Learning in the Shadow of Legislation: The Impact of Anti-Transgender Legislation on Adolescent Medicine Fellows' Training and Future Practice.

PURPOSE: To assess how anti-transgender legislation influences Adolescent Medicine (AM) fellows' training choices, educational experiences, and future clinical practice.

METHODS

A national survey was distributed to US AM fellowship programs (October-December 2024). This survey assessed perceived legislative climate, training quality, and moral distress. Open-ended responses were thematically analyzed.

RESULTS

Fifty-six fellows from 24 institutions across 15 states responded. Most (79.5%) cited gender-affirming care as important in choosing AM; 62.5% reported that legislation influenced their rank list. Fellows in states with actual or perceived restrictive legislation reported higher rates of suboptimal (76.0%) and harmful (24.0%) care, and anticipated greater practice restrictions (80.0% vs. 45.2%). Qualitative themes included fewer educational opportunities, professional censorship, and ethical conflict related to legal threats and patient harm.

DISCUSSION: Anti-transgender legislation significantly impacts the training, wellbeing, and future practice of AM fellows, threatening the clinical pipeline and quality of care for transgender and gender-diverse youth.