While the legislative fight over transgender care has been largely limited to states to date, a spate of campaign ads from Republicans and worried trans advocates both indicate that could change if Republicans take control of Congress and the White House.
Even as GOP presidential nominee Donald Trump has focused, particularly in the final weeks of his campaign, on limiting gender-affirming care for transgender people, top Republican senators have launched inquiries into the legitimacy of the use of puberty blockers for minors.
And in December, the Supreme Court will hear arguments in a landmark case that could determine the fate of access to gender-affirming care for children.
Democrats, lawyers and LGBTQ+ advocacy groups say the federal focus on transgender care is a marked shift from the past, when most policies impacting transgender individuals were approved at the state level.
Twenty-six states have passed legislation banning gender-affirming care for minors up to age 18, according to the Human Rights Campaign. But no such ban exists on the federal level. Republicans have attempted to add policy riders to major spending bills to limit transgender health care access in recent years, but Democrats have blocked them.
A GOP-led Congress in 2025 could change that.
“We’re going to see attempts made to impact trans people’s ability to access health care at both the federal and state levels going forward,” Olivia Hunt, policy director at Advocates for Trans Equality, said of a potential GOP Congress and White House in 2025.
In the lead-up to the election, the Trump campaign is blanketing the southern half of the U.S. on NFL Sundays with ads claiming “Kamala is for they/them, Trump is for you.” The ads also claim Harris supports taxpayer-funded sex change surgeries on transgender inmates — a policy that was actually included in budget documents from the first Trump administration.
The transgender community makes up less than 1 percent of the U.S. population, and voters, according to polling, indicate they’re not particularly interested or motivated by the topic.
More than 60 percent of voters, including 41 percent of Republicans, described the use of political attack ads against transgender people as “shameful,” according to polling from the left-leaning group Data for Progress.
“Republicans have used abortion for so many years [as a political rallying cry] and right now, that’s backfiring,” said Sasha Buchert, a senior attorney at Lambda Legal, an organization aimed at protecting the LGBTQ+ population. “So they’ve embraced this issue, this partisan issue, to go after 1 percent of the population.”
Congressional outlook
Capitol Hill Republicans are taking an increased interest in transgender health policy as the 118th Congress comes to a close, and that is likely a hint about what could happen with a GOP majority next year.
Sen. Bill Cassidy, R-La., is in line to lead the Senate Health, Education, Labor and Pensions Committee if the GOP takes control of the chamber. Earlier this month, he launched an investigation into medical organizations that recommend the use of puberty blockers or gender-affirming surgeries for minors.
Cassidy’s investigation was inspired by 2020 research from the British National Health Service that found for the majority of young people, medical intervention may not be the best way to manage gender dysphoria.
The research, often referred to as the Cass Review, led to a United Kingdom ban on prescribing puberty blockers in those under 18, with few exceptions. The report has received criticism from international health agencies as well as physician groups in the U.S., Canada, Australia and Japan for having weak evidence.
Cassidy describes his investigation as a fact-finding mission for Americans to ensure that “treatment guidelines are based on, and supported by, science and not influenced by extreme ideology.” But advocates worry it could have ripple effects on access to care.
Groups like the American Academy of Pediatrics and the American Medical Association recommend puberty blockers as treatment for gender dysphoria in minors. Surgical interventions are exceedingly rare for transgender children — a recent study from researchers at the Harvard School of Public Health found that just 2.1 per 100,000 diagnosed transgender teens ages 15 to 17 receive any sort of gender-related surgical intervention. The rate for adults ages 18 and over is 5.3 surgeries per 100,000 individuals diagnosed as transgender.
Additionally, Florida Republican Sen. Marco Rubio is urging the National Institutes of Health to investigate if its own researchers are manipulating data about puberty blockers for minors.
Rubio is taking issue with the unpublished results of a federally funded study analyzing the impact of puberty blockers. The study’s lead physician, Johanna Olsen-Kennedy, recently told the New York Times that she has not immediately published the results of the study because of the heated political environment surrounding the topic. Her study did not find that puberty blockers improve the mental health of transgender youth; rather, mental health remained constant.
On Oct. 28, Rubio sent NIH Director Monica Bertagnolli a letter accusing Olson-Kennedy of “abusing her position of trust in order to masquerade political ideology,” and urging the research agency to investigate the matter.
Rep. Mark Pocan, D-Wis., chair of the Congressional Equality Caucus, said the Senate efforts should come as no surprise, considering the objectives of Project 2025. Though Trump has disavowed the document, many Democrats fear that the list’s proposals for a Republican administration could serve as a guiding document for lawmakers.
Lawmakers on Capitol Hill have repeatedly attempted to tie policy riders barring access to puberty blockers for minors or gender-affirming care for members of the military and their families to major spending bills in recent years. But they have not been successful in passing such policies.
Democrats say they plan to do what they can to block such policies in a new administration.
“Thankfully, Democrats have managed to block their efforts to restrict access to medical care from becoming law—and we won’t stop protecting trans rights in the future,” Pocan said in a statement.
Executive policy and Supreme Court implications
On Dec. 4, the Supreme Court is scheduled to hear the case United States v. Skrmetti, which will examine whether Tennessee law prohibiting medical treatments for transgender youth, including puberty blockers and hormone therapy, violates the Equal Protection Clause of the 14th Amendment.
The case could determine the future of health care for transgender youth across the country, regardless of who wins the White House.
But if Trump wins, there are other steps his administration could take to curtail access to care.
Project 2025 calls gender-affirming care for minors “child abuse.” Similarly, the 2024 GOP platform vows to “ban Taxpayer funding for sex change surgeries, and stop Taxpayer-funded Schools from promoting gender transition.”
Trump officials took a number of steps to limit health access for transgender people during his first administration.
For example, the Department of Health and Human Services proposed rules to eliminate protections for transgender people, and others, who experience discrimination in health care settings or by insurers denying coverage of care.
Trump’s Department of Justice filed a brief with the Supreme Court arguing that federal law “does not prohibit discrimination against transgender persons based on their transgender status.”
The nondiscrimination clause of the 2010 health care law, known as Section 1557, is probably the most vulnerable target, said Ma’ayan Anafi, senior counsel for health equity and justice at the National Women’s Law Center. Overturning that statute could impact gender-affirming care as well as reproductive access.
Anafi and several other lawyers noted that a new Trump administration could try to use the mifepristone playbook for hormone therapy, and try to use the Food and Drug Administration to restrict off-label use of hormone therapy for transgender individuals.
“It’s all about basically trying to find ways to weaponize the tools that are available,” Hunt said.
This report has been corrected to accurately reflect the groups recommending puberty blockers as treatment for gender dysphoria in minors.
Sandhya Raman contributed to this report.
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