Michael Haller, a professor and chief of pediatric endocrinology at the University of Florida, has experience in working around threats to gender-affirming health care. He has been advocating for trans youth as Florida’s ban on gender-affirming care for transgender people under 18 and its new restrictions for adults makes its way through litigation.
In August, the Human Rights Campaign reported there were 26 states with a ban or policy against gender-affirming care for minors and that 39% of transgender youth lived in states that have passed bans on gender-affirming care.
For Haller and those gender-affirming care providers in states that are already living under restrictive laws like Florida’s, there are certain strategies they use now that they are unable to provide services like hormone therapy to their transgender youth.
“We are working to try to find ways for our patients to go to other states where they can get care. That’s just the reality of what’s happening for many patients,” Haller says. “But sadly many families and patients just don’t have the resources to travel and are stuck in a state that makes it illegal for them to access health care.”
With President-elect Donald Trump poised to return to the White House, gender-affirming health care providers in states across the country are bracing for impact.
“We’re very well aware of the incoming Congress and Administration’s hostile views of LGBTQ+ communities, and specifically about gender-affirming care and our trans and non-binary communities,” says Wendy Stark, president and CEO of Planned Parenthood Greater New York. “And so we unfortunately are aware that attacks on transgender and non-binary people, their lives, their health care, their access to basic things like bathrooms will likely continue.”
Here are the key ways gender-affirming health care providers are preparing for Trump’s second presidency.
Maintaining a focus and understanding of Trump’s proposals
Trump has made it clear he plans to follow the lead of the states who have restricted transgender health care. On his official website, he outlines a 20-point platform, his roadmap to “Make America Great Again,” called Agenda 47, which includes his plan to end access to gender-affirming care for minors, which he calls his “plan to stop the chemical, physical, and emotional mutilation of youth.”
Some of the concepts in Trump’s plans are vague, including calls to “cease all programs that promote the concept of sex and gender transition at any age,” while others are more specific and indicative of policies that could be genuinely implemented, including his pledge to end Medicaid and Medicare funding for gender-affirming care.
Trump will not have the power to fully shift access to care on his own.
“It’s important to understand that the kind of lawmaking that we’ve seen in Tennessee and other states across the country, that’s not something that the executive branch of the federal government is going to be able to do unilaterally, which is not to say that the federal government couldn’t attempt to ban gender-affirming care for minors, but rather that the President cannot do it unilaterally,” says Elizabeth Sepper, professor of health law at the University of Texas in Austin.
Still, Robert F. Kennedy Jr.—Trump’s pick for Secretary of Health and Human Services (HHS)— is likely to further Trump’s plans, if he’s confirmed by the Senate. Though there has been much focus on Kennedy’s skepticism to vaccines, he has also expressed opposition to gender-affirming care.
In a post shared on X (formerly Twitter) in May, Kennedy said he was “troubled” by the practice of “giving puberty blockers to youth.”
“People with gender dysphoria or who want to change their gender deserve compassion and respect, but these terribly consequential procedures should be deferred till adulthood,” he wrote. “We must protect our children.”
Importantly, puberty blockers are not just used for transgender children, but have been used for cisgender children for decades for children going through puberty too early, or, in some instances, those who are going through puberty very quickly.
Kate Redburn, academic fellow at Columbia Law School and co-director of their The Center for Gender and Sexuality Law, sees education on aspects of transgender health, including puberty blockers, as of incredibly important.
“We should be educating a wider array of primary care providers and other specialists in trans health care, because we just have such a dearth of information about trans people’s health,” they say.
The “elephant in the room,” Sepper says, is the fate of Tennessee’s ban on gender transition care for minors—United States v. Skrmetti—which was argued in front of the Supreme Court earlier this month. The decision could have wide-ranging impacts at a time where almost half of U.S. states have enacted laws to limit access to various aspects of gender-affirming care, like hormones, puberty-blocking drugs or surgery, potentially shifting how Trump’s presidency will affect transgender people. With the judges seemingly reluctant to overturn Tennessee’s ban, it may well open the door for more states to implement such legislation.
Working on anti-discrimination legislation
Beyond Medicaid and Medicare, Sepper also points out that through HHS, Trump could work to change Section 1557 non-discrimination regulations under the Affordable Care Act so that they do not encompass gender identity, something the Biden Administration worked to implement earlier this year.
For certain states, works to reverse anti-discrimination regulations will likely be met with state-wide opposition. New York just saw the successful passage of a ballot initiative which enshrines anti-discrimination protections for various people—including transgender community members—into the state constitution.
Stark says that Planned Parenthood New York is prepared to fight for individual rights like these under Trump’s new Administration, but are also aware of the inequities possible state-by-state, especially as insurance and programs like Medicaid and Medicare are also partially state-funded.
“It’s sort of another example where the access to things that people might feel are protections for them are really dependent on having the resources, so it’s a really inequitable situation,” she says.
This could also further burden endocrinologists and resources in states like New York, while those seeking treatment flock there as health care becomes less and less available to transgender folks in other states.
“There are only so many endocrinologists who are knowledgeable and experienced in providing trans care,” Haller says. “When you eliminate access for trans people who live in states that have made care illegal or impractical, those folks have to go somewhere. The result is even longer waits for folks in states that do have protection. It’s a significant logistical problem that is only going to get worse.”
However, in looking for ways to prepare, there are ways health care officials can bolster themselves. According to Haller, as Trump and his allies attempt to target transgender health care, providers have a responsibility to speak up against it.
“Gender-affirming health care providers need to be vocal. They need to be active in the legislative process,” Haller says. “I didn’t go into medicine to become a lobbyist or a legal expert, but I’ve almost had to become both of those things so that I can effectively protect my patients.”
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Stay the course and stick together
For many health care providers, including Stark and Planned Parenthood, attacks on certain types of health care are not new, as they have also fought for reproductive rights. In taking a page from the playbook for abortion care, Stark plans to “keep on keeping on.”
Redburn, agrees. “In general, providers can and should continue to do what I think are best practices now, which is listening to the patients and in consultation with the patients, providing the best care they can, and making it as easy as possible to access treatments that are considered necessary,” they say.
According to Sepper, this also means providers making sure to protect their patients, and refusing to be a part of a policing system should the Trump Administration work to litigate parents who attempt to help their children access gender-affirming care.
“Something that providers very clearly can do, and can clearly do as a matter of system-wide policy, is to say they don’t really need to be collecting some of the information that they may have been collecting,” Sepper says. “They certainly don’t need to be offering up health care facilities to police and law enforcement efforts.”
For many health care providers, part of being prepared means looking to one another for aid.
“The important thing for people to remember is that no matter how hard the government tries to make it to access medical care, trans people aren’t going anywhere,” says Redburn. “There were trans people transitioning before there were any anti discrimination laws and medicine.”
