Transgender Healthcare

What do I need to know about transgender healthcare?

Over 1.6 million people¹ 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.² Every major medical and mental health association in the US³ recognizes the medical necessity of providing gender-affirming care to people who experience dysphoria. Gender-affirming care⁴ includes mental health care, medical care, and social services.

Gender-affirming care for adolescents and teenagers has been the target of widespread⁵ misinformation⁶ campaigns,⁷ including a recent report on gender dysphoria⁸ 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 risk⁹ for self-harm and depression. Current mainstream research shows that for these youth, gender-affirming care¹⁰ saves lives¹¹ and improves overall emotional well-being.¹²
• No medical therapies¹³ offered to transgender adolescents are “sterilizing.” Puberty-pausing medications—often called puberty-blockers—are fully reversible¹⁴ and in fact regularly prescribed to delay early puberty¹⁵ in cisgender children. There’s no evidence that puberty-pausing medications taken alone compromise future fertility.
• Older teens who add hormone therapies¹⁶ may experience reduced fertility. Discussion of these potential risks are a part of the extensive consultation process¹⁷ 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.¹⁸ A recent Harvard School of Public Health study¹⁹ 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.”²⁰ (About 1 in 60 people in the United States²¹ are born with hormonal, anatomical, or chromosomal characteristics that do not fit neatly into “male” or “female” categories.) These procedures include nonconsensual genital surgeries²² that may result in permanent harm, including sterility.²³

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 and administers²⁴ Medicare; and, jointly with the states, funds and administers Medicaid. Together, Medicare and Medicaid provide healthcare coverage for about a third of people living in the US.
• Sets standards and regulations for state Health Insurance Marketplaces²⁵ created by the Affordable Care Act (ACA); operates HealthCare.gov²⁶ as a platform for finding health plans; and directly operates 28 out of the 51²⁷ state-level marketplaces through the Department of Health and Human Services (HHS).
• Funds hospitals and healthcare clinics²⁸ with grants and loans and funds universities, research hospitals, and public health institutions²⁹ with research grants.
• Provides healthcare coverage³⁰ for federal civilian employees, and for military service members and their families.³¹
• Provides medical care for service members and veterans through the Department of Veterans Affairs³² and to people incarcerated in federal prisons.³³

What is happening?

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

• Restrict coverage for gender-affirming care by blocking federal cost-sharing for this care in Medicaid and preventing states from requiring ACA marketplace plans to cover gender-affirming care. More on this

• 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

On this page, we’ll break down those lines of attack, along with the countermoves and resilience efforts we’re seeing across American society.

Attack: Excluding gender-affirming care from healthcare coverage

Last updated: July 3, 2025

The Trump administration and the Republican-controlled legislature are working in parallel to block coverage of gender-affirming care for transgender people who are enrolled in Medicaid and make it harder for people to buy Affordable Care Act (ACA, also known as Obamacare) marketplace healthcare plans that cover gender-affirming care.

Blocking gender-affirming care for people who use Medicaid. Medicaid is public healthcare coverage funded jointly by states and the federal government. Along with the Children’s Health Insurance Program (CHIP), Medicaid covers care for more than 79 million people in the US. (See our Medicaid page for more on the program and what’s under threat.) The US House of Representatives and Senate, both controlled by Republican majorities, are attempting to pass a budget that slashes federal services to pay for up to $5 trillion in tax cuts.³⁴ Among the many cuts to Medicaid that have been included in various iterations of the bill³⁵ was a block on federal matching funds for “gender transition procedures” for people of all ages enrolled in Medicaid and CHIP. The block also unconventionally redefines those “procedures” to include puberty blockers and hormone therapy in addition to gender-affirming surgery.

Reducing access to gender-affirming care in ACA marketplace plans. The federal government is weakening access to gender-affirming care in marketplace plans in two ways:.

• In May, the House passed a budget reconciliation bill³⁶ that contained significant changes to the Affordable Care Act, including prohibiting states from mandating coverage for “gender transition procedures”³⁷—such as puberty blockers, hormone treatment, and surgery—as an essential health benefit (EHB) beginning on January 1, 2027.
• In March, the Centers for Medicare and Medicaid Services (CMS) proposed a similar change.³⁸ The proposed changes were finalized on June 20th³⁹ and will go into effect in 2026. Once in effect, these new rules will make it harder, and more expensive to access gender-affirming care.⁴⁰

Both of these would prohibit states from mandating that gender-affirming care be considered an “essential benefit”⁴¹—meaning that those plans would no longer be legally required to cover it. Healthcare analysts believe this could lead to some insurers dropping coverage for gender-affirming care⁴²—or to this care becoming more expensive for people on marketplace plans.

Relatedly, the US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) announced on June 17th⁴³ that it would end funding for the LGBTQ+ specialized services piece of a suicide prevention hotline. The hotline has been used over 16 million times,⁴⁴ and SAMHSA estimates that 1.4 million of those connections were routed through the LGBTQ+ service. (The suicide hotline still exists, the change is purely to its LGBTQ+ focused service.)

Where this stands

The budget bill that includes both the Medicaid and ACA marketplace restrictions narrowly passed the House⁴⁵ on May 22nd, sending it to the Senate.

On July 1st, Senate Republicans removed both provisions⁴⁶ that would defund gender affirming care before passing their version of the budget. The bill now returns to the House⁴⁷ for approval. Trump and Senate Republicans are hoping to pass a final budget by July 4th, but House Representatives have indicated they may not accept it.⁴⁸ House Representative Marjorie Taylor Greene immediately attempted to re-introduce a ban on Medicare and CHIP coverage of gender affirming care as an amendment (PDF),⁴⁹ without providing any details. Any changes the House makes will return to the Senate for approval, and it’s unclear whether any amendments will be accepted or not.

Who this affects

An estimated 276,000 transgender adults⁵⁰ are enrolled in Medicaid; 3 in 5 of them live in one of 26 states (including DC) that offer gender-affirming care coverage as part of Medicaid. If the final budget bill matches the current Senate version, these states will either pay for gender-affirming care coverage entirely from their own funds or drop the coverage for their Medicaid enrollees.

In 2023, more than 23 million people⁵¹ 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 who do will pay more⁵² for their care or coverage.

A nationwide block on federal funding for transgender healthcare will be destabilizing⁵³ and dangerous⁵⁴ for trans people, and will make it difficult—or impossible—for providers⁵⁵ to continue offering gender-affirming care.

Prior to 2025, 24 states and the District of Columbia⁵⁶ had already banned health insurers from refusing to cover transgender-related health care benefits. When the Trump administration’s CMS rules go into effect those states may end up paying for a larger portion⁵⁷ of the coverage offered to their residents.

Countermoves

• While the core attacks on gender affirming care are out of the budget for now, the bill still contains plenty of cuts that will impact trans people who need other kinds of care. There are many countermoves underway against the proposed cuts to Medicaid and the budget bill as a whole; you’ll find a selection of them on our Medicaid page.
• Rhode Island announced⁵⁸ that it would be keeping LGBTQ+ support on its suicide hotline despite federal funding cuts.

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

Last updated: June 26, 2025

Through two executive⁵⁹ orders⁶⁰ 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 grants⁶¹ and—crucially—their eligibility to receive Medicare and Medicaid reimbursements⁶² 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 reviews⁶³ to target providers of gender-affirming care.
• Threatening to prosecute⁶⁴ care providers and the manufacturers and distributors of hormones used in gender-affirming hormone therapy.
• Stripping Public Service Loan Forgiveness⁶⁵ eligibility for the employees of hospitals that provide gender-affirming care⁶⁶ to people under 19.
• Hosting a Federal Trade Commission workshop called “The Dangers of ‘Gender-Affirming Care’ for Minors”⁶⁷ that casts gender-affirming care for minors as “unfair or deceptive trade practices.” The workshop appears to be the first attempt by the new FTC Chair to make good on his promises to weaponize the FTC (PDF)⁶⁸ against “doctors, therapists, hospitals, and others” who provide gender-affirming care to children and adults.
• Encouraging people to report clinics⁶⁹ providing gender-affirming care to the FBI Tip Line.

Where this stands

In March, a federal judge blocked part of one order, Executive Order 14187⁷⁰ 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 order⁷¹ when the judge blocked it. Hospital systems in Arizona⁷² and Pennsylvania,⁷³ for example, stopped offering some gender-affirming care to people under 19 after the ruling.

Since the injunction, some have resumed care,⁷⁴ but not all: for example, mounting threats to funding and other forms of external pressure led Children’s Hospital Los Angeles to announce the imminent closure⁷⁵ of its Center for Transyouth Health and Development (which provides care to patients 25 and under) as well as its entire gender-affirming surgical practice for patients of all ages. Three other clinics in California⁷⁶ also ceased offering gender affirming care for adolescents in June.

Another federal judge⁷⁷ 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. Both HHS⁷⁸ and CMS (PDF)⁷⁹ have sent letters to hospitals reinforcing the administration’s stance against gender-affirming care. Neither specifies enforcement mechanisms, so it’s unclear what the “oversight initiative” launched by the CMS is actually going to do if they find hospitals providing this care. The Public Service Loan Forgiveness program has not yet changed its eligibility⁸⁰ requirements.

Relatedly, on June 18, the United States Supreme Court upheld a Tennessee state law (PDF)⁸¹ banning gender-affirming care for adolescents. The ruling preserves the current status quo: states with existing bans on trans healthcare will be permitted to keep those bans. It does not remove healthcare from anyone who currently has it.

Countermoves: Legal & judicial challenges

• States like Washington,⁸² and civil rights organizations like the American Civil Liberties Union⁸³ 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)⁸⁴ and California⁸⁵ 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 care⁸⁶ despite the administration’s actions.

Countermoves: Community campaigns

• Unite & Fight and Chicago DSA are asking community members to call for Lurie Children’s Hospital in Chicago to restore gender-affirming surgeries⁸⁷ for patients under 19.
• Los Angeles LGBT Center is asking community members to demand that Children’s Hospital Los Angeles keep providing gender-affirming care for people of all ages.⁸⁸ They are also hosting rallies⁸⁹ in front of the hospital on Thursdays for several weeks.

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

Last updated: June 19, 2025

Two of the White House’s executive⁹⁰ orders⁹¹ 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)⁹² to carriers that provide health insurance to federal workers,⁹³ 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 memo⁹⁴ 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 members⁹⁵ from the US armed forces.
• Veterans: The Department of Veterans Affairs has rescinded standards⁹⁶ for dignified care⁹⁷ for trans and gender-nonconforming veterans and issued new policies⁹⁸ 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 care⁹⁹ for trans people incarcerated in federal prisons.

Who this affects

These changes will restrict or block gender-affirming care for up to three million¹⁰⁰ federal employees and their dependents, thousands¹⁰¹ of transgender service members, more than 160,000¹⁰² transgender veterans, and thousands¹⁰³ 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—should have been submitted to the Office of Personnel Management on May 31, but we won’t know what changes they have made until the plans become available to workers this fall.¹⁰⁴

The gender-affirming care ban for service members is new, and we don’t yet have details on its implementation. At least one transgender veteran has already filed suit against the VA¹⁰⁵ for dropping coverage for hormone replacement therapy.

In June, a federal judge issued a preliminary injunction ordering the Bureau of Prisons to resume providing hormone therapy to all transgender inmates.¹⁰⁶ This builds on three other temporary restraining orders¹⁰⁷ that had previously been issued to block the administration’s elimination of gender-affirming care for specific groups of federal prisoners. However, the executive order has inspired a wave of legislation to copy this effort in state prisons, including laws passed in Georgia,¹⁰⁸ Kentucky,¹⁰⁹ and Utah.¹¹⁰

Broad countermoves: Community resilience & safety work

• Trans Lifeline¹¹¹ and LGBT National Youth Talkline¹¹² are confidential peer support phone services.
• Point of Pride¹¹³ is offering financial assistance for gender-affirming care and free shapewear to trans people.
• Black and Pink¹¹⁴ 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 project¹¹⁵ provides direct services to incarcerated transgender, intersex, and gender non-conforming people who are experiencing violence, bias, or lack of access to medical care while incarcerated.
• SPARTA Pride¹¹⁶ is an organization that offers community support, services, and mentorship to trans military members.
• The DIY HRT Directory¹¹⁷ is a frequently updated and deeply-researched informational resource about safely accessing hormone replacement therapy.
• TransRescue.org¹¹⁸ 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.
• LGBTQ advocates in New York¹¹⁹ (including the NYC Trans & Queer Provider Advocacy Coalition) are pressing for allocations in the city budget to fund gender-affirming care and provide other vital supports to trans residents whose care is under attack at the federal level.