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. Every major medical and mental health association in the US² recognizes the medical necessity of providing gender-affirming care to people who experience dysphoria. Gender-affirming care³ includes mental health care, medical care, and social services.

Gender-affirming care for adolescents and teenagers has been the target of widespread⁴ misinformation⁵ campaigns,⁶ including a recent report on gender dysphoria⁷ 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 risk⁸ for self-harm and depression. Current mainstream research shows that for these youth, gender-affirming care⁹ saves lives¹⁰ and improves overall emotional well-being.¹¹
• No medical therapies¹² offered to transgender adolescents are “sterilizing.” Puberty-pausing medications—often called puberty-blockers—are fully reversible¹³ and in fact regularly prescribed to delay early puberty¹⁴ in cisgender children. There’s no evidence that puberty-pausing medications taken alone compromise future fertility.
• Older teens who add hormone therapies¹⁵ may experience reduced fertility. Discussion of these potential risks are a part of the extensive consultation process¹⁶ 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.¹⁷ A recent Harvard School of Public Health study¹⁸ 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.”¹⁹ (About 1 in 60 people in the United States²⁰ are born with hormonal, anatomical, or chromosomal characteristics that do not fit neatly into “male” or “female” categories.) These procedures include nonconsensual genital surgeries²¹ that may result in permanent harm, including sterility.²²

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 administers²³ Medicare and—jointly with the states, Medicaid—which together provide healthcare coverage for about a third of people living in the US.
• Sets standards and regulations for state Health Insurance Marketplaces²⁴ created by the Affordable Care Act (ACA); operates HealthCare.gov²⁵ as a platform for finding health plans; and directly operates 28 out of the 51²⁶ state-level marketplaces through the Department of Health and Human Services (HHS).
• Funds hospitals and healthcare clinics²⁷ with grants and loans and funds universities, research hospitals, and public health institutions²⁸ with research grants.
• Provides healthcare coverage²⁹ for federal civilian employees, and for military service members and their families.³⁰
• Provides medical care for service members and veterans through the Department of Veterans Affairs³¹ and to people incarcerated in federal prisons.³²

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. 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: Excluding gender-affirming care from healthcare coverage

Last updated: June 4, 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, 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.³³ Among the many cuts to Medicaid in the current bill³⁴ is 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 through two different efforts. Both of them would prohibit states from mandating that gender-affirming care be considered an “essential benefit”³⁵—meaning that those plans would no longer legally have to cover it. Healthcare analysts believe this could lead to some insurers dropping coverage for gender-affirming care³⁶—or to this care becoming more expensive for people on marketplace plans.

• In May, the House passed a budget reconciliation bill³⁷ that contained significant changes to the Affordable Care Act, including prohibiting states from mandating coverage for “gender transition procedures”³⁸—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 proposed a similar change that would take effect in 2026.³⁹

Where this stands

The budget bill that includes both the Medicaid and ACA marketplace restrictions narrowly passed the House⁴⁰ on May 22nd and now moves to the Senate, where the bill will likely undergo modifications⁴¹ that send it back to the House. The final Senate version will pass the Senate unless four or more Republican senators⁴² (and all Democratic and Independent senators) vote against it. Congressional leaders hope to pass the bill by July 4th.

The public comment period for CMS’ changes ended on April 11, 2025. CMS is now responsible⁴³ for reviewing the 26,000+ submissions,⁴⁴ 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 August⁴⁵ and take effect starting in October.

Who this affects

An estimated 276,000 transgender adults⁴⁶ 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 bill includes the changes in the House bill, 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 people⁴⁷ 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 more⁴⁸ for their care or coverage.

A nationwide block on federal funding for transgender healthcare will be destabilizing⁴⁹ and dangerous⁵⁰ for trans people, and will make it difficult—or impossible—for providers⁵¹ to continue offering gender-affirming care.

Countermoves

• 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.
• Senate Democrats say they will argue⁵² that some parts of the budget bill—including the provisions that target gender-affirming care—are not eligible for the reconciliation process.⁵³ If they succeed, the Republican majority would not be able to pass the bill without bipartisan support unless they overrule the Senate Parliamentarian, which they have claimed they will not⁵⁴ do. It’s not clear whether the trans healthcare bans in Medicaid and the ACA marketplace are a priority for Senate Democrats as they prepare their arguments.
• Journalist Mady Castigan has created a series of templates and contact lists,⁵⁵ along with advice for contacting senators to ask them not to allow Republicans to push the budget bill through reconciliation unless the trans healthcare bans are removed.
• Advocates for Trans Equality⁵⁶ is mobilizing a campaign⁵⁷ to help people contact their representatives and ask them to protect gender-affirming care funding for state Medicaid programs.
• Prior to 2025, 24 states and the District of Columbia⁵⁸ had already banned health insurers from refusing to cover transgender-related health care benefits. If the Trump administration’s CMS rule goes through, those states may end up paying for a larger portion⁵⁹ of the coverage offered to their residents. If the budget bill’s ACA marketplace changes make it into the final bill, conflicts between federal and state law are expected.

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

Last updated: June 4, 2025

Through two executive⁶⁰ orders⁶¹ 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 grants⁶² and—crucially—their eligibility to receive Medicare and Medicaid reimbursements⁶³ 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 reviews⁶⁴ to target providers of gender-affirming care.
• Threatening to prosecute⁶⁵ care providers and the manufacturers and distributors of hormones used in gender-affirming hormone therapy.
• Stripping Public Service Loan Forgiveness⁶⁶ eligibility for the employees of hospitals that provide gender-affirming care⁶⁷ to people under 19.

Where this stands

A federal judge has blocked part of one order, Executive Order 14187⁶⁸ 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 order⁶⁹ when the judge blocked it. Hospital systems in Arizona⁷⁰ and Pennsylvania,⁷¹ for example, stopped offering some gender-affirming care to people under 19 after the ruling. Since the injunction, some have resumed care,⁷² but not all.

Another federal judge⁷³ 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 HHS⁷⁴ (PDF) and CMS⁷⁵ (PDF) 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 eligibility⁷⁶ requirements.

Countermoves: legal and judicial challenges

• States like Washington,⁷⁷ and civil rights organizations like the American Civil Liberties Union⁷⁸ 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 York⁷⁹ (PDF) and California⁸⁰ 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 care⁸¹ despite the administration’s actions.

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

Last updated: June 4, 2025

Two of the White House’s executive⁸² orders⁸³ 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 guidance⁸⁴ (PDF) to carriers that provide health insurance to federal workers,⁸⁵ 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 memo⁸⁶ 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 members⁸⁷ from the US armed forces.
• Veterans: The Department of Veterans Affairs has rescinded standards⁸⁸ for dignified care⁸⁹ for trans and gender-nonconforming veterans and issued new policies⁹⁰ 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 care⁹¹ for trans people incarcerated in federal prisons.

Who this affects

These changes will restrict or block gender-affirming care for up to three million⁹² federal employees and their dependents, thousands⁹³ of transgender service members, more than 160,000⁹⁴ transgender veterans, and thousands⁹⁵ 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.⁹⁶

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.

In June, a federal judge issued a preliminary injunction ordering the Bureau of Prisons to resume providing hormone therapy to all transgender inmates.⁹⁷ This builds on three other temporary restraining orders⁹⁸ 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,⁹⁹ Kentucky,¹⁰⁰ and Utah.¹⁰¹

Broad countermoves: community resilience & safety work

• Trans Lifeline¹⁰² and LGBT National Youth Talkline¹⁰³ are confidential peer support phone services.
• Point of Pride¹⁰⁴ is offering financial assistance for gender-affirming care and free shapewear to trans people.
• Black and Pink¹⁰⁵ 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 project¹⁰⁶ 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 Pride¹⁰⁷ is an organization that offers community support, services, and mentorship to trans military members.
• The DIY HRT Directory¹⁰⁸ is a frequently updated and deeply-researched informational resource about safely accessing hormone replacement therapy.
• TransRescue.org¹⁰⁹ 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 York¹¹⁰ (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.