Since President Donald Trump took office in January, misinformation surrounding transgender healthcare has proliferated—and so have threats of consequences for the clinicians providing it.
For instance, Trump on Jan. 28 issued an executive order attempting to ban clinicians from providing gender-affirming care for youth by threatening to defund institutions providing such services.
Following that, several hospitals and health systems paused gender-affirming care services for minor patients. And while most have since resumed care, confusion over the legality of providing gender-affirming services as well as threats of legal action from government officials have made providers hesitant to continue treating trans patients, Alex Sheldon, executive director of GLMA, an association working toward LGBTQ+ health equity, told Healthcare Brew.
The law remains
Trump’s executive order barring gender-affirming care is not enforceable, as it doesn’t change existing laws that prohibit discrimination against trans patients, according to Kellan Baker, executive director at the Institute for Health Research and Policy at Whitman-Walker, a leading institution in LGBTQ+ health research in Washington, DC.
“Executive orders cannot unilaterally change the law,” Baker told us.
However, shortly after the order was issued, several health systems and hospitals announced pauses on gender-affirming care services, including NYU Langone in New York; UCHealth and Denver Health in Colorado; Children’s National in Washington, DC; VCU Health in Richmond, Virginia; Corewell Health in Grand Rapids, Michigan; and UVA Health in Charlottesville, Virginia.
“Not only was [pausing care] not necessary because the executive order did not constitute a change in policy, but actually they are acting at odds with existing federal protections for trans people in healthcare,” Sheldon said.
Under Section 1557 of the Affordable Care Act, it’s illegal for clinicians to refuse to treat someone based on protected characteristics, including sex. The Biden administration in 2024 clarified that the rule prohibits discrimination based on sexual orientation and gender identity, though Trump has attempted to rescind that rule via executive order.
In February, GLMA and LGBTQ+ advocacy group PFLAG sued the Trump administration over the executive order. On March 4, a US district judge issued a nationwide preliminary injunction, meaning the order cannot be enforced until federal courts make a final ruling.
Fearful physicians
Despite the injunction, providers are wary of providing gender-affirming care, Baker noted.
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A 2021 study from multiple universities including the University of Michigan and Brown University found most of the 103 providers surveyed viewed state legislation restricting or banning access to gender-affirming care as “interfering with their practice of evidence-based medicine and for many causing severe distress and potentially threatening their livelihood.”
At least one attorney general—Ken Paxton of Texas—sued three doctors in 2024 for providing gender-affirming care to minors.
Two of the three—May Lau and M. Brett Cooper, pediatric and adolescent medicine physicians at the University of Texas Southwestern Medical Center—entered into agreements with the state restricting them to practicing medicine in research, academic, and administrative settings and not on patients.
The third, Hector Granados, a pediatric endocrinologist at El Paso Children’s Hospital and the Hospitals of Providence, is under a temporary injunction preventing him from prescribing gender-affirming therapies like hormones until the court makes a final ruling.
The year prior, Paxton attempted to subpoena Seattle Children’s Hospital, accusing doctors there of prescribing puberty blockers or hormone therapy to minors in Texas via telehealth, the Texas Tribune reported at the time. The lawsuit was settled in 2024, and the hospital wasn’t required to release patient data to the attorney general, according to the Tribune.
“It is what has been levied against abortion providers for years, and it is now what is being levied against providers of care for transgender young people in particular,” Baker said.
Not only are providers facing legal threats, but by ordering health agencies to rescind policies relying on guidance from the World Professional Association for Transgender Health, the executive order “undermines the clinical autonomy that providers need to care for all patients and erodes the trust that is fundamental to the patient-provider relationship,” Sheldon said.
“No provider should ever be put in a position where they’re either forced to deny potentially life-saving care or keep their jobs,” they added. “That is an untenable situation for a provider and amounts to an immense, immense moral injury that eventually will drive many providers out of the field itself.”