Impact of U.S. Transition Care Restrictions on Transgender Adults

An 18-year-old transgender college student in Chicago tried refilling her estrogen prescription at Northwestern Medicine, but was informed she needed to wait until her 19th birthday. In Texas, a 37-year-old U.S. Army veteran regularly attended a Veterans Affairs hospital for gender-affirming care, only to have these services suddenly cut. Meanwhile, in Colorado, a 37-year-old federal scientist discovered her insurance would no longer cover her planned transition surgery. These denials were inconceivable a decade ago when the federal government supported transition care access widely.

Changes Under Trump Administration

The shift began last year after the Trump administration’s sweeping directives limiting treatments for people with gender dysphoria. Such directives restrict care meant to alleviate distress from a mismatch between birth sex and gender identity. Conservatives, including President Donald Trump, argue restrictions protect trans youth from consenting to treatments like hormone therapy without understanding their long-term effects. However, these restrictions have impacted thousands of adults, including veterans and older teens.

Upon re-entering office, Trump signed an executive order prohibiting federally-funded hospitals from offering transition services to those defined as ‘children.’ This definition broadly includes anyone under 19. The Department of Veterans Affairs ended transgender care for those not already on hormone therapy. The Department of Health and Human Services reversed coverage for gender-affirming care as an essential health benefit under the Affordable Care Act. Federal and Postal Service employees now find coverage of transition treatment will entirely cease next year.

Trans Community Response

Transgender individuals argue their healthcare requests are ordinary, such as medical care related to gender expression. Many private insurance plans cover gender-affirming care. Many trans adults, unable to access treatment or due to cuts, resort to saving money or using fundraisers to finance necessary surgeries. Significant research shows access to transition care improves mental health among trans patients, reducing suicidal ideation. Without access, many experience depression and anxiety with reduced comfort in public life or professional performance.

One such individual, Kacey Garner, a former Postal Service clerk, lost insurance access to her transition care. Moving off her parents’ insurance, she faced stress over unaffordable hormone therapy costs. Garner ultimately left her job, seeking employment with better health benefits covering her transition.

Conservative Efforts Behind Restrictions

The restrictions emerged from a long-running effort by conservative groups like the American Principles Project and Alliance Defending Freedom aiming to portray being trans as a political ideology. The Heritage Foundation played a significant role with its Project 2025 policy roadmap and proposed model bills. Jay Richards of Heritage Foundation underscores their stance to bar public funding for transition treatments, regardless of age.

Kevin Roberts, foundation president, claimed during a podcast interview that transition and violent extremism intersect, advocating against gender-affirming surgeries entirely. Aside from federal limitations, over a dozen conservative states have proposed or enacted policies restricting adult transition care.

Federal and State Policy Maze

The policies initiated federally laid grounds for similar actions at state levels. There are currently twelve states barring Medicaid from covering transition-related treatment and fourteen preventing state employee plans from doing so. Federal and state prohibitions have prompted institutions like the University of Florida to halt transition services amid unclear legal mandates.

Health care providers navigate complex requirements while maintaining compliance. Nurse practitioners face challenges due to required physician oversight for prescriptions in states like Florida. Overlapping federal and state restrictions force patients to travel extensively for care.

In Nebraska, physician Leslie Dvorak continues providing specialized care while confronting intricate regulatory landscapes across 10 states. Despite being aware of potential legal disputes, she remains steadfast to keep serving her patient base.