Transgender Healthcare

What do I need to know about transgender healthcare?

Over 1.6 million people in the United States over the age of 13 identify as transgender, which means that they do not identify with the sex assigned to them at birth. Experiencing a mismatch between sex assigned at birth and one’s gender identity can be extremely distressing, and that feeling is called gender dysphoria. Every major medical and mental health association in the US recognizes the medical necessity of providing gender-affirming care to people who experience dysphoria. Gender-affirming care includes mental health care, medical care, and social services.

Gender-affirming care for adolescents and teenagers has been the target of widespread misinformation campaigns, including a recent report on gender dysphoria commissioned by the Trump administration. But there is broad medical consensus about the need for gender-affirming care and the risks involved:

• Transgender youth who experience gender dysphoria are at elevated risk for self-harm and depression. Current mainstream research shows that for these youth, gender-affirming care saves lives and improves overall emotional well-being.
• No medical therapies offered to transgender adolescents are “sterilizing.” Puberty-pausing medications—often called puberty-blockers—are fully reversible and in fact regularly prescribed to delay early puberty in cisgender children. There’s no evidence that puberty-pausing medications taken alone compromise future fertility.
• Older teens who add hormone therapies may experience reduced fertility. Discussion of these potential risks are a part of the extensive consultation process for each youth and their care providers, who balance these risks with those of untreated gender dysphoria.
• Gender-affirming surgeries among transgender youth in the US are extremely rare. A recent Harvard School of Public Health study found that well over 90% of all gender-affirming surgeries performed on youth under 18 in the US were chest reduction surgeries performed on cisgender male teens. The researchers found no gender-affirming surgeries were performed on transgender youth under 12.

Notably, in many instances, the same bills that ban gender-affirming care for youth also explicitly permit procedures performed on children with so-called “ambiguous sex characteristics.” (About 1 in 60 people in the United States are born with hormonal, anatomical, or chromosomal characteristics that do not fit neatly into “male” or “female” categories.) These procedures include nonconsensual genital surgeries that may result in permanent harm, including sterility.

How is the federal government involved?

The federal government provides guidance, regulation, funding, and infrastructure for many kinds of healthcare, which means it has many ways to affect the quality and availability of healthcare for transgender people.

The federal government:

• Funds hospitals and healthcare clinics with grants and loans and funds universities, research hospitals, and public health institutions with research grants.
• Funds and administers Medicare and, jointly with the states, Medicaid, which together provide healthcare coverage for about a third of people living in the US.
• Provides healthcare coverage for federal civilian employees, and for military service members and their families.
• Provides medical care for service members and veterans through the Department of Veterans Affairs and to people incarcerated in federal prisons.

What is happening?

The Trump administration and Congress are using the power of the executive and legislative branches to:

• Attempt to coerce healthcare providers into stopping gender-affirming care for people under 19. More on this

• Restrict or end gender-affirming medical care for federal workers, service members, veterans, and people incarcerated in federal prisons. More on this

• Prevent states from requiring Affordable Care Act marketplace plans to cover gender-affirming care. More on this

On this page, we’ll break down those lines of attack, along with the countermoves and resilience efforts we’re seeing across American society. These are not the only lines of attack, nor do they include breaking news. Check the “Last updated” stamp for each attack below and expect updates roughly twice a week.

Attack: Coercing healthcare providers to stop providing gender-affirming care for trans youth

Last updated: May 13, 2025

Through Executive Order 14187 (“Protecting Children…”), Executive Order 14235 (“Restoring Public…”), and related guidance from executive departments, the Trump administration is trying to stop hospitals and other care providers from providing gender-affirming care to trans youth by, among other things:

• Threatening to eliminate hospitals’ research and education grants and—crucially—their eligibility to receive Medicare and Medicaid reimbursements not only for their transgender patients, but for all their patients, by altering the Conditions for Participation in Medicare and Medicaid.
• Using Medicare and Medicaid’s clinical-abuse assessments and mandatory drug reviews to target providers of gender-affirming care.
• Threatening to prosecute care providers and the manufacturers and distributors of hormones used in gender-affirming hormone therapy.
• Stripping Public Service Loan Forgiveness eligibility for the employees of hospitals that provide gender-affirming care to people under 19.

Where this stands

A federal judge has blocked part of Executive Order 14187 nationwide while a lawsuit proceeds through the courts, preventing the administration from withholding federal research and education grants to healthcare providers. Several healthcare providers and insurance companies had already begun complying with the executive order when the judge blocked it. Hospital systems in Arizona and Pennsylvania, for example, stopped offering some gender-affirming care to people under 19 after the ruling. Since the injunction, some have resumed care, but not all.

Another federal judge has blocked part of the order in Washington, Oregon, Minnesota, and Colorado, forbidding the administration from revoking research and education grants to hospitals based on their provision of gender-affirming care.

We haven’t seen any reports of healthcare providers or drug manufacturers or distributors being prosecuted over their use of puberty-pausing medications or hormones in gender-affirming care. Although the Centers for Medicare and Medicaid Services issued an alert to hospitals warning them that it is considering making policy changes, we haven’t seen any new rules or policy changes yet. The Public Service Loan Forgiveness program has not yet changed its eligibility requirements.

Countermoves: legal and judicial challenges

• States like Washington, and civil rights organizations like the American Civil Liberties Union have brought legal challenges through the courts to stop enforcement of the executive order. Some of those have already resulted in the injunctions described above. In a preliminary injunction ruling, one federal judge ruled that suddenly stopping care for youth “seems to put these children at extreme risk.”
• Attorneys general in New York (pdf) and California reminded hospitals in their states that following the executive order would put them in violation of state laws that prohibit discrimination on the basis of gender identity. A coalition of 15 state attorneys general issued a joint statement reaffirming their commitment to protecting gender-affirming care despite the administration’s actions.

Attack: Restricting care for federal workers, service members, veterans, and incarcerated people

Last updated: May 13, 2025

Two of the White House’s executive orders—14168 (“Defending Women…”) and 14187 (“Protecting Children…”)—are the basis of reductions in coverage or care for several groups of people whose healthcare is closely tied to the federal government:

• Federal workers and their families: The Office of Personnel Management has released guidance (pdf) to carriers that provide health insurance to federal workers, directing them not to cover gender-affirming care for dependents under 19, to make coverage of gender-affirming care for adults optional, and to remove recognition of nonbinary gender markers.
• Military service members: The Department of Defense has issued a memo blocking service members from receiving new gender-affirming care. It’s not yet clear how this policy is being carried out, but it runs alongside the administration’s efforts to remove transgender service members from the US armed forces.
• Veterans: The Department of Veterans Affairs has rescinded standards for dignified care for trans and gender-nonconforming veterans and issued new policies stripping access to new gender-affirming hormone therapy and rolling back accommodations around single-sex bathrooms and treatment areas.
• Incarcerated people: The administration is attempting to cut off gender–affirming care for trans people incarcerated in federal prisons.

Who this affects

These changes will restrict or block gender-affirming care for up to three million federal employees and their dependents, thousands of transgender service members, more than 160,000 transgender veterans, and thousands of transgender people incarcerated in federal prisons.

Where this stands

Updated federal healthcare plans for federal workers—with reduced or eliminated coverage for gender-affirming care—will be submitted to the Office of Personnel Management on May 31, and available to workers this fall.

The gender-affirming care ban for service members is new, and we don’t yet have details on its implementation, or on legal challenges. We haven’t seen any legal pushback against the reductions in care at the VA.

Federal judges have issued three different temporary restraining orders to block the administration’s elimination of gender-affirming care for federal prisoners. However, the executive order has inspired a wave of legislation to copy this effort in state prisons, including laws passed in Georgia, Kentucky, and Utah.

Attack: Removing gender-affirming care from Affordable Care Act plans

Last updated: May 13, 2025

In March, the Centers for Medicare and Medicaid Services proposed changes to the Affordable Care Act marketplaces, including prohibiting states from requiring gender-affirming care as an essential benefit in 2026. This change could lead to some insurers dropping coverage for gender-affirming care or shifting more of the cost burden for this care onto individuals who get their health insurance from plans on the ACA marketplace. This would also likely have downstream effects on providers of gender-affirming services.

Where this stands

The public comment period for this proposed rule ended on April 11, 2025. CMS is now responsible for reviewing the 26,000+ submissions, after which it will make a decision about whether to proceed with the proposal, issue a new or modified one, or withdraw it altogether. Historically, final rules on this subject are published around August and take effect starting in October.

Who this affects

In 2023, more than 23 million people in the US got their health insurance through ACA marketplaces. It’s not clear how many of those people will need gender-affirming care, but analysis suggests that those people will pay more for their care or coverage if they do need it.

Countermoves: legal and legislative

Prior to 2025, 24 states and the District of Columbia had already banned health insurers from refusing to cover transgender-related health care benefits. If the Trump administration’s rule goes through, those states may end up paying for a larger portion of the coverage offered to their residents.

Broad countermoves: community resilience & safety work

• Trans Lifeline and LGBT National Youth Talkline are confidential peer support phone services.
• Point of Pride is offering financial assistance for gender-affirming care and free shapewear to trans people.
• Black and Pink supports currently and formerly incarcerated LGBTQ+ people through a pen-pal program, sending solidarity packages and commissary funds, and providing re-entry support. There are local chapters in Denver, Missoula, NYC, and Providence.
• The Sylvia Rivera Law Project’s prisoner justice project provides direct services to incarcerated transgender, intersex, and gender non-confirming people who are experiencing violence, bias, or lack of access to medical care while incarcerated.
• SPARTA Pride is an organization that offers community support, services, and mentorship to trans military members.
• The DIY HRT Directory is a frequently updated and deeply-researched informational resource about safely accessing hormone replacement therapy.
• TransRescue.org is a group based in the Netherlands that assists trans and queer individuals in relocating out of dangerous places. The site has resources for people thinking of leaving the US, including office hours and individual consultations.