President-elect Donald Trump has made attacks on transgender people a cornerstone of the election. His campaign and conservative groups spent money tens of millions dollars in anti-trans ads. He called gender-affirming care for young transgender people “left-wing gender madness” and “child abuse,” and falsely claimed at rallies and events that children undergo gender-affirming surgeries. schools.
As Trump prepares to return to the White House, gender-affirming healthcare providers are preparing for an administration that could upend evidence-based care standards for transgender people.
While it is difficult to predict what policies the Trump administration will pursue, his platform included a pledge to end all federal funding of gender-affirming care and to ban all hospitals that provide care to minors from Medicare and Medicaid. Trump has also said he will ask Congress to create legislation that recognizes only two genders (male and female) assigned at birth.
“I think we should take the Trump administration’s platform at its word,” said Meredithe McNamara, an assistant professor of pediatrics at Yale who also treats patients at a local community health center. “It is a professional responsibility to be incredibly realistic about what it will look like if our patients are constantly placed in a political crosshairs.”
Early Wednesday morning, McNamara was already receiving messages from young patients concerned about their access to care due to gender incongruence. The Trevor Project, a suicide prevention organization for LGBTQ+ youth, told STAT that calls, chats and texts to its crisis line increased nearly 700% the day after the election, compared to the weeks before. Many people in crisis referred directly to the election results.
FOLX, a telehealth platform for queer people, saw a 75% increase in care team messages the day after the election as people reached out with questions about refills and concerns about their future access to care. The company also reported a 115% increase in posts on its community platform.
Before Trump takes office in January, health care providers and hospital systems should improve patient privacy policies, conduct medico-legal training and prepare to work with legal experts who understand the nuances of health care bans, McNamara said. Even those who work and live in states with progressive policies should not assume they will always be able to provide care without interference, she noted. Some states have passed “shield laws” to protect both patients and health care providers from prosecution by restrictive states. But there is still a legal battle to test the strength of those laws, McNamara said.
“Very solid blue states aren’t going anywhere,” said Kate Steinle, FOLX’s chief clinical officer. “They are going to fight even harder.”
FOLX has already been tested for its ability to provide trans health care in restrictive states. In Florida, recent legislation requires that gender-affirming hormones for adults be personally prescribed by a doctor. When the law went into effect, FOLX opened in-person clinics in five Florida cities after previously having no brick-and-mortar locations in the state. The company subsequently saw a surge in sign-ups from transgender people who lost access to their previous providers because they were not physicians or telehealth prescribers. That growth offset the costs of setting up in-person clinics, Steinle said.
“We don’t want to have to do this state by state, but if we need to, we will,” Steinle said. “We are going to adhere to all the rules [restrictive] states.”
Some healthcare providers are thinking differently about how to deliver care in the next era.
“Collective resistance is the best solution,” says Crystal Beal, a physician and founder of QueerDoc, which provides telemedicine care to queer people in 10 states. They hope that the medical profession as a whole can come together to support gender-affirming care and oppose the ban on evidence-based care through civil disobedience. “Organized resistance allows individual support to make a frightening decision. It’s scary to break a law. It’s scary to risk losing your life, and it’s scary to risk how you pay your mortgage.”
A common refrain for trans communities facing discrimination is that trans people have always existed. That will not change with a new government.
“Since 1969, we have adapted and persevered through every shift in the political landscape to ensure our communities receive the lifesaving, affirming care they deserve,” said Patrick McGovern, the CEO of Callen-Lorde, an LGBTQ+ community health center in New York. , said a statement. “Our mission does not change because of the political winds.”