Sources of Hope Among Providers of Adolescent Gender-Affirming Care: Implications for Workforce Sustainability and Social Work Practice

Background and Purpose

Providers delivering gender-affirming care to adolescents and young adults (AYAs) in the United States are navigating an increasingly restrictive policy and sociopolitical landscape, including legislative bans, clinic closures, and targeted harassment. Prior research has documented elevated stress, burnout, and workforce attrition in this context; however, less is known about the factors that sustain providers’ continued engagement in care delivery. Understanding these sustaining forces is critical for social work and interdisciplinary health services research, particularly given social workers’ roles in care coordination, advocacy, and workforce support. This study aimed to identify and characterize sources of hope among AYA gender-affirming care providers and to examine their implications for workforce sustainability and service delivery.

Methods

We conducted a national online survey of gender-affirming medical and mental health providers (n=172; 40.3% response rate). This analysis focused on responses to an open-ended question: “What gives you hope for the future of gender-affirming care?” Participants were recruited via professional listservs, clinical networks, and snowball sampling and included physicians, social workers, nurse practitioners, and mental health providers practicing in the United States. Qualitative data were analyzed using reflexive thematic analysis within a phenomenological framework. A de novo codebook (20 codes) was developed through iterative, team-based coding and applied through full adjudication. Demographic characteristics were analyzed descriptively to contextualize findings.

Results

Participants represented 40 U.S. states and Washington, DC, with most practicing in the Midwest (n=32), Mid-Atlantic (n=28), and Northeast (n=26). The majority were physicians (60.3%) or mental health providers (22.8%), with 10.9% in training. Most identified as female (56.2%), White (78.9%), and non-Hispanic (93.7%); 20.9% identified as transgender or gender-diverse.

Five themes were identified. Community inspiration reflected motivation derived from LGBTQIA+ communities, colleagues, and emerging generations of providers described as “ready for the challenge,” as well as recognition of the enduring resilience of transgender communities. Historical reflection situated current challenges within longer trajectories of social change, emphasizing that progress is “nonlinear” and often cyclical. Advocacy highlighted inspiration from collective action, including organizations and policy efforts mobilizing resources in response to current threats. Patients and families underscored the relational dimensions of care, with providers describing “awe” at the resilience of youth and their families. Evidence-based care reflected confidence in the clinical effectiveness of gender-affirming interventions and a sustained commitment to evidence-informed practice.

Conclusions and Implications

Despite escalating structural and policy barriers, providers described hope as a collective, relational, and practice-based resource that sustains engagement in gender-affirming care. These findings have direct implications for social work research, practice, and policy. Hope is not solely an individual attribute but is produced through community connection, interdisciplinary collaboration, and alignment with evidence-based care. Social workers—who are central to care coordination, psychosocial support, and systems navigation—are uniquely positioned to strengthen these conditions through workforce support interventions, organizational practices that foster collective care, and advocacy aimed at mitigating structural stigma. Future research should examine how these sources of hope can be operationalized within interventions to reduce burnout, support provider retention, and sustain access to gender-affirming services in increasingly restrictive environments.