President-elect Donald Trump made attacks on transgender people a cornerstone issue of the election. His campaign and conservative groups spent tens of millions of dollars on anti-trans advertisements. He called gender-affirming care provided to young trans people “left-wing gender insanity” and “child abuse,” and falsely claimed at a rallies and events that kids are getting gender-affirming surgery in schools.
Now, as Trump gets ready to return to the White House, gender-affirming care providers are preparing for an administration that could upend evidence-based standards of care for trans people.
While it’s hard to predict what policies the Trump administration will pursue, his platform included a pledge to stop all federal funding of gender-affirming care and to expel from Medicare and Medicaid any hospitals that provide the care to minors. Trump has also said that he’ll ask Congress to create legislation recognizing only two genders — male and female — assigned at birth.
“I think we have to take the Trump administration’s platform at its word,” said Meredithe McNamara, an assistant professor of pediatrics at Yale who also sees patients at a local community health center. “It’s a professional responsibility to be incredibly realistic about what it’s going to look like if our patients are continually put in political crosshairs.”
Early Wednesday morning, McNamara had already begun receiving messages from young patients who were worried about their access to care for gender incongruence. The Trevor Project, a suicide prevention organization for LGBTQ+ young people, told STAT that the number of calls, chats, and texts to its crisis line rose nearly 700% on the day after the election, as compared to the weeks beforehand. Many people in crisis directly referenced the election results.
FOLX, a telehealth platform for queer people, saw a 75% increase in messages to its care team the day after the election, as people reached out with questions about refills and anxiety about their future access to care. The company also reported a 115% increase in messages to its community platform.
Before Trump takes office in January, providers and hospital systems need to improve patient privacy policies, conduct medical legal training, and prepare to work with legal experts who understand the nuances of bans on care, McNamara said. Even those who work and live in states with progressive policies shouldn’t presume they’ll always be able to continue providing care without interference, she noted. Some states have passed “shield laws” to protect both patients and providers from being persecuted by restrictive states. But there’s yet to be a legal contest testing the strength of those laws, McNamara said.
“Very solid blue states are not going anywhere,” said Kate Steinle, FOLX’s chief clinical officer. “They’re going to fight even harder.”
FOLX has already been tested on its ability to offer trans health care in restrictive states. In Florida, recent legislation requires gender-affirming hormones for adults to be prescribed in-person by a physician. When the law went into effect, FOLX opened in-person clinics in five Florida cities, after previously having no physical locations in the state. The company then saw a surge of sign-ups from trans people who lost access to their previous providers because they were non-physicians or telehealth prescribers. That growth offset the costs of setting up in-person clinics, Steinle said.
“We don’t want to have to do this state by state, but we will if we need to,” Steinle said. “We are going to follow all the rules in [restrictive] states.”
Some providers are thinking differently about how to provide care in the next era.
“Collective resistance is the best solution,” said Crystal Beal, a physician and founder of QueerDoc, which provides telemedicine care to queer people in 10 states. They hope that the medical profession as a whole can come together to support gender-affirming care and resist bans on evidence-based care through civil disobedience. “Organized resistance is what allows individual support to make a scary decision. It is scary to break a law. It’s scary to risk losing your life and it’s scary to risk how you pay your mortgage.”
A common refrain for trans communities facing discrimination is that trans people have existed forever. That doesn’t change with a new government.
“Since 1969, we have adapted and persevered through every shift in the political landscape to ensure our communities receive the life-saving, affirming care they deserve,” Patrick McGovern, the CEO of Callen-Lorde, an LGBTQ+ community health center in New York, said in a statement. “Our mission does not change with the political winds.”