Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily.
For Khai Devon, fulfilling his longtime goal of finally getting top surgery is as pragmatic as it is aspirational. Devon experiences chronic neck and back pain from having a large chest, and he says that his prominent beard has the effect of immediately outing him to strangers as a trans man. Living in what he describes as a “blood-red” area outside of Tulsa, Oklahoma, he is increasingly terrified of using the men’s restroom in public, going out with friends, or even taking a simple trip to the grocery store. Since President Donald Trump began his second term in late January, Devon has barely left his house at all.
“Have you ever been in a crowd and just felt everybody watching you?” he asks over a phone call. “That is how it feels constantly. It feels like if I don’t shift my shoulders just right, if my shirt pulls the wrong way, or if I don’t pitch my voice low enough, I could be attacked at any moment.”
But Devon’s dreams have been put on hold, indefinitely. His primary care provider approved his referral for top surgery five months ago, but he cannot find a single doctor within reasonable driving distance who will perform the operation. He has been taking time off work to contact surgeons hoping to get an appointment for a consultation, and no one will respond to his phone calls, even for a breast reduction to alleviate his pain. (While much less so than a double mastectomy, a reduction would at least decrease the size of his chest, he notes.) Finding someone to help would be no issue if he were a cisgender woman, but area medical providers are in “wait-and-see mode,” he says, following an executive order from Trump in the second week of his administration, targeting trans health care.
Until someone finally returns his messages, Devon feels trapped in limbo, unable to move forward. “It’s not like I have money to fly to Maine or Pennsylvania, so I will just be waiting forever,” he says.
While Trump’s executive order outwardly targeted gender-affirming medical treatments for patients under the age of 19, Devon—who turns 36 in June—is just one of numerous trans adults who have found their access to care restricted in the directive’s wake. The order has had a chilling effect on medical providers across the U.S.: Children’s hospitals in states like California, Colorado, Illinois, and New York announced that they would be pausing gender-affirming treatments for minors while they weighed the impacts of Trump’s edict. And, as Devon’s story shows, some providers have “over-complied” with the White House’s threat, pausing adult care as well, for fear of losing federal funding.
Estimates from the Kaiser Family Foundation suggest that in 2023 alone, hospitals received $283 billion in Medicaid dollars; the order threatens that health centers will no longer be able to participate in that program if they engage in the “chemical and surgical mutilation of children,” the administration’s preferred dysphemism for trans youth health care. Alex Sheldon, executive director of the LGBTQ+ health advocacy association GLMA, says that the executive order forced providers to make an extremely hard choice: between keeping their doors open and providing trans health care for patients, treating even just one young person.
“The federal administration is essentially bullying hospitals into denying care for one population by potentially denying care for all populations,” Sheldon says. “I honestly cannot imagine the rationale to say, ‘We are no longer going to fund all of your oncology care for young people with cancer. We’re not going to fund your emergency department.’ It’s really unconscionable.”
Although GLMA successfully fought for a temporary injunction against the executive order while a lawsuit proceeds through the courts, some trans people say they are still not able to get their health care needs met — including trans adults, who should ostensibly be unaffected. Everett Palmer, a 25-year-old trans man in South Dakota, is currently subsisting off a six-month supply of testosterone after his medical care provider announced that it would no longer offer gender-affirming care for patients of any age. Because that’s the only provider covered by his insurance plan, Palmer doesn’t have the option to simply go to another doctor, unless he switches to a new insurer. (He says that he has begun looking at alternative plans.)
Were he forced to pay out of pocket, Palmer says that his testosterone would cost him $700 every refill. As prohibitively expensive as that would be, he feels that he has no other choice but to pay it, saying that he wouldn’t be here today if he couldn’t be himself. “I want to stay optimistic because we have to get through this,” Palmer says. “That’s the only way I can view it: We have to get through this. But I question: Where are our allies? We cannot do this by ourselves.”
A De Facto Ban
Other medical providers have also found their ability to meet the needs of trans patients hampered by the Trump administration’s actions. In early February, Trump’s Centers for Disease Control canceled a $1.6 million grant earmarked for the transgender health clinic at St.
John’s Community Health, a nonprofit care center based in Los Angeles. Just days later, a trans adult patient in Georgia reported that a Savannah hospital, Memorial Health, canceled his top surgery in light of White House policy. In a statement, a spokesperson said that the medical center was merely following the required “laws and regulations around age,” even though those restrictions would not actually apply to medical treatments for individuals above the age of majority.
More recently, the Veterans Affairs office announced that its hospitals will no longer cover gender-affirming treatments for former service members, in light of White House policy. “I mean no disrespect to anyone, but VA should not be focused on helping Veterans attempt to change their sex,” said VA Secretary Doug Collins in a statement. “The vast majority of Veterans and Americans agree, and that is why this is the right decision.”
These barriers targeting trans adult health care are not merely the work of federal officials: This year, at least 27 states have introduced legislation that would restrict the ability of people over the age of 18 to medically transition, according to data provided by Trans Legislation Tracker. These states include Arizona, Georgia, Iowa, Montana, North Dakota, Oklahoma, Utah, and Wyoming, many of which have banned Medicaid coverage for transition care at any age. (Ten states already have laws on the books restricting Medicaid funding for trans adult health care.)
Some states have taken their own novel approaches. Since 2023, Missouri Attorney General Andrew Bailey and Republican Ohio Gov. Mike DeWine have attempted to enforce strict regulations making it unnecessarily difficult for all trans people to get gender-affirming medicine, although those policies were later rescinded following threats of lawsuits from civil rights groups. Bailey’s directive required that prior to receiving any form of transition care, trans people undergo 18 months of therapy and have three years of medical documentation demonstrating a gender dysphoria diagnosis. Meanwhile, the American Civil Liberties Union of Ohio described DeWine’s order, which placed severe restrictions on clinics providing necessary health treatments for trans youth and adults, as a “de facto ban.”
As in many matters of anti-LGBTQ+ policy, Florida pioneered the attacks on trans adult care by unveiling a Medicaid ban on gender-affirming care in 2022 and restrictions on telehealth providers and nurse practitioners treating trans patients the following year. While the Medicaid regulations solely targeted minors, the Florida-based care center SPEKTRUM Health projected that the latter regulations would negatively impact 80 percent of all trans patients in the state.
Although the restrictions on telehealth and nurse practitioner care were subsequently enjoined in court, trans adults in Florida have found it difficult to get medications they’ve been prescribed for years. Kristen Browde, a 74-year-old trans woman, says that her insurance provider abruptly denied coverage for her estrogen after questioning why she would need it. Browde has been taking her medication, she notes, for a decade and has never had a previous issue. Riki Thomas (a pseudonym) is a 72-year-old who began her transition in the late 1970s, and she’s begun having her friends act as “estrogen mules” and bring her back hormone pills from other countries, where, she explains they are “cheap” and “you can get them over the counter without a prescription.”
“It’s humiliating to have to do this,” Thomas says. “I’ve been taking hormones now for almost half a century. I have to fight to get a medication that I’ve been taking for nearly 50 years. There’s no point to do this, except to try to harm transgender people and make our lives worse.”
The dispute over trans health care could eventually end up being decided by the Supreme Court, which heard oral arguments in November regarding a case that could decide the legality of state-level bans on transition care for minors. SCOTUS will soon decide whether it will take up the issue of trans adult health care as well: Idaho has appealed to the nation’s highest court to consider a law restricting both Medicaid providers and government-funded care centers from providing gender-affirming treatments. Justices heard briefings on the petition in March.
Idaho’s law has had a dramatic impact on the ability of trans people in the state to get their health care needs met, according to attorney Howard Belodoff. Belodoff, who is representing six trans adult plaintiffs affected by the regulations, says there is one health clinic in all of eastern Idaho that provides gender-affirming care. But as a recipient of government funding, it is no longer permitted to do so.
“They didn’t want to break the law, and the doctors there had to stop providing treatment,” Belodoff says, adding that his clients have experienced extreme depression, anxiety, and suicidal ideation because of the clinic’s closure. “What has happened is that, by definition, Medicaid recipients are low-income, and they don’t have the financial means to pay for their own medications. It’s been a real restriction on some of them who have been unable to get the care, so they’ve had to discontinue their transitions. I have one client who had to leave the state of Idaho so she could get the care she needed.”
The Bigger Goal
While actually procuring gender-affirming care is getting harder by the day, it remains broadly legal for trans adults in the U.S. Kate Steinle, chief medical officer at FOLX Health, says that the LGBTQ+-focused telemedicine provider has continued to operate in the face of intentionally onerous regulations. In order to meet the new requirements, FOLX began renting office spaces across Florida to ensure that care providers would be able to meet with trans patients in person. “The operational costs of providing in-person care has been really high,” Steinle notes, including hiring doctors and medical assistants to staff each location and paying to get them there.
Because FOLX doesn’t receive federal funding, Steinle says the company’s work won’t be impacted by the Trump administration’s directives targeting trans health care. “Nothing in terms of our ability to provide the same type of gender-affirming hormone care and primary care has changed,” she says. “We can still initiate and prescribe medications in all of the states that we were able to before. We are not preemptively complying or over-complying with anything.”
But as right-wing policymakers keep trying to make it harder to access best-practice medicine, it’s ever clearer that for all the hand-waving about “protecting children,” the real goal all along has been to outlaw gender-affirming care for everyone. According to the nonprofit think tank Movement Advancement Project, the share of bills targeting transition care for patients over the age of 18 is growing every single year. Logan Casey, MAP’s director of policy research, says that’s because opponents of LGBTQ+ equality have made it clear that “they believe that this is not health care.” Far-right groups like Alliance Defending Freedom and the American Principles Project, he adds, don’t believe that trans people even exist.
“They believe that, in their own words, there are only two sexes, and those are immutable and unchangeable,” he says. “They’re saying this is part of God’s design for [humanity] and also for America, specifically. They want to prevent access to this care, regardless of age, so as to create or protect, in their minds, a Christian nation.”
Having moved back to Missouri to be near his mother, who has had cancer twice, Casey has had a front-row seat to the assault on his very existence. When his home state temporarily issued emergency regulations banning the health care that has made his life possible, he was forced to contemplate an impossible question: Does he stay and spend this time with his family? Or does he have to leave in order to go somewhere safer, where he can get the medical treatments that he needs? Many trans people, all across the U.S., are currently being forced to ask themselves the same and finding there are no easy answers.
Casey, though, takes solace in knowing that Missouri’s trans health care ban was ultimately defeated—noting that 92 percent of all anti-LGBTQ+ proposals over the past 15 years have been, too. “Even in the face of these unprecedented attacks, we still continue to win way more often than we lose,” he says. “Even in the cases where we lose, that’s still not the end. We will fight with lawsuits. We will fight with protests. We will fight by talking to our elected officials. We’ll also fight by taking care of each other.”
link