The second Trump administration has made eliminating federal funding for organizations that provide gender-affirming care for transgender teens a priority, leaving some clinics’ futures uncertain.
On Jan. 28, Trump signed an executive order prohibiting organizations that receive federal research or education grants from providing gender-affirming surgery, hormones, or puberty blockers to people under 19. A judge temporarily paused that order on Feb. 13 following a lawsuit from the American Civil Liberties Union (ACLU) and others.
Across the US, over two dozen states already have their own restrictions on gender-affirming care for transgender adolescents. Meanwhile, the Supreme Court is expected to rule in early spring or summer on the constitutionality of banning treatments for trans youth.
“Even if ultimately the president’s actions are struck down, in the meantime, they’re just going to cause all kinds of waves of disruption,” Elana Redfield, federal policy director at the Williams Institute, a sexual orientation and gender identity law and policy think tank, told Healthcare Brew.
Barriers to care
Faced with a fluctuating legal landscape and a threat to their federal funding, some hospitals and clinics across the country have paused or limited gender-affirming care for transgender minors, including Children’s National Hospital in Washington, DC, and NYU Langone in New York.
Gender-affirming care for transgender minors is endorsed by major health organizations including the American Medical Association and American Academy of Pediatrics. But if a transgender teen can’t find anywhere offering gender-affirming care near them, options are limited.
This type of care for minors is hard to administer remotely, for instance, because it requires a team of pediatricians, endocrinologists, therapists, and other members to form a support system, Kate Steinle, chief clinical officer of LGBTQ+ digital primary care company Folx Health, told Healthcare Brew.
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Steinle said that Folx gives education and support to transgender teens and their families, but only prescribes hormones like testosterone and estrogen to adults.
“There’s so many different [law] variations from a federal perspective and a state perspective that taking on minor care at this point is not what we want to be doing yet,” Steinle said.
Providing medication to people under 18, especially via telehealth, means taking on a legal risk that could jeopardize the entire operation, she added.
“We want to do our best to show up for every single person in this community that is under attack,” she said. “We also need to make sure…we’re not risking care for our other members.”
Uncertain future
Fourteen states and DC have “shield” laws that are intended to protect healthcare providers and patients from civil or criminal charges related to gender-affirming care, according to the nonprofit think tank the Movement Advancement Project (MAP).
But the state of these laws is uncertain. Similar shield laws for abortion are facing challenges in courts in Texas and Louisiana.
“The interstate ability to prescribe and regulate treatments is somewhat untested in courts, and I think we’re going to see some litigation around this in these states where there are bans,” Redfield said.
Though state and federal efforts to ban this care are largely limited to minors, providers and patients are worried about access for transgender adults, too, Steinle said.
Folx is fielding calls from patients concerned about having continuous access to their medications.
“Anxiety and depression and fear is off the charts in this community right now,” Steinle said.