What will happen to Trans Health Care under Trump?
“I will then ask Congress to permanently stop federal taxpayer dollars from being used to promote or pay for these procedures.” “I will then ask Congress to permanently stop federal taxpayer dollars from being used to promote or pay for these procedures.”
He also promised to pass a law banning gender-affirming care for minors in all 50 states. Some even said they’d be less accepting of a trans friend or family member.
Now that Trump is re-entering office, trans people and their health providers are bracing for potential attacks on gender-affirming care for children and adults alike. They suspect the anti-abortion playbook could follow. Some even reported they’d be less accepting of a trans friend or family member.
Now that Trump is re-entering office, trans people and their health providers are bracing for potential attacks on gender-affirming care for children and adults alike, which they suspect could follow a familiar pattern–the anti-abortion playbook.
Trump could withhold federal funds for gender-affirming care
Trump’s promise that a national ban on youth gender-affirming care would “go very quickly” may not come to fruition, because even though his party captured majorities in both chambers of Congress, its Senate majority isn’t filibuster-proof. In the immediate aftermath of the election, gender-affirming care providers told Rewire News Group they hoped this fact might help stave off total bans.
However, federal attacks on gender-affirming care have begun in advance of Trump’s arrival. Democrats are largely choosing not to fight back. In the House of Representatives, 81 Democrats voted for this version of NDAA. And though President Joe Biden said his administration “strongly opposes” the gender-affirming care ban written into the bill, in one of his final acts as president, he signed it.
Shutterstock
Since 1977, a provision known as the Hyde Amendment has prohibited federal funds from being used to pay for abortion care except when pregnancy is the result of rape or incest, or when a pregnant person’s life is in danger. Since 1977, a provision known as the Hyde Amendment has prevented federal funds from being used to pay for abortion care except when pregnancy is the result of rape or incest, or when a pregnant person’s life is in danger.
Initially, Hyde only applied to Medicaid. Over time, a similar clause was added to all federally funded health benefit programs. This included TRICARE and Medicare as well as the Indian Health Service. The Hyde Amendment is not a separate law. The Hyde Amendment is a “rider,” attached to big spending bills, like the NDAA, that Congress must pass each session. Crystal Beal is a family doctor and the founder of QueerDoc. She serves patients across ten states. When federal funding is cut, many state funds follow. Returning to the example of abortion care, in the decades after the Hyde Amendment was first enacted, many states also enacted policies banning public funding for abortion care.
In the decade or so leading up to the overturn of Roe v. Wade, several states took it a step further, banning abortion coverage in private insurance plans, or at least those available on Affordable Care Act-mandated health exchanges.
Jona Tanguay, a physician associate, clinical instructor, and gender-affirming care and substance use disorder expert, said they worry the same could happen to trans health care.
“We’ve already seen places like Florida ban Medicaid coverage for gender-affirming care,” they said. Florida’s abortion ban has been overturned in federal court but is still in place as the state appeals that ruling. “And so if they feel like they can get away with it, they’re absolutely going to stop covering
.”
Project 2025’s plan to end gender-affirming care
Revoking federal funding for gender-affirming care is one of many steps outlined in the Project 2025 plan.
“Radical actors inside and outside government are promoting harmful identity politics that replaces
biological sex with subjective notions of ‘gender identity’ and bases a person’s worth on his or her race, sex, or other identities,” Project 2025’s “Mandate for Leadership” reads. “This destructive dogma, under the guise of ‘equity,’ threatens American’s
fundamental liberties as well as the health and well-being of children and adults alike.”
Another Project 2025-recommended change that would affect gender-affirming care–and potentially all access to health care for trans people–is to transform Section 1557 of the Affordable Care Act.
Ben Von Klemperer/Shutterstock
[gender-affirming care]Section 1557 protects Americans from discrimination in health-care settings, and under the Obama administration, the Department of Health and Human Services’ (HHS) interpretation of this provision was broad, explicitly including anti-discrimination protections for patients based on gender identity and termination of pregnancy.
However, the first Trump administration swiftly changed this rule, removing the explicit protections for trans people, adding broad “religious freedom” protections for health-care providers who refuse to participate in certain kinds of medical care and effectively allowing insurers to discriminate against LGBTQ+ people and those living with HIV.
From day one, experts urged the Biden administration to re-adopt Obama-era Section 1557 protections. Biden’s HHS finally adopted the Obama-era Section 1557 protections, but it wasn’t until 2024 that they were finalized. Trump is expected back it.
Dr. Julius Johnson Weaver, the founder of Resolve MD in Maryland, which provides gender-affirming health care, is concerned that some pharmacists may refuse to fill prescriptions. This could be a part of an anti-abortion strategy that would spread into gender affirming health care. This is a phenomenon that could be enabled or even encouraged depending on the changes the Trump administration makes to policies like Section 1557.[sic]Testosterone’s status as a controlled substance[sic]At the start of the pandemic, the Drug Enforcement Administration (DEA) relaxed some of its rules around telemedicine prescriptions for controlled substances. The DEA extended these changes for one more year in November. But in November, the DEA extended these changes for one more year.
Though Beal is concerned about escalating bans on gender-affirming care, they aren’t particularly worried about Trump reversing this one change.
“Telemedicine access has historically had bipartisan support, and Trump himself has supported additional expansion of telemedicine access in the past,” Beal said.
They also added that the popularity of easier testosterone access among cisgender men may help protect that access for trans people.
“Hormone replacement therapy (HRT) for cis men has also become a very standard thing, especially if you’re going to an ‘anti-aging’ doctor,” Beal said.
However, the fact that testosterone is a controlled substance still poses a risk for the trans people who need it in an increasingly hostile environment, Johnson-Weaver said.
“You could be completely cis-passing as a trans man, for instance, and not wanting anyone to know. He said that maybe you are just taking testosterone like a cis man. But picking up a prescription for a controlled substance usually requires more stringent identity verification.
“It scares me to think of the potential dangers of self-administering HRT. But I would rather self-medicate without any physician’s assistance than to detransition.”
– Lee, a trans man in Arizona
“Now you’re handing over an ID and outing yourself” if you haven’t–or can’t–change the gender marker on that ID, Johnson-Weaver said.
The fact that testosterone is a controlled substance while estrogen is not also creates a disparity in access to hormones–one that isn’t based in science. Testosterone was only added to the the list of controlled substances in 1990 due to concerns over its use as a performance-enhancing drug in sports. The DEA, Food and Drug Administration and American Medical Association were all against this change at the time. It is very different. It is something very different.”
They noted that the DEA has only existed since President Richard Nixon’s administration, and that the agency’s architects have admitted its purpose was to criminalize people of color and anyone else the federal government viewed as a threat.
What’s on the line
For trans people, the stakes are high.
“I know me and many other individuals are already making plans on non-traditional routes of accessing our meds if the federal government attempts to stop trans adults from transitioning,” said Lee, a trans man in Arizona who asked to be identified by his first name only for safety.
These measures include “stockpiling, traveling across borders, buying from others who can travel to get them, rationing to stretch them out,” and more, Lee said.
Even in the relatively protective state of Maryland, Johnson-Weaver said, “I’m still getting those calls. The patients are asking, “How can I obtain more medication?” How can I stockpile?'”
Within the trans community, there is a long history of “do-it-yourself” hormone therapy, because trans people have so often been without access to supportive health care, and because they are more likely to live in poverty and be uninsured.
Ringo Chiu/Shutterstock
On one hand, it is “hopeful,” said Justice Williams. He’s an activist and founder of Fitness 4 All Bodies. There are alternatives if the path for transition-related medical care is blocked within the system. Williams worries that new limits on gender-affirming care could lead to a rise in the sharing of needles and injectable medications, which poses serious risks. “It’s frightening to think about the potential risks of self-administering HRT,” Lee stated. “But I would rather self-medicate without any physician’s assistance than to detransition.”
The hateful rhetoric of the election, combined with fears about what could happen during Trump’s second term, is also taking a toll on the mental health of many trans Americans.
“Witnessing the backswing of this pendulum has been absolutely soul-crushing,” said Jessica McHegg, a trans woman in Seattle.
McHegg came about eight years ago, in her fifties.
“I thought I was too old, and that there was too much water under the bridge,” she said. She said: “I thought I was too old, and that there was too much water under the bridge.” I was worried about marriage. I was worried about many different things. But, I reached a point where it was just like, ‘I can’t live this fake life anymore.'”
And Seattle, McHegg said, was a “pretty great place to come out.” People were generally very accepting. But now, she is worried for her future, and especially for that of one of her children, who is also trans.
“When you’re a parent that has a transgender child, and then you face the data about suicide, and self-harm, and all these different things, and all of a sudden your kid is in that category, you do not want your child to suffer that,” she said.
“Puberty was devastating to me,” McHegg added. “When we discuss suicidal thoughts, depression and self-harming, I understand exactly what it is.” My teenage years were really miserable.”
McHegg stressed that she is in a very privileged position relative to most trans people in the U.S. She and her family can consider moving out of the U.S. if necessary. Her wife is Canadian so they could also do that if need be. I’ve written emails to politicians in an attempt to convince them that we need their support. I have donated as much money as I could and will continue to do so to organizations such the ACLU and Gender Justice League. But it still feels like a hole. You may want to prepare a worst-case scenario plan. If you’re in a state where things could really turn bad in terms of having access to care, how can you get your medication?”
In that vein, Williams is working to hold a series of summits on the state of trans health care, and is looking for ways to encourage those in more protective states to support those in states that have already placed restrictions on gender-affirming care, or may do so in the near future.
“What does that look like, to extend our resources to communities and trans folks across the nation that don’t have this privilege, who can’t afford to move to ‘safety’ states?” Williams said.
Beal added that staying connected to your local community is helpful not only in terms of accessing resources, but also to fight what is likely to be a further onslaught of state-level attempts to ban care.
“We’re a marginalized community, and we have to guard our energy and take care of ourselves,” Beal said. Audre Lorde defines self-care as both radical individual care and radical community care. And one of the big things we can do is be involved in local-level politics, because local-level politics filter up, and they can have such a huge impact on individual safety within our own communities.”
