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BC Strength review: Finding the best glute machine for 2025

Yahoo

27 minutes ago

Yahoo

BC Strength review: Finding the best glute machine for 2025

Looking for the best glute machine for home workouts? You're not alone! Strong, sculpted glutes have become the fitness world's holy grail — and their appeal extends far beyond the gym. A round, chiseled backside is a must-have accessory, thanks to celebrity influence and glute-focused social media reels. With #glutegains and #gluteworkout trending on TikTok and Instagram, it's clear these backside-building workouts are here to stay. And that's a good thing. Strong glutes are vital for everyday function (think posture, balance and stability), injury prevention and athletic performance. Whether you're climbing stairs or sprinting a 100-meter race, your glutes play a starring role. "Your glutes are the biggest muscles in your body," says Andy Galpin, PhD, a human performance expert and executive director of Parker University's Human Performance Center in Dallas. Without them, you'd basically fall over. Glutes not only keep our bodies upright, they help us move forward, backward and side to side. And if your glutes are weak, well, you're going to have problems. "When glutes are underdeveloped, they can't produce enough force or control and they fatigue quickly, putting pressure on other areas — your lower back, knees or hips," says Galpin. Since these muscles are crucial for stabilizing your pelvis, when they're weak, surrounding muscles compensate, often leading to imbalances, pain and potential injuries. In fact, research shows that weak butt muscles are connected to everything from knee and back pain to hamstring pulls and ankle sprains. Why are our collective rears so weak? Essentially, it's because we're sitting on them too much. In fact, a full 25 percent of Americans are classified as physically inactive, meaning folks simply aren't getting enough exercise to protect their health, let alone strengthen their glutes. So in a quest to find the best tools to help target and develop these important muscle groups, we tested a range of glute-focused equipment from BC Strength to help determine what's worth using and what's worth skipping. To be clear, you can target your glutes with standard exercise equipment by doing squats, deadlifts, hip thrusts and lunges with barbells or dumbbells. You can also use basic resistance bands to do side steps and hip abductions. That said, if you're serious about getting the most from your glute day, you may want to invest in equipment that makes hitting these powerhouses a little easier. To find the best glute machine, we test-drove glute-building equipment from BC Strength — the brand built by Bret Contreras, PhD. This exercise science professor turned entrepreneur built his career studying the biomechanical and performance benefits of training the glutes, earning himself the monikers "Glute Guy" and "Godfather of Glute Training." After years in the lab and classroom, he began developing tools and programs to help people level up their booty-sculpting game based on his own research. We tested a range of the glute machines from BC Strength. The types of equipment we tested included variations of: Hip thrust machines/benches: Designed for optimal glute isolation, these home-use machines help perfect the hip thrust movement. Resistance band systems: These versatile bands work for multiple exercises, including lunges, bridges and squats, making them an accessible option for any fitness level. Glute ham sliders: While primarily targeting the hamstrings, these sliders activate the glutes during hip rotation movements. Strong hamstrings can also enhance the appearance of your glutes, making them look more "lifted." Based on three months of hands-on training, these are the best glute machines from BC Strength. There's no such thing as the "best" glute exercise, says Brad Schoenfeld, PhD, a professor of exercise science at CUNY Lehman College in the Bronx. Instead of searching for one magical move, he recommends targeting all three gluteal muscles with a variety of exercises. Here's what you're working with: Gluteus maximus: This is your power player, making up most of your backside. It's crucial for basic movements like running, walking, jumping, stepping sideways and even standing up from a chair. It also stabilizes your pelvis and trunk when standing or balancing. Gluteus medius: Sitting at the upper outer part of your buttock, the glute medius works with the maximus for stability and helps move your leg away from your body's center. These are known as abduction movements, like side-stepping. Gluteus minimus: Though it's the smallest butt muscle, it plays a key supporting role under the glute medius, helping with stability and turning the thigh inward. These three muscles work together for hip stability, power and overall function. For the best results —both performance and aesthetic — you need to target them all. "While it's impossible to perfectly isolate different parts of the glute, you can bias different muscles," says personal trainer and researcher Daniel Plotkin. Standard glute exercises like hip hinges, squats, lunges, bridges and thrusts work your entire backside. Want that "booty shelf" look? Add exercises where you move your leg out to the side to target the glute medius and minimus using cables, bands or machines. These hit all three major muscles but with a focus on the smaller ones that are positioned higher on your backside. "Combining multi-joint exercises such as the squat and its variations along with an exercise like the hip thrust may provide additive benefits," says Schoenfeld. To get the most bang for your butt (har har), our experts recommend following these guidelines: Find what works for you. "Especially early on, find what's comfortable for you to do consistently. There will be time to make your training better if you so choose, but first build a love for, or at least a 'don't hate,' relationship with consistent exercise," says Plotkin. With so much conflicting information out there, remember that there are almost no must-do exercises — simply ignore all the noise about this or that exercise being "better" and focus on what works for you. Perfect your technique. "One of the most important considerations is to focus on acquiring the proper technique for each exercise," says Schoenfeld. For those new to strength training, a few sessions with a personal trainer can help ensure proper form and prevent injury Start small. "Don't bite off so much the very first time that you can't sit for four days," says Galpin. Instead, do just enough to challenge yourself — and then slowly increase the frequency, weight or volume of your training as you go. (This is known as progressive overload.) Remember, "results take time, but if you stay consistent, you'll see initial improvement over the course of several weeks," says Schoenfeld. Challenge yourself. Many beginners focus too much on light weights and high repetitions, but the best way to make progress is to continually challenge your muscles. "Sets should be highly challenging where the last few reps are difficult to complete," says Schoenfield. For best results, Plotkin recommends three sets of seven to 15 repetitions (for example, doing 10 hip thrusts, resting, then repeating twice more). In addition to the products called out as top picks, we also tested the BC Strength Thruster Lite, the Resistance Band Package and the BC Box. While we liked each piece of equipment, there were drawbacks that kept them from making the cut. For one, the Thruster Lite lacks the adjustable backrest and rotating back pad that make the Strength Thruster 3.0 such a stellar addition to a home gym. At a much more affordable price, it does the trick (particularly for those of average height who don't need or want a higher backrest), but it wasn't our favorite choice. Likewise, the resistance bands and BC Box were each high-quality, but there are other, similar products on the market that work just as well for a similar or more affordable price (like our favorite resistance band set). We're all for spending a little extra money for a high-quality product that offers superior functionality and durability, but in cases where products are essentially equal in function and design, we always say to grab the one that's easier on the wallet. To find the best glute machine, we assessed BC Strength's products on everything from cost and quality to ease of use and footprint. To ensure our recommendations were solid, we consulted three fitness experts who research muscle development, each sharing insights on effective glute training — not just for aesthetics, but for overall strength and function. To complete the picture, my own journey includes 20+ years of lifting weights, with seven focused on glute training. (Why the rear focus? Running-related back pain revealed that, you guessed it, I had weak glutes.) Throughout my strength-building journey, I've learned from top-tier bodybuilding coaches whose expertise proved invaluable during testing. Armed with this combined knowledge, we spent months using each product, drawing from my experience with both home and commercial glute-training equipment, to identify the best glute machine for your home gym. While there are many types of glute machines available, the most effective one is the one you can use properly and consistently. "You should feel your glutes working during the exercise, they should be slightly sore the next day, and you should be getting progressively stronger," says Galpin. If you're a beginner, start with bodyweight exercises. Once you have the form down, go ahead and add dumbbells, barbells or resistance bands to the mix. If you can easily do 12 to 15 reps of a specific movement, it's time to add more weight. Unsure what to do or how to implement progressive overload? Consult a personal trainer who can help you get started. Most gyms offer a free training session when you sign up for a membership. The three most common mistakes when using a glute machine are improper form, poor movement control and incorrect machine setup. Using improper form, like arching your back or not engaging your core, can easily lead to injury. Relying on momentum instead of making controlled movements reduces the exercise's effectiveness. And failing to adjust the machine settings to your specific body size means you won't target your glutes properly. Absolutely! Depending on the specific machine you're using, you can hit different glute muscles by adjusting your body position and the direction of the movement. Training your glutes twice weekly is the sweet spot for most people, says Plotkin. However, if glute training is your major focus, three to four times a week is fairly standard. Just be sure to allow yourself at least a day of rest between strength training sessions that target your glutes to allow sufficient time for muscle recovery. Andy Galpin, PhD, executive director of the Human Performance Center at Parker University in Dallas and host of the podcast Perform with Dr. Andy Galpin Daniel Plotkin, PhD candidate in molecular and applied muscle physiology at Auburn University in Alabama and certified personal trainer Brad Schoenfeld, PhD, fitness expert and professor in exercise science at CUNY Lehman College in the Bronx Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.

What is gender-affirming care? Your questions answered

CNN

30 minutes ago

CNN

What is gender-affirming care? Your questions answered

The right of transgender minors to access gender-affirming care has sparked debate across the United States. With a US Supreme Court ruling upholding Tennessee's ban on the practice, experts say, activists will probably be emboldened to enact even more restrictions. Currently, about 40% of trans youth live in a state that restricts access to gender-affirming care, according to KFF, a health policy and research organization. Major medical associations support access to such care at all ages, saying it can be lifesaving. Tennessee is among the 27 states that have passed bans on gender-affirming health care for transgender children and teenagers, according to a CNN analysis of data from the Movement Advancement Project, a nonprofit think tank that advocates for LGBTQ rights. Until this year, the federal government described early gender-affirming care as 'crucial to overall health and well-being' for trans and nonbinary children and adolescents. But the Trump administration has been cracking down on access. Soon after President Trump took office, he issued an executive order called 'Protecting Children from Chemical and Surgical Mutilation.' It characterized gender-affirming care as 'immoral, unjust, and disproven' and ordered the US Department of Health and Human Services to complete a review of evidence used to support its practice. That report – which was created by authors whom HHS refused to name – was issued May 1. That month, HHS Secretary Robert Kennedy Jr. sent a letter to health care establishments telling them to ignore long-held science-based professional guidelines and instead rely on the his agency's review even though the document says that 'it is not a clinical practice guideline.' The HHS review was highly critical of the science used to inform the practice of gender-affirming care. When it was released, the American Academy of Pediatrics said it was 'deeply alarmed,' and organization President Dr. Susan Kressly said it 'misrepresents the current medical consensus and fails to reflect the realities of pediatric care.' Additionally, at the start of LGBTQ+ Pride month, the FBI tweeted the number for a tip line to report providers that offer certain gender-affirming care services for minors. Gender-affirming care is a multidisciplinary approach that includes medically necessary and scientific evidence-based practices to help a person safely transition from their assigned gender – the one a clinician assigned them at birth, based mostly on anatomic characteristics – to their affirmed gender – the gender by which the person wants to be known. Although the term gender-affirming care came into the public's lexicon fairly recently, Dr. Madeline Deutsch, director of the UCSF Gender Affirming Health Program, said the practice has been around for some time and is based on decades of scientific research. Major mainstream medical associations – including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – have affirmed the practice of gender-affirming care and agree that it's the gold standard of clinically appropriate care that can provide lifesaving treatment for children and adults. 'While we are always assessing the strength of the evidence for this kind of care, every major US medical association has found that the medical evidence is strong and in support of centers that provides this kind of care and have been doing so for decades,' said Dr. Kellan Baker, executive director of the Whitman-Walker Institute, a health care organization that works on LGBTQ+ issues. Last year, an extensive but controversial research review in the UK called the use of puberty-delaying medications into question, saying that the rationale for early puberty suppression was 'unclear' and that any benefit for mental health was supported by 'weak evidence.' Although the review — known as the Cass Review for Dr. Hilary Cass, the pediatrician who conducted it — has come under sharp criticism from several scholars and practitioners, it prompted the UK to ban puberty blockers for use in trans patients. Other children who enter early puberty still have access to the medication. The process typically starts with a conversation between a clinician and the individual. If the patient is a child, the conversation will also include the caregivers when possible. 'It's to really get a better sense of what's bringing them into the clinic,' said licensed clinical psychologist Dr. Melina Wald, who co-founded the Gender Identity Program at Columbia University Medical Center. 'We are also looking to understand the child's understanding of their own gender, gender expression and a history related to that.' After experts determine what the person needs, a multidisciplinary group of clinicians will design a plan just for them. Depending on the person's age, care can include mental health care and support groups, legal help and sometimes medical help like hormones or surgery when a person is past puberty. 'This is individualized care, not some one-size-fits-all-plan,' Baker said. A transition plan can be as simple as offering support to someone when they start using different pronouns, change their hairstyle or clothing, or use a different name. 'When we support and allow people to do these things, their lives get better,' Deutsch said. Mental health care: Often, gender-affirming care will include counseling. A 2018 study found that the prevalence of mental health problems among transgender youth was seven times higher than among their cisgender peers. Mental health problems don't necessarily stem from a person's identity; a growing number of studies show that they often occur because of social discrimination and what's known as minority stress. Stigma, marginalization, discrimination, bullying, harassment and violence can lead to feelings of isolation and rejection. People who identify as transgender may also need mental health help just to determine what their identity is, to come to terms with it and to find self-acceptance. Mental health care can also help people come out to their family and friends and develop coping mechanisms so they can be who they are in a world that isn't always friendly or accepting. Gender-affirming care, studies show, lowers a person's odds of depression and suicidality and is associated with improved well-being. Medication and surgery: Some people may also receive age-appropriate medical care like hormone treatments, puberty blockers, voice and communication therapy, gynecologic and urologic care and reproductive treatments. Typically, surgeries are offered only to adults. The World Professional Association for Transgender Health's guidelines, which are considered the gold standard for gender-affirming care around the world, say this kind of care should provide a person 'safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment.' When children get to a certain stage of puberty – diagnosed by a medical provider – and still have a persistent, well-documented sense that their gender does not align with the sex assigned at birth, doctors and family may decide to move forward with reversible pubertal suppression, commonly called puberty blockers. Although not all patients choose this treatment, some research shows that gender-incongruent youth may feel increased distress when they start to develop secondary sex characteristics. These gonadotrophin-releasing hormone drugs were first used to delay puberty for people with what's known as precocious puberty, when a child's body changes into that of an adult too soon. Puberty blockers can keep secondary sex traits from developing for a few years, to give the child time to access support, explore their gender identity and develop coping skills, according to the American Academy of Pediatrics. If a patient decides to stop treatment, puberty resumes. 'That just basically puts everything on pause, and children can be on that for a couple of years without any ill effects, and it's totally reversible,' Deutsch said. 'If it's stopped, then everything just continues where you left off.' Studies show that puberty blockers can reduce the distress that may happen when a child develops secondary sex characteristics such as breasts, an Adam's apple or voice changes. Studies show that transgender adolescents who used puberty blockers were less likely to have suicidal thoughts than those who wanted the treatment but did not get it. Puberty blockers can also make a transition later in life easier, since the person did not develop these secondary sex characteristics. At this stage in the gender-affirming care process, after a thorough evaluation by a medical professional, a patient may also receive hormone therapy that can lead to gender-affirming physical change. Puberty blockers can carry some risks, and more long-term studies are needed, according to the Pediatric Endocrine Society. Long-term studies on fertility and bone health are limited and provide 'varied results,' according to the American Academy of Pediatrics. The World Professional Association for Transgender Health guidelines say that before giving puberty blockers, the provider must make sure the person has demonstrated a sustained and persistent pattern of gender dysphoria or gender incongruence; they must have the emotional and cognitive maturity to provide informed consent; any coexisting mental health problems that could interfere with treatment or consent need to be addressed; the person needs to be told that there could be reproductive effects, and fertility preservation options should be discussed; and the child must have reached Tanner Stage 2 of puberty, which is when a girl starts to develop breast buds and a boy's scrotum and testicles begin to increase in size. A pediatric endocrinologist must agree with this decision. Professional medical guidelines, with some rare exceptions, do not recommend puberty blockers, hormone therapies or surgery for children who have not gone through puberty. If such treatment is indicated, the clinician would first do a thorough evaluation in collaboration with the patient and their caregiver to understand the child's unique needs. 'I think one of the big myths out there is that there's a sense that kids are rushed into decisions related to medical care, like hormone therapy or surgery. That's just not the case,' Wald said. Dr. Leana Wen, an emergency physician and the former Baltimore Health Commissioner, told CNN's Pamela Brown that the 988 suicide prevention hotline service should be a " bipartisan, nonpartisan initiative to get services to as many people as need them, including LGBTQ individuals." The administration is considering eliminating the service as a way to cut back on funding for next year's discretionary budget for mental health, according to an internal document reviewed by CNN. Deutsch agreed: 'Kids don't make stuff up about this, wanting to become trans because it's trendy or something,' she said. 'Trans youth and trans people in general do not have access to a hormone vending machine.' Some critics point out that youth who take puberty blockers may change their minds about their gender identity later in life. Several studies have shown most people who opt for gender-affirming care don't later regret their choices — including an October 2022 study in the Netherlands that found 98% of transgender youth who had started gender-affirming medical treatment in adolescence continued to use those hormones around five or six years later in adulthood. Among 3,306 UK Gender Identity Development Service patients included the Cass Review analysis, fewer than 10 patients detransitioned to their birth-registered gender. Questions about the benefits of puberty-blocking medications gained fresh attention in October when the author of a federally funded study was quoted as saying she had delayed publication of some of her results because of fears that they would be 'weaponized' in a heated political climate. Johanna Olson-Kennedy, medical director at the Center for Transyouth Health and Development at Children's Hospital of Los Angeles, said that in the study, which she helped lead, puberty blockers did not appear to improve the mental health of 95 children ages 8 to 16 who were followed for two years to understand their mental and physical functioning as doctors used the medications to delay the physical changes associated with puberty. Some advocates for gender-affirming care for youth said this is a typical level of caution taken by researchers to carefully present and interpret scientific data. However, researchers said it remains critical to publish data; puberty blockers may have prevented a decline in mental health, even if they didn't lead to improvement in mental functioning, but it's impossible to know if the data isn't released. If a child identifies as transgender or gender-diverse, research suggests that they know their gender as clearly and consistently as their peers who identify as cisgender or the gender they were assigned at birth, even if it conflicts with other people's expectations about what a typical 'boy' or 'girl' is. Some critics of the process suggest that children should wait until adulthood to transition, but the American Academy of Pediatrics says in its guidelines that this approach is 'outdated,' in part because it assumes that gender identity becomes fixed at a certain age, and the approach is based on 'binary notions of gender in which gender diversity and fluidity is pathologized.' The group also argues that the approach was based on early studies with methodological flaws, limited follow-up and validity concerns. More recent research shows that 'rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family.' Wald says that waiting to transition can create additional psychological distress for a child and can raise their risk of depression, suicidality, self-harm or substance misuse. 'Withholding intervention means that the child is going to go through a puberty that is discordant with their gender identity and would ultimately mean that later, at the age of 18, there would be changes to their body that they would make it even more difficult,' she said. 'These children and teens can be incredibly resilient,' Wald added. 'With support and access to care, they will thrive and can be just as successful as any kid.' A 2022 analysis of data from the US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System and its Youth Risk Behavior Survey found that a tiny fraction of people in the United States – about 0.6% of those 13 and older, or about 1.6 million people – identify as transgender, according to the Williams Institute, a think tank at UCLA Law that provides scientific research on gender identity and sexual orientation. While the percentage of adults who identify as transgender in the US has remained basically the same, the number of young people who identify as such doubled – to 300,000 – from the last time the Williams Institute did the research in 2016 and 2017. A 2022 Pew Research Center survey determined that 5.1% of adults younger than 30 are trans or nonbinary. It may not be a direct comparison, however, as the Williams Institute's previous survey did not have survey data for younger teens and had to use statistical modeling to extrapolate based on adult data. The report cannot explain why more young people may be identifying as transgender, but it notes that more data has become available about this population. CNN's Brenda Goodman, Meg Tirrell and Kristen Rogers contributed to this report.

CNN

34 minutes ago

CNN

What is gender-affirming care? Your questions answered

The right of transgender minors to access gender-affirming care has sparked debate across the United States. With a US Supreme Court ruling upholding Tennessee's ban on the practice, experts say, activists will probably be emboldened to enact even more restrictions. Currently, about 40% of trans youth live in a state that restricts access to gender-affirming care, according to KFF, a health policy and research organization. Major medical associations support access to such care at all ages, saying it can be lifesaving. Tennessee is among the 27 states that have passed bans on gender-affirming health care for transgender children and teenagers, according to a CNN analysis of data from the Movement Advancement Project, a nonprofit think tank that advocates for LGBTQ rights. Until this year, the federal government described early gender-affirming care as 'crucial to overall health and well-being' for trans and nonbinary children and adolescents. But the Trump administration has been cracking down on access. Soon after President Trump took office, he issued an executive order called 'Protecting Children from Chemical and Surgical Mutilation.' It characterized gender-affirming care as 'immoral, unjust, and disproven' and ordered the US Department of Health and Human Services to complete a review of evidence used to support its practice. That report – which was created by authors whom HHS refused to name – was issued May 1. That month, HHS Secretary Robert Kennedy Jr. sent a letter to health care establishments telling them to ignore long-held science-based professional guidelines and instead rely on the his agency's review even though the document says that 'it is not a clinical practice guideline.' The HHS review was highly critical of the science used to inform the practice of gender-affirming care. When it was released, the American Academy of Pediatrics said it was 'deeply alarmed,' and organization President Dr. Susan Kressly said it 'misrepresents the current medical consensus and fails to reflect the realities of pediatric care.' Additionally, at the start of LGBTQ+ Pride month, the FBI tweeted the number for a tip line to report providers that offer certain gender-affirming care services for minors. Gender-affirming care is a multidisciplinary approach that includes medically necessary and scientific evidence-based practices to help a person safely transition from their assigned gender – the one a clinician assigned them at birth, based mostly on anatomic characteristics – to their affirmed gender – the gender by which the person wants to be known. Although the term gender-affirming care came into the public's lexicon fairly recently, Dr. Madeline Deutsch, director of the UCSF Gender Affirming Health Program, said the practice has been around for some time and is based on decades of scientific research. Major mainstream medical associations – including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – have affirmed the practice of gender-affirming care and agree that it's the gold standard of clinically appropriate care that can provide lifesaving treatment for children and adults. 'While we are always assessing the strength of the evidence for this kind of care, every major US medical association has found that the medical evidence is strong and in support of centers that provides this kind of care and have been doing so for decades,' said Dr. Kellan Baker, executive director of the Whitman-Walker Institute, a health care organization that works on LGBTQ+ issues. Last year, an extensive but controversial research review in the UK called the use of puberty-delaying medications into question, saying that the rationale for early puberty suppression was 'unclear' and that any benefit for mental health was supported by 'weak evidence.' Although the review — known as the Cass Review for Dr. Hilary Cass, the pediatrician who conducted it — has come under sharp criticism from several scholars and practitioners, it prompted the UK to ban puberty blockers for use in trans patients. Other children who enter early puberty still have access to the medication. The process typically starts with a conversation between a clinician and the individual. If the patient is a child, the conversation will also include the caregivers when possible. 'It's to really get a better sense of what's bringing them into the clinic,' said licensed clinical psychologist Dr. Melina Wald, who co-founded the Gender Identity Program at Columbia University Medical Center. 'We are also looking to understand the child's understanding of their own gender, gender expression and a history related to that.' After experts determine what the person needs, a multidisciplinary group of clinicians will design a plan just for them. Depending on the person's age, care can include mental health care and support groups, legal help and sometimes medical help like hormones or surgery when a person is past puberty. 'This is individualized care, not some one-size-fits-all-plan,' Baker said. A transition plan can be as simple as offering support to someone when they start using different pronouns, change their hairstyle or clothing, or use a different name. 'When we support and allow people to do these things, their lives get better,' Deutsch said. Mental health care: Often, gender-affirming care will include counseling. A 2018 study found that the prevalence of mental health problems among transgender youth was seven times higher than among their cisgender peers. Mental health problems don't necessarily stem from a person's identity; a growing number of studies show that they often occur because of social discrimination and what's known as minority stress. Stigma, marginalization, discrimination, bullying, harassment and violence can lead to feelings of isolation and rejection. People who identify as transgender may also need mental health help just to determine what their identity is, to come to terms with it and to find self-acceptance. Mental health care can also help people come out to their family and friends and develop coping mechanisms so they can be who they are in a world that isn't always friendly or accepting. Gender-affirming care, studies show, lowers a person's odds of depression and suicidality and is associated with improved well-being. Medication and surgery: Some people may also receive age-appropriate medical care like hormone treatments, puberty blockers, voice and communication therapy, gynecologic and urologic care and reproductive treatments. Typically, surgeries are offered only to adults. The World Professional Association for Transgender Health's guidelines, which are considered the gold standard for gender-affirming care around the world, say this kind of care should provide a person 'safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment.' When children get to a certain stage of puberty – diagnosed by a medical provider – and still have a persistent, well-documented sense that their gender does not align with the sex assigned at birth, doctors and family may decide to move forward with reversible pubertal suppression, commonly called puberty blockers. Although not all patients choose this treatment, some research shows that gender-incongruent youth may feel increased distress when they start to develop secondary sex characteristics. These gonadotrophin-releasing hormone drugs were first used to delay puberty for people with what's known as precocious puberty, when a child's body changes into that of an adult too soon. Puberty blockers can keep secondary sex traits from developing for a few years, to give the child time to access support, explore their gender identity and develop coping skills, according to the American Academy of Pediatrics. If a patient decides to stop treatment, puberty resumes. 'That just basically puts everything on pause, and children can be on that for a couple of years without any ill effects, and it's totally reversible,' Deutsch said. 'If it's stopped, then everything just continues where you left off.' Studies show that puberty blockers can reduce the distress that may happen when a child develops secondary sex characteristics such as breasts, an Adam's apple or voice changes. Studies show that transgender adolescents who used puberty blockers were less likely to have suicidal thoughts than those who wanted the treatment but did not get it. Puberty blockers can also make a transition later in life easier, since the person did not develop these secondary sex characteristics. At this stage in the gender-affirming care process, after a thorough evaluation by a medical professional, a patient may also receive hormone therapy that can lead to gender-affirming physical change. Puberty blockers can carry some risks, and more long-term studies are needed, according to the Pediatric Endocrine Society. Long-term studies on fertility and bone health are limited and provide 'varied results,' according to the American Academy of Pediatrics. The World Professional Association for Transgender Health guidelines say that before giving puberty blockers, the provider must make sure the person has demonstrated a sustained and persistent pattern of gender dysphoria or gender incongruence; they must have the emotional and cognitive maturity to provide informed consent; any coexisting mental health problems that could interfere with treatment or consent need to be addressed; the person needs to be told that there could be reproductive effects, and fertility preservation options should be discussed; and the child must have reached Tanner Stage 2 of puberty, which is when a girl starts to develop breast buds and a boy's scrotum and testicles begin to increase in size. A pediatric endocrinologist must agree with this decision. Professional medical guidelines, with some rare exceptions, do not recommend puberty blockers, hormone therapies or surgery for children who have not gone through puberty. If such treatment is indicated, the clinician would first do a thorough evaluation in collaboration with the patient and their caregiver to understand the child's unique needs. 'I think one of the big myths out there is that there's a sense that kids are rushed into decisions related to medical care, like hormone therapy or surgery. That's just not the case,' Wald said. Dr. Leana Wen, an emergency physician and the former Baltimore Health Commissioner, told CNN's Pamela Brown that the 988 suicide prevention hotline service should be a " bipartisan, nonpartisan initiative to get services to as many people as need them, including LGBTQ individuals." The administration is considering eliminating the service as a way to cut back on funding for next year's discretionary budget for mental health, according to an internal document reviewed by CNN. Deutsch agreed: 'Kids don't make stuff up about this, wanting to become trans because it's trendy or something,' she said. 'Trans youth and trans people in general do not have access to a hormone vending machine.' Some critics point out that youth who take puberty blockers may change their minds about their gender identity later in life. Several studies have shown most people who opt for gender-affirming care don't later regret their choices — including an October 2022 study in the Netherlands that found 98% of transgender youth who had started gender-affirming medical treatment in adolescence continued to use those hormones around five or six years later in adulthood. Among 3,306 UK Gender Identity Development Service patients included the Cass Review analysis, fewer than 10 patients detransitioned to their birth-registered gender. Questions about the benefits of puberty-blocking medications gained fresh attention in October when the author of a federally funded study was quoted as saying she had delayed publication of some of her results because of fears that they would be 'weaponized' in a heated political climate. Johanna Olson-Kennedy, medical director at the Center for Transyouth Health and Development at Children's Hospital of Los Angeles, said that in the study, which she helped lead, puberty blockers did not appear to improve the mental health of 95 children ages 8 to 16 who were followed for two years to understand their mental and physical functioning as doctors used the medications to delay the physical changes associated with puberty. Some advocates for gender-affirming care for youth said this is a typical level of caution taken by researchers to carefully present and interpret scientific data. However, researchers said it remains critical to publish data; puberty blockers may have prevented a decline in mental health, even if they didn't lead to improvement in mental functioning, but it's impossible to know if the data isn't released. If a child identifies as transgender or gender-diverse, research suggests that they know their gender as clearly and consistently as their peers who identify as cisgender or the gender they were assigned at birth, even if it conflicts with other people's expectations about what a typical 'boy' or 'girl' is. Some critics of the process suggest that children should wait until adulthood to transition, but the American Academy of Pediatrics says in its guidelines that this approach is 'outdated,' in part because it assumes that gender identity becomes fixed at a certain age, and the approach is based on 'binary notions of gender in which gender diversity and fluidity is pathologized.' The group also argues that the approach was based on early studies with methodological flaws, limited follow-up and validity concerns. More recent research shows that 'rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family.' Wald says that waiting to transition can create additional psychological distress for a child and can raise their risk of depression, suicidality, self-harm or substance misuse. 'Withholding intervention means that the child is going to go through a puberty that is discordant with their gender identity and would ultimately mean that later, at the age of 18, there would be changes to their body that they would make it even more difficult,' she said. 'These children and teens can be incredibly resilient,' Wald added. 'With support and access to care, they will thrive and can be just as successful as any kid.' A 2022 analysis of data from the US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System and its Youth Risk Behavior Survey found that a tiny fraction of people in the United States – about 0.6% of those 13 and older, or about 1.6 million people – identify as transgender, according to the Williams Institute, a think tank at UCLA Law that provides scientific research on gender identity and sexual orientation. While the percentage of adults who identify as transgender in the US has remained basically the same, the number of young people who identify as such doubled – to 300,000 – from the last time the Williams Institute did the research in 2016 and 2017. A 2022 Pew Research Center survey determined that 5.1% of adults younger than 30 are trans or nonbinary. It may not be a direct comparison, however, as the Williams Institute's previous survey did not have survey data for younger teens and had to use statistical modeling to extrapolate based on adult data. The report cannot explain why more young people may be identifying as transgender, but it notes that more data has become available about this population. CNN's Brenda Goodman, Meg Tirrell and Kristen Rogers contributed to this report.

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