Envisioning More Inclusive Gender-Affirming Care Amid Widespread Attacks

An androgynous individual with a split-dyed mullet and pink eyeshadow looks into the camera sullenly. — Credit: Owen Vangioni on Unsplash

How do you access medical care when the federal government doesn’t believe you have a right to exist? This is the reality facing many trans, intersex, and gender nonconforming adolescents after the Trump administration’s anti-trans policies have led to multiple hospitals across the nation ending their gender-affirming care programs for minors. In some cases, hospitals have stopped care for adults as well.

For the most part, these halts in care are in response to the administration’s investigations of health systems, even if much of the gender-affirming care they offer focuses on mental health. The Trump administration has also threatened to remove Medicaid and Medicare funding from health systems providing care to trans youth.

The administration argued that its push against gender-affirming care for minors is targeted at preventing, as stated in Executive Order 14187: “the chemical and surgical mutilation” of youth. This ignores the fact that most youth only socially transition unless they, their care team, and parents agree that the inclusion of puberty blockers, which delay puberty, or even more rarely hormones, would be lifesaving. This is literal, as access to puberty blockers has been shown to reduce suicidal ideation in adolescence and later life.

Simultaneously, the Trump administration is also making it harder to take gender-affirming steps that do not involve chemicals or surgery, including actively targeting articles of clothing that allow youth and adults to socially transition.

Immediate Harm

Clothing under scrutiny by the Trump administration includes binders, which are worn similarly to sports bras, and are purchased out of pocket. The FDA sent letters notifying companies making and retailers selling binders that the agency would seize their products if the companies did not register them as Class 1 medical devices: a process that costs $11,423.

There has been a 72 percent increase in youth suicides in states that pass anti-trans legislation.

The reasoning behind these letters was, according to FDA Commissioner Marty Makary, that binders were marketed to children. But as The Advocate reported, “There is no chest binder designed for exclusively minors or using a child model on any of the sites sent warnings.”

What is clear is the immediate harm Trump’s policies are having on trans youth.

Gender-affirming care has been a lifeline for trans youth, a population at high risk of suicide, and care received in adolescence can have lifelong impacts for mental health. For example, about nine in 10 trans adults who wanted but were not able to access puberty blockers in youth have reported lifetime suicidal ideation, according to a 2020 study published in the journal Pediatrics. In the United Kingdom, new restrictions on gender-affirming care led to a spike in youth suicides, and as anti-trans legislation spreads across the United States, suicide attempts by trans and nonbinary youth have increased significantly.

This is a primary reason that many medical organizations have come out against legislation targeted at ending gender-affirming care for minors. For example, the Endocrine Society, an international organization promoting hormone science and public health, argued: “Medical evidence, not politics, should inform treatment decisions.” Meanwhile, the American Medical Association (AMA) publicly stated that “trans and non-binary gender identities are normal variations of human identity and expression” and supports “standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria.”

“Banning Everything”

But anti-trans rhetoric and legislation does not stop at gender-affirming care for minors. There have also been targeted attacks on middle and high school-aged children by right-wing activists endorsed by the Trump administration, like Riley Gaines, who has posted pictures and names of trans youth online.

Executive Order 14168, another presidential decree targeting trans people, seeks to define biological sex while excluding intersex variation; and federal anti-trans policies, from removing sexual violence protections for immigrants and prisoners to banning trans athletes, are increasing. South Dakota, Utah, and Kansas have joined states like Texas and Arkansas in drafting anti-trans legislation. These laws may make gender-affirming care inaccessible for lower-income minors and adults, including by prohibiting reimbursement for care.

Then there is the creation of what Merv Riepe, Republican state senator of Nebraska, called the “potty police,” bills concerning who has the right to use which bathrooms. Laws like these ignore the health impacts of bathroom restriction for youth and adults, including dehydration, urinary tract infections, and kidney infections—even physical violence. The risks are greatest for youth, who are legally required to be in school, but may not have access to safe bathrooms or locker rooms there.

Legislation like this kills. Trans journalist Erin Reed has noted there has been a 72 percent increase in youth suicides in states that pass anti-trans legislation.

Families of trans youth seeking care are “risking everything to get their families here, to get themselves here.”

Eric Lowe, one of the doctors who spoke out against anti-trans legislation in Montana, wrote in 2023, after sharing the experience of an anonymous patient who was suicidal: “Every yes vote on a discriminatory bill targeting transgender Montanans contributed to this child being driven to the point of wanting to kill themselves.”

Legislation around gender-affirming care or recognition for trans youth is often framed as protecting not only youth but also their parents’ rights to determine medical care. Yet Arial, using a pseudonym for safety, whose transgender daughter’s care has been interrupted, takes issue with the idea.

As she told NPQ, “Personally, I don’t feel like I’m being supported as a parent at all.” She said the current climate of hardships and threats is “making it so parents have to drive further or can’t afford [care] now…if our child’s feeling some sort of way, or is trying to get help and they’re like, ‘We’re going to take the insurance from you…we’re going to basically ban everything.’”

Sanctuary States

This multi-pronged assault on trans youth has led many families to move to sanctuary states like Minnesota, one of 13 states arguing the illegality of anti-trans legislation. The state’s laws enshrine trans rights as human rights as part of the “Trans Refuge Law” and the Minnesota Human Rights Act.

Hannah Edwards, executive director of Transforming Families, a nonprofit support network in Minnesota for trans youth and their families, has already seen an influx of people fleeing other states to access care. There have been so many families migrating to Minnesota, planning to move, or simply reaching out seeking advice that the nonprofit has begun a new series of support groups for recent arrivals or families looking to move.

She told NPQ that families of trans youth seeking care are “risking everything to get their families here, to get themselves here.”

Edwards notes that this process is even harder on youth who do not have family support. Data from the Pew Research Center show that only about 30 percent of trans and nonbinary individuals have the support of their parents.

Edwards said she wants these young people to know that “you just existing as your beautiful, wonderful self is so radical, and that there are so many adults who are fighting for you specifically….You might see the narrative and the federal government and all these people attacking you, but there are as many adults who love and care about you and think about you daily.”

Nearly half of the US population opposes anti-trans legislation.

In Minnesota, that love looks like advocacy groups like Gender Justice and OutFront Minnesota that show up to the Capitol and provide expert testimony to help bolster the work being done by legislators. As Ash Tifa, communications coordinator and legal advocate at OutFront, told NPQ, “The community itself showing up and being ready to be active, vocal advocates for ourselves and getting to show legislators the importance of why it’s important to fight all of these bills, whether it be attacks on gender affirmative care or…trying to ban books…[trying] to institute banning the pride flag….They come at all of these issues from so many different angles, and community always shows up to stop them.”

Yet even here, care has been disrupted. Minnesota Children’s Hospital paused some treatment, like hormonal care and puberty blockers, when faced with cuts to Medicaid and Medicare, until a federal judge blocked the rule change that would have stripped the hospital’s federal funding. Tifa sees the temporary nature of this interruption as proof of the work the community as a whole has done to make gender-affirming care a medically supported guideline in Minnesota, backed up by law.

More Inclusive Care

While trans, intersex, and gender nonconforming people make up only a small percentage of the US population, nearly half of the US population opposes anti-trans legislation, even as the trend thunders through some state legislatures.

Opposition to federal attacks may look like individual states and locales pivoting away from the federal system altogether.

In Vermont, legislators have introduced a new bill that would funnel state and nonprofit funds into a new clinic providing gender-affirming care regardless of patients’ ability to pay. If passed, this bill promises a new way to envision not only gender-affirming care but all healthcare; it offers a state and nonprofit alternative to federal funding, sidestepping potential federal withholding of critical resources.

The Vermont model suggests that a more inclusive healthcare system may be one where those in the community decide what is medically necessary and ensure that the care is provided, no matter what.