How Gender-Affirming Care Providers Are Preparing for Trump

M.Michael Haller, professor and chief of pediatric endocrinology at the University of Florida, has experience working on threats to gender-affirming healthcare. As Florida’s representative, she advocates for transgender youth gender-affirming care ban New restrictions for transgender people under 18 and for adults are working their way through litigation.

In August, Human Rights Campaign reported that there are 26 states that prohibit or have policies that prohibit gender-affirming care for minors, and that 39% of transgender youth live in states that prohibit gender-affirming care.

For Haller and gender-affirming care providers in states that currently live under restrictive laws like Florida’s, there are some strategies they use because they can’t provide services like hormone therapy to transgender youth.

“We’re trying to find ways for our patients to travel to other states where they can receive care. “That’s the reality of what’s going on for many patients,” Haller says. “But unfortunately, many families and patients don’t have the resources to travel and are stuck in a situation that makes it illegal for them to access healthcare.” They stayed.”

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With President-elect Donald Trump poised to return to the White House, gender-certifying healthcare providers in states across the country are poised to make an impact.

“We are well aware of the hostile views of the incoming Congress and Administration toward LGBTQ+ communities, particularly toward gender-affirming care and our transgender and non-binary communities,” says Wendy Stark, president and CEO of Planned Parenthood Greater New York. “And unfortunately, we recognize that attacks on trans and non-binary people, their lives, their access to healthcare, their access to basic things like bathrooms, will likely continue.”

Here are the key ways gender-affirming healthcare providers can prepare for Trump’s second presidency.

Continue to focus on and understand Trump’s proposals

Trump has made clear that he plans to follow the lead of states that restrict health care for transgender people. The following summary is given on the official website: 20 point platformThe “Making America Great Again” roadmap, called Agenda 47, includes a plan to end minors’ access to gender-affirming care. calls “a plan to stop the chemical, physical and emotional mutilation of youth.”

Some concepts in Trump’s plans are vague; these include calls to “stop all programs that promote the concept of sex and gender transition at all ages”; Others are more specific and are indicative of policies that can actually be implemented, including Trump’s promise on this issue. End Medicaid and Medicare funding for gender-affirming care.

Trump will not have the authority to change access to care entirely on his own.

“It’s important to understand that the type of lawmaking we see in Tennessee and other states across the country is not something the executive branch of the federal government can do unilaterally. The federal government can’t attempt to ban gender-affirming care for minors, but the President can’t do it unilaterally, says Elizabeth Sepper, a health law professor at the University of Texas at Austin.

Still, Trump’s pick for Health and Human Services (HHS) Secretary, Robert F. Kennedy Jr., will likely advance Trump’s plans if confirmed by the Senate. Although much focus has been placed on Kennedy’s skepticism vaccinationsShe also expressed opposition to gender-affirming care.

In a shared post in x (formerly Twitter) In May, Kennedy said he was “problematic” with the practice of “giving puberty blockers to teenagers.”

“People who experience gender dysphoria or want to change their gender deserve compassion and respect, but these extremely important procedures need to be postponed until adulthood,” he wrote. “We must protect our children”

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More importantly, puberty blockers just not used It has been used for decades for transgender children, but not for cisgender children, for children who enter puberty too early, or in some cases, for those who enter puberty too quickly.

Kate Redburn, a Columbia Law School academic and co-director of the Gender and Sexuality Law Center, thinks education about various aspects of transgender health, including puberty blockers, is incredibly important.

“We need to educate a broader range of primary care providers and other professionals about transgender health care because we lack so much knowledge about the health of transgender people,” they say.

Sepper says the ‘elephant in the room’ is his fate Tennessee’s ban on gender transition care for minors—United States of America v. Skrmetti—It was argued before the Supreme Court earlier this month. The decision could have far-reaching implications at a time when nearly half of U.S. states have passed laws limiting access to various aspects of gender-affirming care, such as hormones, puberty-blocking drugs or surgery, potentially changing how Trump’s presidency will impact transgender people. people. with the judges seemingly reluctant to topple Tennessee’s ban could open the door to more states implementing such legislation.

We are working on anti-discrimination legislation

Beyond Medicaid and Medicare, Sepper also points out that Trump, through HHS, may seek to amend Section 1557 non-discrimination regulations under the Affordable Care Act to not cover gender identity, something the Biden Administration is trying to implement. earlier this year.

In some states, efforts to reverse anti-discrimination regulations will likely be met with statewide opposition. New York just witnessed a successful transition ballot initiative Incorporating into the state constitution anti-discrimination protections for diverse people, including members of the transgender community.

Stark says Planned Parenthood New York is prepared to fight for individual rights like these under Trump’s new administration, but is also aware of potential disparities on a state-by-state basis, especially because insurance and programs like Medicaid and Medicare are partially government-funded. .

“This is another example where access to things that people might think are protections for them is really dependent on having resources, so it’s really unfair,” he says.

This could also put a greater strain on endocrinologists and resources in states like New York, while those seeking treatment flock there as transgender people in other states increasingly lack health care.

“There are many endocrinologists who are knowledgeable and experienced in providing transgender care,” says Haller. “When you take away access for trans people who live in states that make care illegal or impractical, those people have to go somewhere. The result is that people in states with protections wait even longer. “This is a significant logistical problem that will only get worse.”

But there are ways paramedics can support themselves as they look for ways to prepare. As Trump and his allies seek to target transgender healthcare, providers also have a responsibility to speak out against it, according to Haller.

“Gender-affirming healthcare providers need to be heard. Haller says they need to be active in the legislative process. “I didn’t go into medicine to be a lobbyist or a legal expert, but I almost had to be both in order to effectively protect my patients.”

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Stay the course and stay together

For many healthcare providers, including Stark and Planned Parenthood, attacks on certain types of healthcare are not new; reproductive rights. Stark plans to “move on” by taking a page from the playbook for abortion care.

Redburn agrees. “Overall, providers can and should continue to do what I think are best practices at this time, which is listening to and consulting with patients, providing the best care they can, and making access to treatments as easy as possible,” they say.

According to Sepper, this also means ensuring providers are protecting their patients and refusing to become part of the policing system if the Trump Administration sues parents who try to help their children access gender-affirming care.

“One thing that providers can do very clearly, and they can do explicitly as a system-wide policy, is to say that they don’t really need to collect some of the information that they may have collected,” says Sepper. “They certainly don’t need to provide health facilities to police and law enforcement.”

For many healthcare providers, part of being prepared means turning to each other for help.

“The important thing for people to remember is that no matter how hard the government tries to provide access to medical care, transgender people are not going anywhere,” Redburn says. “There were trans people who transitioned before there were anti-discrimination laws and medications.”