Transgender Healthcare

Millions of people in the United States rely on the federal government to fund, support, or provide healthcare, including gender-affirming care. These services have been targeted by those who wish 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. While many of these attacks have been deemed illegal by the courts, healthcare providers across the country are still cutting care and resources out of fear of being targeted by the federal government.

What do I need to know about transgender healthcare?

Over 2.8 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 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, Congress, and the Supreme Court are using the power of the executive, legislative, and judicial branches to:

• Restrict coverage for gender-affirming care by attempting to block 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

• 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: October 2, 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 make it harder for people to buy Affordable Care Act (ACA, also known as Obamacare) marketplace healthcare plans that cover gender-affirming care in two main ways:

• In March, the Centers for Medicare and Medicaid Services (CMS) proposed a change³⁴ to the ACA that would prohibit states from mandating coverage for gender-affirming care — such as puberty blockers, hormone treatments, and surgery — as an essential health benefit (EHB). That means that those plans would no longer be legally required to cover it.
• In May and June, the legislature attempted to include similar changes to the ACA in their budget reconciliation bill.³⁵ The early version of the budget bill also included an attempt to block the federal government from matching funds³⁶ for “gender transition procedures” for people of all ages enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
• In August, the Republican-controlled House passed a series of appropriations bills³⁷ that included a complete ban on federal funding for any kind of gender-affirming care for transgender patients (regardless of their age). The bills also included³⁸ a ban on funding gender-affirming care in any “federally owned, leased, or used facilities” which would impact prisoners, veterans, and active duty military members.

Where this stands

The US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) announced on June 17, 2025³⁹ that it was ending funding for the LGBTQ+ specialized services piece of a suicide prevention hotline. The hotline has been used over 16 million times,⁴⁰ 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.)

The proposed CMS changes were finalized on June 20, 2025⁴¹ and will go into effect in 2026. Once in effect, these new rules will make it harder⁴² and more expensive⁴³ to access gender-affirming care.

The first attempt at including a ban on federal funding for gender-affirming care using a budgetary process failed in July, when a ban was ruled outside the scope of a reconciliation bill⁴⁴ and cut from the final text.

Right now, a different federal budgeting process is playing out with a similar attempt at a ban on healthcare. The current House versions of several appropriations bills would end insurance coverage of gender-affirming care⁴⁵ for people enrolled in Medicare, Medicaid, or Children’s Health Insurance Program (CHIP). Another appropriations bill would end gender-affirming care for trans veterans, active duty military members and their families, or prisoners at any government-owned facility.⁴⁶ The Senate versions of the various appropriation bills⁴⁷ do not include the various gender-affirming care bans.

In late September, the House and the Senate were debating a bill to extend federal funding⁴⁸ for a few weeks while lawmakers try to come to some kind of agreement about those appropriation bills. That extension bill has no provisions in it that impact gender-affirming healthcare. Right now, the government is shut down⁴⁹ because Congress could not reach agreement on a spending bill.

Who this affects

In 2023, more than 23 million people⁵⁰ 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 more⁵¹ for their care or coverage. Prior to 2025, 24 states and the District of Columbia⁵² 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 portion⁵³ of the coverage offered to their residents.

Countermoves

• There are many countermoves underway aiming to reduce the negative impact of the summer federal budget bill and the cuts to Medicaid; you’ll find a selection of them on our Medicaid page.
• Rhode Island announced⁵⁴ 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: October 2, 2025

Through two executive⁵⁵ orders⁵⁶ 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 prosecute⁵⁷ care providers and the manufacturers and distributors of hormones used in gender-affirming hormone therapy.
• Sending more than twenty subpoenas from the Department of Justice⁵⁸ to doctors and clinics who provide gender-affirming care to youth, at least one of which demanded⁵⁹ confidential patient records and contact details, personnel files, and doctor-patient communications.
• Threatening to eliminate hospitals’ eligibility to receive Medicare and Medicaid reimbursements⁶⁰ not only for their transgender patients, but for all their patients, by altering the Conditions for Participation in Medicare and Medicaid.
• Encouraging people to report clinics⁶¹ providing gender-affirming care to the FBI Tip Line.
• Using Medicare and Medicaid’s clinical-abuse assessments and mandatory drug reviews⁶² to target providers of gender-affirming care.
• Creating financial hardship for employees of targeted hospitals by stripping them of eligibility⁶³ for Public Service Loan Forgiveness.⁶⁴
• Hosting a Federal Trade Commission workshop called “The Dangers of ‘Gender-Affirming Care’ for Minors”⁶⁵ that cast gender-affirming care for minors as “unfair or deceptive trade practices.” During the workshop, the new FTC Chair reiterated his promises to weaponize the FTC (PDF)⁶⁶ against “doctors, therapists, hospitals, and others” who provide gender-affirming care to children and adults.

Where this stands

The status of some threats is unclear. For example, the Public Service Loan Forgiveness program has not yet changed its eligibility⁶⁷ requirements, but we don’t know if those changes are underway. Similarly, we haven’t seen any reports of prosecution proceeding against manufacturers, distributors, or providers over their use of puberty-pausing medications or hormones in gender-affirming care. And we don’t know how many doctors or clinics complied with the DOJ subpoenas. In early September a federal judge ruled⁶⁸ that the subpoena issued to Boston Children’s Hospital was too broad and that the hospital did not have to answer to it.

Immediately after Trump’s Executive Orders were signed, several healthcare providers and insurance companies began pulling back on gender-affirming care, and across the country many have continued to do so in the wake of additional threats from the DOJ and FTC. All told, more than twenty clinics⁶⁹ across the country have discontinued providing some or all gender-affirming care.

There have been a handful of challenges to the administration’s attempts to push care providers to give up on care. In March, a federal judge extended a ruling⁷⁰ preventing the administration from withholding federal research and education grants to healthcare providers. Since that ruling, some clinics have resumed care,⁷¹ but nowhere near all. In August, a coalition of 17 states filed a lawsuit against the Trump administration⁷² over its efforts to destroy access to gender-affirming care for youth. There is no ruling yet on this case.

In a move that does not change federal policy, but does inform our understanding of this issue, in June, the Supreme Court upheld a Tennessee state law⁷³ 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

• As noted above, states like Washington,⁷⁴ and civil rights organizations like the American Civil Liberties Union⁷⁵ 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),⁷⁶ California,⁷⁷ and Michigan⁷⁸ 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 care⁷⁹ despite the administration’s actions.
• In March, the National Indian Health Board passed a resolution (PDF)⁸⁰ asserting their tribal sovereignty over healthcare, and their support for gender-affirming care.
• Several 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, including University of Pittsburgh Medical Center,⁸¹ Corewell Health in Michigan,⁸² Children’s Hospital Los Angeles,⁸³ Stanford,⁸⁴ and Kaiser Permanente.⁸⁵ In Michigan, Corewell Health restored gender-affirming care⁸⁶ in response to the pushback.
• In July, Boston Children’s Hospital issued a statement saying it would not be pressured into cutting gender-affirming care.⁸⁷
• Doctors in Illinois are organizing a rapid response network of providers⁸⁸ who can help connect patients who might have lost care recently to doctors who are willing to provide it.
• One hundred and forty-nine employees at the FTC signed a letter⁸⁹ protesting the commission’s anti-trans workshop, saying that it oversteps the agency’s role and “would chart new territory for the Commission by prying into confidential doctor-patient consultations.”
• Illinois launched IL Pride Connect,⁹⁰ a statewide resource hub and legal hotline offering support to LGBTQ+ people across the state.

Attack: Defunding and manipulating medical research about transgender people

Last updated: August 7, 2025

The Trump administration has attempted to defund, erase, alter, and discredit medical research about transgender and intersex people in order to further their inaccurate and harmful policies.

Defund
As part of a much larger attack on research grants, the National Institutes of Health (NIH) has specifically targeted research on transgender healthcare⁹¹ for being a form of “woke DEI ideology.” It is extremely hard to get an accurate picture of how many grants have been cancelled at any given time, but some analyses suggest that about a quarter of the terminated NIH grants were related to trans health,⁹² totaling over $125 million in research funding.⁹³ Of the clinical trials cancelled, 42% mentioned LGBTQ+ populations (PDF).⁹⁴ (For more on grant terminations generally, see our Medical Research page.)

Alter, Erase, Discredit
The administration has also attempted to manipulate existing information about transgender healthcare by:

• Directing the National Institutes of Health⁹⁵ to research negative effects of transition, transition regret, and detransition rates among children and adults and ignoring the results of studies commissioned⁹⁶ by Republicans that conclude that gender-affirming care helps trans youth.
• Ordering all agencies, through an executive order,⁹⁷ 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 executive order commissioned a 400 page report⁹⁸ by anonymous contributors on treating gender dysphoria in children, which has been denounced as disinformation by many⁹⁹ medical¹⁰⁰ organizations¹⁰¹ since its publication.
• Removing websites relating to sexual health and LGBTQ+ health, which were restored 2 weeks later following a federal judge’s orders (PDF).¹⁰²
• Stopping the collection of transgender identity data¹⁰³ in the Centers for Disease Control’s public health data starting in late February 2025. This exacerbates the existing lack of data on health conditions for trans and nonbinary people in the US.

Where this stands

Several judges have ruled that both the funding freezes and research cuts, and the destruction of government webpages and data, were not legal (see below for a more detailed breakdown of cases). Some projects have had their funding restored,¹⁰⁴ but not all. In many cases, funding remains in limbo as the administration fights and appeals injunctions in court. Most of the affected websites seem to be back — although often with disclaimers¹⁰⁵ saying “This page does not reflect biological reality and therefore the Administration and this Department rejects it.”

The administration continues to push its discredited research and framing of gender-affirming care as fraudulent and dangerous at every opportunity. Many of the attacks in other sections of this page include citations to the flawed and biased research described above.

And, as we covered above in the section about coercion of healthcare providers, the threat of funding cuts has been used to pressure hospitals to stop providing gender-affirming care, in order to protect their NIH funds from being cut.

Countermoves: Legal & judicial challenges

• In February, Doctors for America sued¹⁰⁶ several government organizations including the CDC, FDA and HHS over the removal of health information from federal websites. A judge ordered the agencies to restore those sites.¹⁰⁷
• Also in February, Washington, Oregon, Minnesota and Colorado banded together and sued the Trump administration¹⁰⁸ for revoking research and education grants to hospitals based on their provision of gender-affirming care. In March, a judge ruled in favor of the states,¹⁰⁹ blocking the administration from withholding federal funds purely because a clinic provides care for trans people.
• In April, the American Public Health Association filed suit against the National Institutes of Health,¹¹⁰ arguing that the organization’s grant cancellations were unlawful. A judge in Massachusetts agreed and ordered that the grants be restored, and in June the NIH began reinstating around 900 grants.¹¹¹
• Also in April, sixteen states sued the Department of Health and Human Services (DHS) over NIH grant terminations, on the same grounds. The same Massachusetts judge ruled in favor of the states,¹¹² saying the move to cut funding “represents racial discrimination and discrimination against America’s LGBTQ community.”

Countermoves: Data archiving and community responses

• Several groups and organizations have worked to backup datasets¹¹³ and websites¹¹⁴ related to gender-affirming care at risk of deletion or alteration by the Trump Administration.
• Multiple professional organizations in the medical world have come out with statements rejecting the Trump administration’s narrative around transgender healthcare, including the American Academy of Pediatrics,¹¹⁵ The American College of Nurse-Midwives,¹¹⁶ and the Oregon Pediatric Society.¹¹⁷
• In June, after the Supreme Court issued its Skrmetti decision, a group of seven large medical associations, including the American College of Physicians and the Endocrine Society issued a joint statement¹¹⁸ expressing disappointment and saying that “Health care professionals must be able to rely on their training, education, and expertise to provide appropriate care based on the needs and values of each patient and their family, without bans or interference.”

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

Last updated: October 2, 2025

Two of the White House’s executive¹¹⁹ orders¹²⁰ 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: In January, the Office of Personnel Management released guidance (PDF)¹²¹ to health insurance providers for federal workers,¹²² 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. In August 2025, OPM released a follow-up (PDF)¹²³ instructing carriers to drop coverage for gender-affirming care for trans adults as well.
• Military service members: The Department of Defense issued a memo¹²⁴ blocking service members from receiving new gender-affirming care, despite federal court judges previously finding the restrictions unconstitutional.¹²⁵ This runs alongside the administration’s efforts to remove transgender service members¹²⁶ from the US armed forces.
• Veterans: The Department of Veterans Affairs has rescinded standards¹²⁷ for dignified care¹²⁸ for trans and gender-nonconforming veterans and issued new policies¹²⁹ 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 care¹³⁰ for trans people incarcerated in federal prisons.

Who this affects

These changes will restrict or block gender-affirming care for around 17,000 transgender¹³¹ federal and postal service employees (and countless more dependents thereof), thousands¹³² of transgender service members, more than 160,000¹³³ transgender veterans, and thousands¹³⁴ 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.¹³⁵

Several cases¹³⁶ have been brought against the federal government around its attempt to exclude trans people from serving in the military (an exclusion that removes them from their healthcare)¹³⁷. In May, the Supreme Court allowed the Trump administration to move forward with its ban, pending further legal challenges. Those are moving along, but it’s not clear when they might be decided.

In June, a transgender veteran filed suit against the VA¹³⁸ for dropping coverage for hormone replacement therapy. In early September, three families filed a lawsuit¹³⁹ against the Pentagon for cutting off gender-affirming care for military dependents. These cases are still working their way through the courts.

Also in June, a federal judge issued a preliminary injunction ordering the Bureau of Prisons to resume providing hormone therapy to all transgender inmates.¹⁴⁰ This builds on three other temporary restraining orders¹⁴¹ 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,¹⁴² Kentucky,¹⁴³ and Utah.¹⁴⁴

Broad countermoves: Community resilience & safety work

• Trans Lifeline¹⁴⁵ and LGBT National Youth Talkline¹⁴⁶ are confidential peer support phone services.
• Point of Pride¹⁴⁷ is offering financial assistance for gender-affirming care and free shapewear to trans people.
• Black and Pink¹⁴⁸ 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 project¹⁴⁹ 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 Pride¹⁵⁰ is an organization that offers community support, services, and mentorship to trans military members.
• The DIY HRT Directory¹⁵¹ is a frequently updated and deeply-researched informational resource about safely accessing hormone replacement therapy.
• TransRescue.org¹⁵² 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 York¹⁵³ (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 Equality¹⁵⁴ has a guide specifically for those in the South, documenting health and legal services that are trans-affirming.