Attacks on Gender-Affirming and Transgender Health Care

Published: 8/29/25

A growing number of states are banning gender-affirming health care and pursuing anti-LGBTQ+ legislation, contrary to ACP policy, which urges non-discrimination in health care.  ACP opposes these restrictions on health care for transgender individuals, who already may face extreme barriers to accessing care, and strongly objects to government interference with evidence-based health care services.

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Background

In 2021, Arkansas became the first state in the country to ban gender-affirming health care for transgender minors. Since then, at least 26 other states have restricted gender-affirming services for minors and/or adults.  These bans are typically enforced by criminal, civil, and professional penalties for clinicians who provide services, as well as sometimes penalties for parents of children who support their children's access to essential health care.   The recent trend to restrict gender-affirming care is part of an overall proliferation of anti-LGBTQ+ legislation at the state level, with over 600 anti-LGBTQ+ bills introduced so far in 2025.

As described in ACP’s 2024 paper Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities, gender-affirming care is the standard of care for treating gender dysphoria and gender incongruence and is widely accepted by the medical community.  ACP and other leading medical organizations support gender-affirming care as evidence-based medicine, with study after study showing that gender-affirming care reduces depression and suicide among transgender youth. Together with other organizations, ACP has condemned efforts to criminalize gender-affirming care and other evidence-based care as interference with the physician-patient relationship.

While restrictions initially focused on preventing minors from accessing gender-affirming care, states have increasingly targeted transgender health care for adults, with several states proposing bans through age 26 or restricting care for patients of all ages.  Multiple states have also sought to limit both public and private insurance coverage of gender-affirming care, endangering access to essential care for transgender individuals of all ages. The Williams Institute at the UCLA School of Law found that at least 237,500 transgender youths ages 13-17 live in states that have already banned gender-affirming care or where such a law has been proposed, with approximately 114,000 of these young people living in states that have already enacted bans.  In multiple states, care restrictions have forced transgender youth to medically detransition and stop successful gender-affirming treatments.  With patients facing loss of medical care and their families and clinicians under legal threat, some transgender people and their families who can relocate have fled to states supportive of transgender rights, or are trying to navigate traveling out of state for routine care.  Beyond immediate impacts, these laws drive stigma and endanger the wellbeing of LGBTQ+ people.  According to the Trevor Project’s 2024 National Survey on LGBTQ Youth Mental Health, 90% of LGBTQ+ young people reported that their mental health has been negatively impacted by recent politics.

ACP’s 2024 paper reaffirmed the College’s commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.  This paper recognized the pressing need for physicians and other health professionals to take a stance against discriminatory policies proliferating at the federal and state levels, particularly the imposition of medically unnecessary restrictions on gender-affirming care.  ACP is committed to challenging political interference in the patient-physician relationship, including by strongly supporting access to evidence-based, clinically-indicated gender-affirming care.

Federal Activity

The Trump administration opposes gender-affirming care and has taken several actions to limit access to these services, part of the Trump administration’s larger opposition to transgender identity. On Inauguration Day for his second term, President Trump issued an executive order asserting that sex is “not changeable” and ordering federal policy changes including withholding federal funding from all institutions that “promote gender ideology,” restricting access to medical care for transgender prisoners in Bureau of Prisons custody, and not allowing gender marker changes on US passports, among other policy directives. Later in January, President Trump issued another executive order directing various agencies of the federal government to restrict access to gender-affirming care specifically, including withholding all federal funding from institutions providing gender-affirming care services for transgender minors.

These orders have resulted in significant disruption of medical services.  Major medical institutions, including Children’s National in Washington, D.C. and Children’s Hospital in Los Angeles, have announced the shutdown of pediatric gender-affirming care services citing the legal and regulatory risks.  In August 2025, 16 state Attorneys General sued the Trump administration arguing that their enforcement activities constituted a de facto national ban on gender-affirming care, citing the administration's intimidation of hospitals and medical professionals by launching investigations, issuing subpoenas, demanding data on transgender patients, and threatening prosecutions.

As directed in Trump’s executive order, in May 2025 the US Department of Health and Human Services (HHS) released a report it claimed reviewed the evidence and best practices regarding treatment for gender dysphoria.  While ACP, every other major medical organization in the country, and most express agree there is strong evidence supporting gender-affirming care, HHS drew the opposite conclusion.  Medical organizations and LGBTQ+ advocates have criticized the report for flawed methodology, spreading misinformation, discounting of medical guidelines established by qualified experts, promoting “exploratory therapy” that could include discredited conversion therapy practices, and failure to disclose the report’s authors.  Despite these criticisms, HHS Secretary Kennedy wrote in June 2025 to health professionals, health care risk managers, and state medical boards urging them to discount the well-recognized WPATH’s standards of care and instead align their care standards with the administration’s position.

Following a Trump executive order banning openly transgender individuals from serving in the military, the Pentagon has ended coverage for gender-affirming care for military personnel.  TRICARE had already been prohibited from covering gender-affirming care services for transgender children of military personnel under the 2024 National Defense Authorization Act.

In June 2025, the Supreme Court issued a decision in the case US v. Skrmetti, upholding Tennessee’s ban on youth gender-affirming care and ruling that these bans do not violate the US Constitution’s equal protection clause.  As part of our advocacy in the courts, ACP had submitted an amicus brief to the court in this case urging protection of gender-affirming care alongside other medical and mental health organizations.  With this ruling upholding Tennessee’s ban, challenges to state bans in federal courts will likely be dismissed and the laws allowed to go into effect.  Because the court ruled narrowly in this case on grounds of equal protection, challenges to gender-affirming care bans may continue to be brought on due process grounds or provisions of state constitutions.

State Activity

Among the more than 600 anti-LGBTQ+ bills introduced in state legislatures in 2025, at least 139 of those bills have proposed restrictions in at least 39 states on gender-affirming care or transgender health care.

While the 2021 Arkansas ban that started this legislative trend had been blocked since its passage, an appeals court allowed it to go into effect in August 2025 following the US v. Skrmetti decision.   Among the at least 27 states that have enacted bans on gender-affirming care, only Montana’s ban remains blocked by courts as a lawsuit challenges it violates the state constitution.  Despite the legal challenge, the only remaining hospital providing gender-affirming care services in the state ended care for minors citing legal risks.

In response to the rise in restrictions, a number of states have taken actions to protect access to gender affirming care.  At least 18 states and DC have enacted “shield laws” to protect patients and clinicians from penalties associated with obtaining or providing gender-affirming care in their states, usually by legislation and in some states by a governor’s executive order.  Many of these laws also include protections for reproductive health services as abortion care has been criminalized following the overturning of Roe v. Wade.  In total, 24 states and DC have prohibited insurance from excluding transgender health care services from coverage.

Still, as a result of federal actions to restrict access to gender-affirming care by applying legal pressure on hospitals, access is being limited even in states that have enacted their protections for this care.

References