Transgender Healthcare

Millions of people in the United States rely on the federal government to fund, support, or provide healthcare, including gender-affirming care¹ — an umbrella that includes mental health care, medical care, and social services. These services are being targeted by those who seek to deny and erase the existence of trans people entirely. The Trump administration is attempting to remove access to gender-affirming care through direct funding cuts and care restrictions, intimidation and coercion, and spreading misinformation. Many of these attacks have been deemed illegal by the courts, but healthcare providers across the country are still cutting care and resources out of fear of being targeted by the federal government.

In nearly all the policies, regulations, executive orders and memos described below, gender-affirming care is being restricted solely for trans people. That same exact care — including puberty blockers and surgeries — is explicitly permitted for cis patients.

What do I need to know about transgender healthcare?

Over 2.8 million people² 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.³ Every major medical and mental health association in the US⁴ recognizes the medical necessity of providing gender-affirming care to people who experience dysphoria.

Gender-affirming care for adolescents and teenagers has been deliberately chosen⁵ as a political wedge issue. It is the target of widespread⁶ misinformation⁷ campaigns,⁸ including a report on gender dysphoria⁹ 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 risk¹⁰ for self-harm and depression. Current mainstream research shows that for these youth, gender-affirming care¹¹ saves lives¹² and improves overall emotional well-being.¹³
• No medical therapies¹⁴ offered to transgender adolescents are “sterilizing.” Puberty-pausing medications — often called puberty-blockers — are fully reversible¹⁵ and in fact regularly prescribed to delay early puberty¹⁶ in cisgender children. There’s no evidence that puberty-pausing medications taken alone compromise future fertility.
• Older teens who add hormone therapies¹⁷ may experience reduced fertility. Discussion of these potential risks are a part of the extensive consultation process¹⁸ 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 already extremely rare.¹⁹ A recent Harvard School of Public Health study²⁰ 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.”²¹ (About 1 in 60 people in the United States²² are born with hormonal, anatomical, or chromosomal characteristics that do not fit neatly into “male” or “female” categories.) These procedures include nonconsensual genital surgeries²³ that may result in permanent harm, including sterility.²⁴

How is the federal government involved?

The federal government provides guidance, regulation, funding, and infrastructure for many kinds of healthcare, including:

• Funding and administering²⁵ Medicare; and, with the states, funding and administering Medicaid. Together, Medicare and Medicaid provide healthcare coverage for about a third of people living in the US.
• Setting standards and regulations for state Health Insurance Marketplaces²⁶ created by the Affordable Care Act (ACA); operates HealthCare.gov²⁷ as a platform for finding health plans; and directly operates 28 out of the 51²⁸ state-level marketplaces through the Department of Health and Human Services (HHS).
• Funding hospitals and healthcare clinics²⁹ with grants and loans and funds universities, research hospitals, and public health institutions³⁰ with research grants.
• Providing healthcare coverage³¹ for federal civilian employees, and for military service members and their families.³²
• Providing medical care for service members and veterans through the Department of Veterans Affairs³³ and to people incarcerated in federal prisons.³⁴

The federal government also controls many departments and processes designed to protect people — such as the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and the Federal Trade Commission (FTC) — which can be weaponized against citizens if the government redefines certain forms of healthcare as harmful. By using these tools to create an environment of fear the government encourages gender-affirming care providers to “comply in advance” by cutting access to care pre-emptively.

What is happening?

The Trump administration, Congress, and the Supreme Court are using the power of the executive, legislative, and judicial branches to:

• Restrict coverage for gender-affirming care. More on this

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

• Defund and manipulate medical research about transgender people. 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: December 19, 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 Medicare or Medicaid, and to make it harder for people to buy healthcare plans that cover gender-affirming care in the Affordable Care Act (ACA, also known as Obamacare) marketplace . These attacks are happening in three main ways:

Changing³⁵ the ACA to prohibit insurers from considering gender affirming care an essential health benefit (EHB). In practice, that means that those plans would no longer be legally required to cover it. These proposed changes were finalized on June 20, 2025³⁶ and went into effect on November 1st, of this year with the latest enrollment period. These new rules make it harder³⁷ and more expensive³⁸ to access gender-affirming care.

Using budget-making processes — like the budget reconciliation bill³⁹ and later budget appropriations bills⁴⁰ to restrict or ban federal funding for gender-affirming care.

The first attempt at including this sort of ban using a budgetary process failed in July, when the provisions were ruled out of scope⁴¹ for a reconciliation bill and cut from the final text.

The latest attempt is still in play — this time using appropriations bills. At least six⁴² of the House appropriations bills for 2026 included some kind of restriction on federal funding for gender-affirming care — including ending insurance coverage⁴³ of gender-affirming care for people enrolled in Medicare, Medicaid, or Children’s Health Insurance Program.

The inability to reconcile those House bills with their corresponding Senate versions forced a 43 day government shutdown,⁴⁴ which ended on November 12th⁴⁵ with a resolution⁴⁶ that extended federal funding through January 30th, 2026. That bill did not include any specific restrictions on gender-affirming care.

However, the resolution that re-opened the government did not include all of the various funding bills across the many appropriations committees. There are still nine left that the House and the Senate have not reconciled and have thus not been signed. Over the next few months, Congress will have to sort out⁴⁷ many of these bills, which will include debates over whether to include restrictions on gender-affirming care.

Changing Medicaid and Medicare rules to effectively ban hospitals from offering gender-affirming care, even in states where it remains entirely legal. In mid-December, the GOP-controlled house passed a bill⁴⁸ that would ban the use of Medicaid funds⁴⁹ for gender affirming care for anybody under 19. That bill now heads to the Senate for debate and a vote.

The very same day, the Department of Health and Human Services released a proposed rule (PDF)⁵⁰ that also targeted gender-affirming care for patients under 19. Under the new HHS rules, hospitals that choose to continue offering these services would be stripped of any and all Medicare or Medicaid reimbursements or funding for all patients at the hospital. This would destroy most healthcare facilities’ ability to operate and is designed to operate⁵¹ as a ban on gender-affirming care. The rule is now in a 60-day public comment period and is likely to be challenged⁵² in the courts.

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

Last updated: December 19, 2025

Through two executive orders (EO 14187⁵³ and EO 14235⁵⁴) and related guidance from executive departments, the Trump administration is pressuring hospitals and other care providers into ceasing gender-affirming care (with a particular focus on trans youth) by, among other things:

• Threatening to prosecute⁵⁵ care providers as well as the manufacturers and distributors of hormones used in gender-affirming therapy. This includes the DOJ sending more than 20 subpoenas⁵⁶ to doctors and clinics who provide gender-affirming care to youth, demanding⁵⁷ confidential patient records and contact details, personnel files, and doctor-patient communications.
• Attempting to pass bills⁵⁸ that criminalize gender-affirming care,⁵⁹ by reclassifying it as a felony.
• Investigating state health departments⁶⁰ for “discrimination”⁶¹ if those states require behavioral health providers to offer services related to gender-affirming care.
• Encouraging people to report clinics⁶² providing gender-affirming care for people under 18 to the FBI.
• Using Medicare and Medicaid’s clinical-abuse assessments and mandatory drug reviews⁶³ to target providers of gender-affirming care.
• Creating financial hardship for employees of targeted hospitals by stripping them of eligibility for Public Service Loan Forgiveness Program.⁶⁴
• Trying to recast gender affirming care as “unfair or deceptive trade practices⁶⁵” and use the tools of the Federal Trade Commission to punish those who provide that care⁶⁶.

Taken together, these tactics have been very effective in intimidating and coercing providers to reduce gender-affirming care options — particularly for patients under 19. Immediately after Trump’s executive orders were signed, healthcare providers across the country⁶⁷ began cancelling⁶⁸ appointments and cutting gender-affirming care programs⁶⁹, and many have continued to do so⁷⁰ in the wake of additional threats from the DOJ, FBI, HHS and FTC.

We don’t have a true count of how many clinics have paused or stopped providing gender affirming care, but we know it’s more than twenty.⁷¹ In some cases, these clinics are the only option for trans folks in the area.⁷²

Several⁷³ lawsuits⁷⁴ have been⁷⁵ filed⁷⁶ attempting to halt the administration’s broad-spectrum attempts to intimidate and defund institutions that provide gender-affirming care. Some suits argue that Trump’s executive orders constitute illegal discrimination on the basis of sex or gender and violate organizations’ free speech and due process. Others argue that the Trump administration is trying to dictate policies, regulations, or laws that are not within their right to control. This focus on executive overreach has been the more successful tack so far. At least two judges⁷⁷ have ruled,⁷⁸ that the Executive Orders overstep the power of the president’s desk.

After those rulings, some clinics resumed care,⁷⁹ but nowhere near all. And more have removed access to care than have resumed it.

Many groups — including nurses and healthcare providers — have organized rallies, petitions, and other actions to protest hospitals and clinics that have rolled back gender-affirming care. In at least one case — Corewell Health, in Michigan — they worked to restore gender-affirming care.⁸⁰

We don’t know exactly how many healthcare providers were issued DOJ subpoenas at this point, nor do we know if any of them complied. But two⁸¹ clinics⁸² responded to the subpoenas by reducing or cutting gender-affirming care to reduce their risk of federal investigation or prosecution.Several organizations resisted by asking judges to quash the subpoenas. In two⁸³ cases,⁸⁴ the judges have agreed that the requests were too broad and that the providers did not have to comply.

Many states have laws in place that protect gender-affirming care. By the end of 2024, 25 states⁸⁵ had banned health insurers from refusing to cover transgender-related health care benefits. In 2025, attorneys general in New York (PDF),⁸⁶ California,⁸⁷ and Michigan⁸⁸ sent letters reminding hospitals in their states that following these executive orders would put them in violation of state law. But despite those letters and the judicial rulings, care providers have continued to pull away⁸⁹ from offering gender-affirming care — including in states where that care is legally protected.

Attack: Defunding and manipulating medical research about transgender people

Last updated: December 19, 2025

The Trump administration has defunded, erased, altered, and attempted to discredit medical research about transgender and intersex people in order to further their inaccurate and harmful policies.

Defunding research on transgender people and care. As part of a much larger attack on research grants, the National Institutes of Health (NIH) has specifically targeted research on transgender healthcare⁹⁰ for being a form of “woke DEI ideology.”

It’s impossible to give a precise count of how many grants have been cancelled, but analyses suggest that about a quarter of terminated NIH grants were related to trans health,⁹¹ totaling over $125 million⁹² in research funding. Of the clinical trials cancelled, 42% mentioned LGBTQ+ populations (PDF).⁹³ (For more on the withdrawal of research funding, see our Medical Research Funding page.)

Several judges have ruled that both the various grant terminations⁹⁴ and funding freezes,⁹⁵ and the destruction of government webpages and data,⁹⁶ were unlawful. Thanks to those rulings, some projects — but not all — have had their funding restored.⁹⁷ In many cases, funding remains in limbo as the administration fights and appeals injunctions in court. And, as we covered above, the threat of these funding cuts has been successfully used to pressure hospitals to stop providing gender-affirming care.

Rejecting best-practice research that exists, by ordering all agencies,⁹⁸ to rescind or amend any policies that follow guidance from the World Professional Association for Transgender Health (WPATH), which it smeared as “junk science.” In its place, the administration commissioned its own 400 page report⁹⁹ on treating gender dysphoria in children, which has been denounced as inaccurate and biased disinformation by many¹⁰⁰ medical¹⁰¹ organizations¹⁰² since its publication.

The White House also directed the National Institutes of Health¹⁰³ to research negative effects of transition, transition regret, and detransition rates among children and adults and ignoring the results of studies (including those previously commissioned¹⁰⁴ by Republicans) that conclude that gender-affirming care helps trans youth.

Removing websites¹⁰⁵ relating to sexual health and LGBTQ+ health. Most of the affected websites seem to be back — although often with disclaimers¹⁰⁶ reading, “This page does not reflect biological reality and therefore the Administration and this Department rejects it.” Several groups and organizations have worked to back up datasets¹⁰⁷ and websites¹⁰⁸ related to gender-affirming care at risk of deletion or alteration.

Stopping collection of transgender identity data¹⁰⁹ in the Centers for Disease Control’s public health data. This exacerbates the existing lack of data¹¹⁰ on health conditions for trans and nonbinary people in the US.

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

Last updated: December 19, 2025

Healthcare for certain groups of people is particularly closely tied to the federal government. Federal and postal service workers and their families, military service members and their families, veterans, and incarcerated people are facing reductions in coverage or care. These impacts are the result of two executive¹¹¹ orders¹¹². Other efforts, such as this appropriations bill, seek to ban gender-affirming care for trans individuals at any government-owned facility.¹¹³

Federal workers and their families: Since January, the Office of Personnel Management made two updates to their policies related to gender affirming care. The first¹¹⁴ banned health insurance providers for federal workers from covering gender affirming care for dependents under 19. The second expanded that ban,¹¹⁵ dropping coverage for gender-affirming care for trans adults as well.

Military service members and their families: One of Trump’s executive orders in January explicitly directed¹¹⁶ the Secretary of Defense to remove coverage of gender-affirming care from TRICARE, the military’s healthcare program. In response, the Department of Defense issued at least two memos¹¹⁷ blocking service members from receiving new gender-affirming care, despite federal court judges previously finding the restrictions unconstitutional.¹¹⁸ Military families have challenged this change¹¹⁹ in court, and that case is still pending.

This runs alongside the administration’s efforts to remove all transgender service members¹²⁰ from the US armed forces — which would also cut off their access to healthcare. Several¹²¹ cases¹²² have been brought against these efforts, and two different federal judges¹²³ ruled that the order constituted illegal discrimination. However, in May, the Supreme Court allowed¹²⁴ the Trump administration to move forward with its ban pending further legal challenges. Those cases are in continuing litigation and it’s not clear when they will be decided.

Veterans: The Department of Veterans Affairs has rescinded standards¹²⁵ for dignified care¹²⁶ for trans and gender-nonconforming veterans and issued new policies¹²⁷ stripping access to new gender-affirming hormone therapy and rolling back accommodations around single-sex bathrooms and treatment areas.

Incarcerated people: One of Trump’s executive orders¹²⁸ directs the Bureau of Prisons to cease offering gender–affirming care¹²⁹ for trans people incarcerated in federal prisons. A wave of legislation to copy this effort in state prisons followed, including laws passed in Georgia,¹³⁰ Kentucky,¹³¹ and Utah.¹³² In addition, there are three cases right now that we know of related to inmates being threatened with transfers to facilities that don’t match their gender, which would also mean losing access to gender-affirming care. In all¹³³ three¹³⁴ cases,¹³⁵ judges have blocked the transfers, ruling in favor of the plaintiffs. The administration has appealed these decisions, and they are all still working their way through the courts.

In total: Taken together, these changes will restrict or block gender-affirming care for around 17,000 transgender¹³⁶ federal and postal service employees (and countless more dependents thereof), thousands¹³⁷ of transgender service members, more than 160,000¹³⁸ transgender veterans, and thousands¹³⁹ of transgender people incarcerated in federal prisons.

Broad countermoves: Community resilience & safety work

• Trans Lifeline¹⁴⁰ and LGBT National Youth Talkline¹⁴¹ are confidential peer support phone services.
• Point of Pride¹⁴² is offering financial assistance for gender-affirming care and free shapewear to trans people.
• Black and Pink¹⁴³ 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 project¹⁴⁴ 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 Pride¹⁴⁵ is an organization that offers community support, services, and mentorship to trans military members.
• The DIY HRT Directory¹⁴⁶ is a frequently updated and deeply-researched informational resource about safely accessing hormone replacement therapy.
• TransRescue.org¹⁴⁷ 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 York¹⁴⁸ (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 support to trans residents whose care is under attack at the federal level.
• The Campaign for Southern Equality¹⁴⁹ has a guide specifically for those in the South, documenting health and legal services that are trans-affirming.
• Doctors in Illinois are organizing a rapid response network of providers¹⁵⁰ who can help connect patients who might have lost care recently to doctors who are willing to provide it.