What's Going On with Gender Affirming Care?

Hey friends. Tough news week, huh? I had another article planned to go out today, but as is sometimes the case, we’re pivoting. I want to address two topics/headlines that I’ve seen a lot of panic about.

1. Marriage equality in Texas

2. Gender affirming care for minors

Marriage equality:

You might have seen the headline blasting around social media lately that “New Texas Rule Allows Judges to Stop Marrying Same-Sex Couples”. It’s true that the rule is the latest example of Texas doing some bullshit, but it’s important to accurately assess how bad the bullshit is. No, this is not proof that they’re going to overturn gay marriage, and queer couples’ ability to get married in Texas has not changed. Queer couples are still being issued marriage licenses whenever and wherever they apply, there are just certain judges who now have permission to opt out of officiating a ceremony. Notably, in Texas a judge doesn’t have to be the one to officiate—I’m ordained online, let me do it instead! Let Lucy Daucus do it! Please feel free to express your discontent at the Texas High Court—it’s always deserved—but don’t categorize this as “existential threat”.

Gender Affirming Care:

Okay, now let’s get into the heavier stuff. Let’s start with some basic info on what is actually happening. The Centers for Medicare and Medicaid, which are the forms of health insurance that many Americans use, are run by the federal government. An employee somewhere within the federal government leaked to NPR that they are planning to propose new rules saying that any hospital that wants to accept or receive reimbursement for Medicare and Medicaid from the government cannot provide pediatric gender affirming care, period. You’ve likely heard headlines that feel pretty dramatic, but I want to pump the brakes for a moment. Nothing is changing overnight.

So what happens from here? First, the rules haven’t even actually been proposed yet and HHS is declining to comment on them, so we wait an unknown amount of time (probably a week or two) for the rules to be proposed, at which point they enter a public comment period.

Yes. The public comment period will be a farce, and they don’t care what you have to say, but we’re still going to flood the system anyways to make sure they know continuously that we hate them and everything that they’re doing. If you’re not sure whether our presence sends a message, think about what kind of message it would send if we didn’t show up at all. Shudder. Then, most likely, the rule will go into effect. As they’ve written, many hospitals, if not all of them, will have no choice but to pause their pediatric gender affirming care for a moment.

Notice the intentional word choice I’m using here: pause. We will likely see a temporary interruption in care for a lot of people. It really sucks. AND I am not using the word ban, because it’s not a ban. Barrier? Absolutely. Attack? Certainly. But not a ban. Private providers are free to continue providing the care where it is legal, as are online providers as well.

At some point in this journey, lawsuits will be filed by one of our many delightful powerhouses of legal defense. Since this has been a move we’ve been anticipating since well before day 1, we’ve got plenty of our own plans in place for how we respond to it. Lawsuits can run the gamut from impacted patients to state attorney generals suing the Trump administration like they’ve done on a variety of other topics, including attacks on gender affirming care. So we will see blue states stand up to the Trump administration in this way. We’ll likely/hopefully be able to get a TRO or Preliminary Injunction blocking enforcement of the rules. While these wins are temporary, remember that the name of the game here is harm reduction until we can get him out of power. Every single day we can get people access to the medical care they need is a victory.

I know it’s easy to say “I wish people wouldn’t comply in advance and would just be brave and stand up to the Trump administration and come up with alternative sources of funding!” And I hear you. I do. But right now, that’s not possible. On average, without Medicare or Medicaid reimbursement, a hospital will be able to stay open for one week. This would be very bad and is simply not possible. Does it absolutely suck that the Trump administration is holding entire hospitals’ patient populations hostage so that they can win a few points in their base for attacking trans kids? Yes. It’s super sucks. But that’s where we are.

So what the heck are we supposed to do now? How do we feel okay?

1. Just because HHS hasn’t released the rules yet doesn’t mean they aren’t closely watching to see how the leak is received. Feel free to call or email and let them know that we are watching, and we are not happy. (1-877-696-6775)

2. We also can take this opportunity to help people around us understand why it matters that all of us stand up against transphobia. This is not just an issue impacting trans people. This is the government testing a new tool in its arsenal to see how much power it can wield over hospitals and institutions in blue states with protective laws in place, how much power they can wield using federal funding or threatening to rescind that federal funding. If this works here, they will extend it to reproductive rights, and abortion access, birth control, IVF, and who knows what else that they decide they don’t like anymore. Who knows what they’ll decide? This is a great opportunity to talk to our friends, neighbors, and family simply about government overreach, about the ways that this is not an appropriate or good use of government powers, rather than just debating their opinions on gender affirming care for youth.

3. Help major LGBTQ rights organizations stay informed. If your hospital stops covering care, especially before these rules actually go into effect, reach out to your to ACLU or A4TE or GLAAD or Lambda Legal or any of those wonderful advocacy organizations to let them know because it’s impossible to stay on top of what every single hospital is doing. They have all the plans for lawsuits in place, except the plaintiffs they’re representing! We want to help them find an impacted party or just stay informed.

4. It’s also important to call your elected officials (yes. I know. It’s annoying.) to let them know that this is something you’re angry about. As you’ve likely heard before, elected official staff members literally keep counts of how many times they hear about certain issues every day so that they know what the priorities for their policy work should be.

5. Consider donating or volunteering with the race for Virginia Governor. This race is a referendum on trans rights in many ways, the Republican candidate has focused almost exclusively on attacking transgender youth and transgender athletes in her campaign messaging to the point where many Virginia Republicans are annoyed about it. If she fails to win using the playbook that many Republicans used in 2024, they will take notice that this community was no longer as effective a punching bag as it used to be, and they will move on. We absolutely need to win this race. You can donate here. You can volunteer for the candidate herself here or volunteer for the election protection hotline, help voters know their rights, and access their polling places here. If you have a friend in Virginia, text them!!

6. If you have a local special election going on this November, vote and make sure every single person that you know is also making a plan to go vote. There is no such thing as an off season election, and the old white Republicans are certainly not going to miss this one. We cannot either. If you are someone who complains that there are no good candidates to choose from in a presidential election, this is the moment where that gets decided. This is the moment where the National Democratic Party is watching the races of younger, more progressive politicians to say, what do we think the future of this party is? Can progressive politics win? They look and learn on a local level before they try that on a bigger scale. If you want to see more progressive presidential candidates, locally is where that has to happen. So get your ass to the polls!

Beyond action, though, we are also human people and we are getting tired.

How do we feel okay right now?

1. Be mindful about where you’re getting your news from and how much is speculation vs fact. Without naming any names, some folks have a tendency to look at a headline/policy, come up with an absolute worst case scenario from that headline/policy, and then report on that as if it’s already happening. With these kinds of big, frightening stories, my trusted sources are almost exclusively major legal LGBTQ+ rights organizations. Lambda, A4TE, PFLAG, GLADLaw, Lesbian Law Center, and ACLU, or I’ll reach out directly to leaders and advocates I trust not to fearmonger me.

2. Remember that your personal doctor or the person who is actually providing the care to you or your family is not the one making this choice and does not deserve your anger, and they’re likely just as angry, if not even more angry, than you are. Send some extra love to your providers who are likely going to be really struggling with this, too.

3. Give yourself grace for the wide range of emotions that are probably going to come up around this. Rage. exhaustion. Defeat. Sadness. Grief. Numbness. Fear. All these emotions are beautiful and important and teach us about needs that are going unmet and lines that we will not cross, and we can sit with these feelings, but we need to continue choosing to come home to joy. Give the soft animal of your body what it needs right now.

4. To the transgender people in our lives, we’ll wanna recognize that they’re struggling right now. This doesn’t feel good. It feels like an escalation, a continued focus on stripping away our rights and attacking our access to health care and bodily autonomy, this sucks. So we want to reach out to check-in and show them that we love them because this is the moment where it really feels like they are not seen and not loved.

When "How Are You" Isn't Enough

5. Don’t send your friends or loved ones a bad headline. More likely than not, they’ve already heard. They already know. Send them something to be hopeful about. Maybe spend some time researching a good news story and send it to them because that kind of news is much harder to find (even though it doesn’t actually occur less).

6. For the trans kids in our lives, this is a hard conversation. I get it. We wanna sit down with them and help them understand that this might be an obstacle, but it’s not the end of the road by any means. And that some people are angry or are cowards or are insecure or have a variety of stupid reasons to not like them. But that nobody gets to say who they are except them. Perhaps share some cool stories of the legacies of trans history and trans resistance and the ways we’ve been challenged and still survived through history. Maybe we just turn off our phones and bake a cake instead. Ask them what they need.

7. If you need help accessing resources for yourself or your family, send me a message.

Last but not least, please continue to breathe. I know how it feels. I know this sucks. I know it’s scary. I know it feels like the world is falling apart. I need us to contextualize this moment: we knew that this presidency was going to suck. We knew that we were going to be a major target. And I know that we will survive this.

We are experiencing interruptions in care, but we have forces of allyship and passionate advocates, the likes of which we have not seen post-colonization in the history of the queer rights movement. The amount of public support that we have from everyday people, the amount of people who are ready to ask questions or learn more or show up as an ally for everyone is nearly impossible to count. We have so much more power than we think we do. We just need to survive this moment. Our systems may fail us, but our people will not.

Please, please do not try to get through this moment alone. Text a friend. Ask if they wanna hang out. Host a board game night with some people that you love. Bake cookies for a transgender coworker.

Give your trans kid the most magical dress up party they could imagine where they get to feel fully and completely seen as they are in that moment, in that space, in that room with those people. Our community has been attacked so many times before. And each time, we have found ways to survive by leaning on each other, by looking for the joy. And if nothing else, there’s always spite.

Deep breath. Hold on. Stay with me. Okay?

I love you.