogi et al., 2025). Trans youth are 2 to 2.5 times more likely to report depressive symptoms and attempt suicide than cisgender LGBQ youth (Price‐Feeney et al., 2020). These elevations and mental health risks stem from societal rejection, stigma, and discrimination, not from their identities. One study also found a direct correlation between anti-trans laws and a 72% increase in suicide attempts among trans youth (Lee et al., 2024). Mental health struggles among trans adults mirror the experiences of youth. According to the 2022 U.S. Transgender Survey, 78% of respondents considered suicide and 40% attempted suicide at some point (Rastogi et al., 2025). These laws can include legislation that restricts access to gender-affirming care (GAC), including gender-affirming hormone treatment. While recent actions by the Trump administration have sought to restrict access to GAC by limiting the use of Federal funds, there have been no changes to Federal or Maryland state laws regarding GAC as of writing. Individuals in Maryland, including those covered by Medicaid, can still access gender-affirming care.

Gender-affirming care refers to a range of supportive services tailored to the needs of trans individuals. These services can include medical care, surgical procedures, mental health treatment, and non-medical forms of assistance. Gender-affirming hormone therapy is one aspect of gender-affirming care. It typically involves the administration of testosterone for individuals assigned female at birth and estrogen for individuals assigned male at birth. Gender-affirming healthcare, especially hormone therapy, has been shown to dramatically improve mental health outcomes, including lower rates of depression and suicidality (Green et al., 2022). To ensure trans Marylanders receive the care they need and deserve, it is essential to consider their experiences in relation to their access and use of gender-affirming hormones.

This brief presents project data related to Gender-Affirming Hormone Treatment for the purpose of helping advocates, policymakers, and community-serving entities to better understand and support the current needs of trans people in Maryland.