Gender-Affirming Care in Trump’s America

Content warning: This article mentions suicide.
In the first days of Donald Trump’s second term as United States president, he signed 2 executive orders that carry significant, immediate implications for patients who are lesbian, gay, bisexual, transgender, queer or questioning, and more (LGBTQ+). Experts have also voiced grave concerns about the long-term effects of these actions on health care and the fields of science and medicine at large.
Executive Orders Affecting Gender-Affirming Care
“The executive order most directly affecting gender-affirming care is the one that directly attempts to shut down gender-affirming medical care for transgender people under the age of 19,” said Hyun-Hee Kim, MD, instructor of psychiatry at Massachusetts General Hospital and Harvard Medical School in Boston and co-author of a recent paper on protecting and advancing gender-affirming care in the current sociopolitical environment.1,2
“The other major executive orders affecting LGBTQ+ people are the ones mandating recognition of only 2 sexes — whichever one you happened to be ‘at conception’ —ending all diversity, equity, and inclusion (DEI) programs,” Dr Kim continued.4,5 “The first executive order demands cessation of the provision of gender-affirming care to transgender people who are incarcerated and even demands that transgender people be placed in facilities not matching their affirmed gender but rather their sex assigned at birth.” In early February, a US judge issued a ruling temporarily blocking the Trump administration from implementing these demands.6
According to Arjee Restar, PhD, MPH, a social and legal epidemiologist at the Yale University School of Public Health in New Haven, Connecticut, and co-author of a 2024 paper on the state of transgender health care and policy, the executive order mandating the recognition of only 2 sexes is a “pseudo-definition of sex that disregards scientific and medical consensus.” This order also instructed federal agencies to rescind all guidance documents that are inconsistent with the requirements of the order.4
Subsequently, “Many government organization websites removed information relevant to LGBTQ+ people, as well as information about reproductive health care, HIV, and STI treatment guidelines,” which clinicians and researchers often reference in providing care to LGBTQ+ patients, Dr Kim said.
Federal health agencies including the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) restored some of the initially deleted information after a US District Judge issued a temporary restraining order (requested by the advocacy group Doctors for America) requiring that the agencies restore the missing webpages and datasets.7,8
The current administration has also “made executive moves to defund LGBTQ+ and HIV research, cutting crucial funding streams for studies on HIV prevention and treatment,” which would have the greatest impact on “populations disproportionately affected by the virus, such as transgender women and men who have sex with men,” according to Harry Barbee, PhD, assistant professor in the Department of Health, Behavior, and Society in the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, Maryland.9
“These cuts, coupled with previous rollbacks of nondiscrimination protections under Section 1557 of the Affordable Care Act (ACA), have increased the barriers to care for LGBTQ+ patients,” Dr Barbee added.10 “Furthermore, restrictions on gender-affirming treatments — such as hormone therapy and puberty blockers — have been encouraged at the state level, creating a chilling effect on providers who may fear legal or professional repercussions.”
The executive orders issued in the second term of the Trump administration “also impose discriminatory restrictions on gender-affirming care, including the Congressionally unauthorized withholding of federal funds from institutions and clinics, particularly those that receive Medicare and Medicaid and provide such care or carry out gender-specific services,” Dr Restar explained.11
“
The attack on science will severely impact the options that will be clinically available in terms of future therapies, and a generation of scientists may very well abandon the field given the increasing barriers, as it is already incredibly difficult to be successful as a scientist in the US.
Health Care Impact of Anti-LGBTQ+ Measures
Dr Restar emphasized that the potential impact of the Trump administration’s executive orders is not limited to LGBTQ+ individuals but threatens the well-being of all Americans. “Instead of fostering a healthier society and strengthening the health care workforce, these orders simply aim to provoke chaos and dismantle the very infrastructure and resources needed to care for all communities, including those in rural America who rely on federal resources to function,” she said.
These executive orders “conflict with extant law, threaten Congressional authority, challenge the balance of power, and dehumanize the majority of people who live in the US,” according to Mandi Pratt-Chapman, PhD, associate professor of medicine at the School of Medicine and Health Sciences at George Washington University in Washington, DC, and associate center director of Patient-Centered Initiatives and Health Equity for the GW Cancer Center.
“The stakes are very high — if Congress and the Supreme Court relinquish their constitutional powers, our nation will be moving in a non-democratic direction and will no longer have a balance of powers between the executive, legislative, and judicial branches,” Dr Pratt-Chapman continued. “This is very dangerous for free speech, free elections, and freedom generally.”
The resulting freeze on some funding streams has had an alarming impact on research that was underway before Trump’s second term began. “Pausing clinical trials left real patients stranded with medical devices inside of them and without access to trials with very regimented cadences for hypothesis testing,” Dr Pratt-Chapman said.12 “And pausing science that relies on consistent timeframes to test hypotheses renders the data collected up to the point of the pause virtually meaningless.”
Pausing and interfering with the flow of grant funding results in dismissal of staff, and significant resources for retraining staff would be needed if the experiment is ultimately allowed to resume. “For an administration that claims to value efficiency, this is a waste of resources and extremely inefficient, as is the intentional creation of confusion and chaos at the National Institutes of Health and CDC and in scientific labs,” Dr Pratt-Chapman stated. “Allowing scientists to complete their work would be exponentially more efficient.”
Dr Pratt-Chapman is among the scientists whose work has been affected by the Trump administration’s actions. “My study was canceled as a result of Trump’s executive order, ‘Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,’ which was issued on January 20, 2025,” she shared.4 “In issuing this order, President Trump breaks with the law established by the Supreme Court in Bostock v. Clayton County (2020), which explicitly defined sexual discrimination as including discrimination related to gender identity and sexual orientation.”13
Accordingly, the executive orders “actively endorse such discrimination and place providers and health care systems in a corner to comply with discriminatory practices that keep communities unsafe and unhealthy,” Dr Restar noted.
Dr Pratt-Chapman said that the termination of research aimed at improving the health of LGBTQ+ individuals represents a sweeping reversal of progress that health care providers and scientists have painstakingly strived to achieve.
“We have worked for decades to build trust and improve the safety and accuracy of asking patients and research participants about sexual orientation and gender identity,” she explained. “These Executive Orders have intentionally created fear and mistrust and set us back significantly in our efforts to improve the health of LGBTQ+ people,” and banning the collection of data on sexual orientation and gender identity “makes it impossible to build the evidence base to improve and tailor care” for these populations.
Clinician Education and Advocacy Needed
The experts interviewed for this article emphasized the need for clinicians to educate themselves about gender-affirming care and to advocate for the right to provide and for patients to receive such care. “Gender-affirming care is lifesaving, medically necessary care for people who want and need it. It is not experimental. It is not mutilation,” Dr Kim stated.
Dr Restar added that gender-affirming care encompasses much more than hormones and surgeries and is “not a niche or an isolated specialty but an essential component of comprehensive, evidence-based health care that is integrated in all aspects of medicine — including primary care, behavioral health, mental health, cancer care, cardiovascular care, and more.”
Dr Kim noted that the field of gender-affirming care in the US has been in existence for many decades.14 “While we are always learning and gathering more longitudinal data, the overwhelming evidence shows that gender-affirming care is safe and effective and that people’s lives improve significantly with it.”15 Clinicians can explore a range of educational resources, such as those provided by the Fenway Institute, to learn more about gender-affirming care and ways to support their LGBTQ+ patients.
Dr Barbee suggested that clinicians engage with professional organizations such as the Endocrine Society and the World Professional Association for Transgender Health (WPATH) to follow updates regarding federal and state policy changes that affect LGBTQ+ health care, and if necessary, consult legal and advocacy organizations to familiarize themselves with legal protections and potential risks.
Regarding responses by medical associations to the Trump administration’s recent actions, the American College of Physicians has published a statement reaffirming their commitment to equity, opposing discrimination of all types, and acknowledging the patient harms caused by disparities in gender identity, sexual orientation, and other aspects of identity.16 Meanwhile, the American Medical Association and the American Academy of Pediatrics have remained silent on these issues to date.
“Within healthcare institutions, clinicians can advocate for comprehensive nondiscrimination policies and support continued access to gender-affirming treatments,” Dr Barbee said. “Given the significant stress and marginalization that LGBTQ+ patients face, integrating mental health support and connecting patients with affirming community resources can further enhance their overall well-being.”
Along with efforts by health care workers to provide and protect gender-affirming care, Dr Kim says that institutions should support clinicians in these endeavors and ensure the continued provision of this life-saving care. “Preemptively shutting down or curtailing gender-affirming care does incredible harm to an already vulnerable community of patients and their families and irreversibly damages the institution’s credibility.”
Dr Pratt-Chapman recommends that health care providers contact their legislators and use their voice to advocate for ethical, humane, and medically sound health care. “The attack on science will severely impact the options that will be clinically available in terms of future therapies, and a generation of scientists may very well abandon the field given the increasing barriers, as it is already incredibly difficult to be successful as a scientist in the US.”
She also advised, “Protect your patients and let them know that you see them, care about them, and will continue to provide them with the highest standard of care possible regardless of sexual orientation or gender identity.”
Patient Resources
Dr Barbee cited various ongoing efforts to counter the recent anti-LGBTQ+ initiatives, including lawsuits by civil rights organizations such as the American Civil Liberties Union and Lambda Legal on behalf of the families of transgender children.17
On the clinical level, “As certain states impose bans on gender-affirming care, the expansion of telehealth services and interstate care networks has become increasingly important to ensure continuity of care for patients seeking treatment across state lines,” Dr Barbee said.
“Beyond policy and clinical care, it is crucial to recognize the broader impact that anti-LGBTQ+ measures and rhetoric have on public health,” Dr Barbee continued. “Increased stigma and discrimination contribute to higher rates of anxiety, depression, and suicidality among LGBTQ+ individuals, reinforcing the urgent need for affirming and supportive healthcare environments.”18-21
Dr Kim mentioned several organizations “doing important survival work” that physicians can recommend to patients, including the Trans LifeLine, the Trevor Project, and local LGBTQ+ community organizations and mutual aid groups across the country.
If you or someone you know is struggling or in crisis, help is available. Please call, text, or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.
link