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Sweeping Federal Policy Changes Restrict Transgender and Queer Health Care in the United States
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In January 2025, the United States entered a new era of federal health policy with the inauguration of President Trump, whose administration quickly enacted a series of executive actions rolling back protections and access for LGBTQ+ people, especially transgender individuals seeking gender-affirming care . The administration rescinded previous equity orders, ended funding for diversity, equity, and inclusion programs, and directed federal agencies to stop recognizing gender identity as a category in health-related programs and services.
One of the most consequential moves was the signing of Executive Order 14187 on January 28, 2025. This order mandated the rescission of policies reliant on standards issued by the World Professional Association for Transgender Health and directed all federal agencies to end support for gender-affirming care for individuals under nineteen. The Department of Health and Human Services was tasked with taking regulatory and legal steps to restrict access to such care through Medicare and Medicaid, while federal research and education grants were conditioned on the cessation of gender-affirming care for youth by recipient institutions .
Additionally, the administration ordered a reinterpretation of Section 1557 of the Affordable Care Act , removing explicit protections on the basis of sexual orientation and gender identity. This move laid the groundwork for potential exclusion of LGBTQ+ people from non-discrimination provisions in health care, further limiting their rights and access .
These federal actions have accelerated a wave of state-level legislation targeting transgender health care. As of March 2025, twenty-seven states had enacted bans on gender-affirming healthcare for minors, with several states extending restrictions to adults . Anti-trans lawmakers introduced a record 120 bills seeking to restrict LGBTQ+ health rights in the first quarter of 2025, up substantially from 80 bills in the previous year .
Many state laws now classify the provision of gender-affirming care as a felony offense for providers, while eight states have adopted ambiguous “aiding and abetting” provisions that penalize health professionals for facilitating, referring, or even discussing gender-affirming care for minors. These laws have fostered an environment of fear and confusion, leading many providers to overcomply or cease offering care altogether .
The consequences of these policy changes have been profound and far-reaching. Mental health crises among transgender youth have escalated, with suicide attempt rates increasing by 72 percent in the year following the adoption of state-level bans, according to a 2024 Trevor Project study cited in Human Rights Watch reporting . Families have reported multiple incidents of suicide attempts or ideation directly linked to legislative bans, with some resulting in hospitalization.
Even those who retain access to care are experiencing heightened anxiety, depression, and isolation, exacerbated by the hostile legal and political environment. Providers, facing legal jeopardy and unclear guidance, have been forced to reduce or end gender-affirming care, further deepening disparities in access to essential medical services.
Low-income families, people of color, and rural residents have been particularly hard-hit, facing compounded barriers to care. Twelve states now prohibit Medicaid coverage for transgender youth seeking gender-affirming care, and ten of these states extend this exclusion to all transgender people, regardless of age. Families excluded from Medicaid coverage report facing exorbitant costs; some say that three months' worth of medications costs up to $26,000.
LGBTQ+ advocacy organizations are mobilizing in response to these sweeping changes. Groups such as the Movement Advancement Project and A4TE are providing real-time resources and legal guidance for transgender people navigating the shifting policy landscape . Advocates emphasize that the attacks on transgender health care are rooted in misinformation and misunderstanding and stress the importance of affirming, evidence-based care for transgender and queer individuals.
Despite setbacks, activists continue to fight for the rights of LGBTQ+ people to access the care they need, highlighting decades of research that demonstrate the safety and effectiveness of gender-affirming health care. They argue that decisions about such care should rest with transgender people and their medical providers, not politicians or external authorities .
While the current policy landscape in the United States presents significant challenges, it is important to situate these developments within broader international trends. Many countries continue to expand protections and access for transgender and queer people, offering models for more inclusive health policy. Advocacy groups are closely monitoring the situation and working to build coalitions across borders to defend trans and queer health rights.
Looking forward, the durability of these restrictions remains uncertain. Legal challenges to federal and state bans are underway, and the upcoming congressional and presidential elections may play a decisive role in shaping the future of LGBTQ+ health policy in the United States.
