Before the 2024 election, Dr. Molly McClain, a family medicine doctor at the University of New Mexico, was seeing an influx of patients seeking gender-affirming care from states like Texas that have banned it. The center is doing its best to accommodate more and more patients from in and outside the state, but there’s still a waitlist, stretching for months for some patients awaiting treatment.
Members of the transgender and gender-diverse community are fearful that it’s going to get even harder to access care, now that president elect Donald Trump has won reelection. Sources who provide or connect people to gender-affirming care told Salon that patients are trying to bump up their appointments out of fear that they will soon be inaccessible.
“People are devastated and terrified about what this might mean for their access to medications,” McClain told Salon in a phone interview. “This is evidence-based and life-saving care.”
The first Trump Administration notoriously enacted a host of anti-LGBTQ policies, including repealing health care regulations that prohibited discrimination based on gender identity, implementing a ban on transgender troops, and rescinding a policy that allowed transgender and intersex inmates to be housed with inmates of the same gender identity rather than their assigned sex at birth.
Although the Biden Administration reversed all of the above-mentioned rollbacks, the new Trump Administration has shown signs of doubling down on anti-LGBTQ policies, and many are concerned he will restrict access to gender-affirming care. During the election, Trump spent $38 million on anti-trans campaign ads, promised to ban minors from having gender-affirming surgeries, and has said that he would end Medicare and Medicaid funding for hospitals providing this care to youth.
Gender-affirming care involves social transitioning, puberty blockers, hormone therapy, or surgical procedures. It can be lifesaving for children, and more than 30 medical associations have issued policy statements that support its use. Surgeries are typically not performed until transgender people near adulthood, despite the central focus surgeries often play in politics.
“The data are strong for the benefit of what we call gender-affirming health care, that is medical care for transgender and gender diverse people,” said Dr. Joshua Safer, the executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York City. “Blocking access to care is associated with worse mental health outcomes – perhaps as we would expect if we blocked access to health care for any group of people.”
Transgender people are at a higher risk of dying by suicide than the general population due to the discrimination they face in schools, health care settings, and beyond. Gender-affirming care has been shown to reduce dysphoria, suicidality and depression for transgender and gender-diverse communities.
“These kids are being targeted and bullied by some of the most powerful people in their state and now at the national level,” said Kellan Baker, the executive director of the Whitman-Walker Institute, an LGBTQ health center based in Washington D.C. “So what we expect is even greater increases in the number of kids feeling hopeless when all they're trying to do is live their lives.”
The day after Trump won the election, The Trevor Project crisis hotline reported a 700% increase in calls and texts compared to two weeks prior. Joan Erwin, CEO at Transhealth, which provides gender-affirming services to the trans and gender-diverse community in Massachusetts, said the center also saw a huge increase in call volume.
“It’s this sort of mentality that they better do this now, before they no longer have the option to do so,” Erwin told Salon in a phone interview. “Unfortunately, people are now feeling forced to transition faster than maybe they would have chosen to … They just want to blend in and not be easily identifiable as trans, and that's very concerning.”
At least 26 states have enacted partial or total bans on youth gender-transition care, according to the Human Rights Campaign. Last week, Texas Attorney General Ken Paxton sued a third doctor for providing gender-affirming care in the state, where it was outlawed last year. These punitive policies have caused many doctors providing this care and families with transgender children who can no longer access it to leave the state, Baker said.
“Now we are getting to the point where the net is closing and people are feeling like there's nowhere to go,” Baker told Salon in a phone interview. “As a transgender person who needs health care or a parent who's trying to get care for their kid, they're terrified because the message that is coming out loud and clear right now is: You are not safe anywhere.”
On Dec. 4, the Supreme Court will hear arguments for a landmark case, United States v. Skrmetti, which will determine whether bans on gender-affirming care are unconstitutional. If gender-affirming care is not protected, it could have dramatic consequences for the right to health care for everyone. And now that Republicans control both the Senate and Congress, the party has the power to enact major changes to health care.
This week, Trump selected many officials to join him in leadership who have a history of passing or advocating for anti-trans legislation: for Secretary of Defense he tapped Fox News host Pete Hegseth, who opposes having women in combat roles and has said transgender members create “complications” in the ranks; for Secretary of State, he picked Sen. Marco Rubio, R-Fla., who requested questions about gender identity be removed from the Census in 2023; and for Department of Homeland Security, he landed on South Dakota Governor Kristi Noem, who signed legislation banning gender-affirming medical care in her state of South Dakota.
“The thing that is worrisome is, in the last administration, there were at least some guardrails,” Erwin said. “It feels like that's out the window this time … And when he says in the first 100 days he plans to ban health care for trans youth, it feels like he will have more ability to do that this time because there's no one there to stop him.”
Transgender candidates did also celebrate some firsts this election. Delaware state Sen. Sarah McBride became the first openly transgender person elected to Congress, Aime Wichtendahl won a spot to become Iowa’s first trans lawmaker, and Zooey Zephyr, who has advocated to defend youth access to gender-affirming care, was reelected to the Montana House.
This is not the first time the transgender community has been the target of a political campaign, and it won't be the last time the community shows how resilience it is to get through it, Erwin said, adding "We've had to just kind of walk through the fire and come out better on the other side.”
McClain, at UNM, said the children she sees who have a support system there to help them get the treatment they need are often far healthier and happier than the adults she sees who didn’t have access to that supportive environment growing up. Once they start treatment, they light up when they walk in the room during their first appointments, she said.
“The first visit, kids are always just grinning from ear to ear, they're texting their friends … They're so excited,” McClain said. “Once they start hormone therapy, they feel aligned on the inside … And I have parents say things like, ‘I got my kid back.’”
In more than half of the country, this practice has been banned. The concern is that the second Trump administration is ready to further restrict it.
“My fear is that now, with this kind of legislation and who knows what will happen next, that is going to change even for kids who do have supportive families,” McClain said.
