I’ve talked about the war against trans people on this Substack before, but it’s reached a fever pitch. If you’ve been on the fence, it’s time you hopped down onto one side or the other. I really hope you’ll join me on the side of protecting trans people, especially the young ones who need to know people love and care about them.
What are the latest battles in the war against trans people?
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On Wednesday, the House passed HR 3492, sponsored by outgoing GOP Rep Marjorie Taylor Greene, which if passed in the Senate and signed into law would (1) subject healthcare providers to up to 10 years in prison for providing gender-affirming care to minors, and (2) would criminalize parents who help their children access gender-affirming care, even if determined to be medically necessary in discussion with their child’s doctor.
Before I continue, let’s get something clear. Gender-affirming care for young people mostly consists of mental health supports and hormone blocking medications to prevent usual body changes experienced during puberty. Major medical associations, including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry have supported such care. They universally agree that gender-affirming care is clinically appropriate and can be lifesaving treatment for both children and adults. Professional medical organizations do not recommend surgery for children as a part of care, and research shows that it’s rare among transgender or gender-diverse teens. If you thought otherwise, that’s because the Republican talking points on this issue are meant to mislead you.
You don’t have to like this idea of gender-affirming care for young people. You don’t even have to understand it, to get on the right side of the fence. If like me you’re a parent, you most likely want whatever’s best for your kid(s). Parenting is really hard. It’s often very difficult to know what to do when complicated situations arise with your kids. Very often there’s no clear answer, though there is no shortage of overconfident people who are happy to tell you that they know what’s best, and that you’re not doing it right. The parents I know who have trans or non-binary kids spend a lot of time talking with them and thinking about what’s best—usually involving talking together with their pediatrician to discuss options and next steps to take (or not). But these moves by the feds—the very people who talk about needing smaller government and more parental choice when it comes to things like vaccines—are designed to prevent parents from having choice. HR 3492 literally tries to criminalize both doctors and parents who try to make choices the government doesn’t like. Imagine if the government tried to criminalize doctors and parents in the US who chose non-medically necessary circumcision of their children at birth? How would that go over? I have news for you: that’s elective surgery on a child who’s too young to make the decision for themselves. Sound familiar?
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OK, but maybe MTG’s criminalization bill seems an obvious step too far to you, and you’re confident it won’t pass the Senate (probably true), so it doesn’t matter. On Thursday, RFK Jr’s Department of Health and Human Services issued a proposed rule that would prohibit hospitals and health systems that accept Medicare or Medicaid from providing gender-affirming care to young people—regardless of how that care is paid for. If this rule is finalized and allowed to stand, it will effectively end most gender-affirming care for youth nationwide, regardless of what laws Congress passes. Put in simple terms, this proposed rule says that if any hospital prescribes puberty blockers to any trans patient under the age of 18, that hospital can no longer receive Medicare or Medicaid reimbursements for any care they provide. Since in the US, Medicare and Medicaid are the primary financial drivers for hospitals—together covering nearly half of all hospital spending and more than 60% of patient volume—this is a major dealbreaker. HHS is trying to force the hands of hospital administrators. Not to mention, “Allowing the government to determine which patient groups deserve care sets a dangerous precedent,” said Dr. Susan Kressly, president of the American Academy of Pediatrics.
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Oh, and the same day the HHS rule was proposed by RFK Jr. and Dr. Oz, the House passed HR 498, which doubles down by barring Medicaid from covering gender-affirming care for trans youth. Medicaid covers about 40% of children nationwide, so this bill means that families who can afford private alternatives might be able to figure out ways to get their trans kids the care they need, but families with more limited means will be left without options to support their kids. If the Senate also passes this (unlikely), it would only serve to deepen health disparities among rich and poor in this country.
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But there’s more! Back on October 30, a federal rule was finalized that will bar nonprofits from qualifying for Public Service Loan Forgiveness if they “engage in chemical castration” of minors—intentionally inflammatory phrasing for what the administration later defines in the rule as, yes, puberty blockers and hormone therapy, which as I’ve said above is clinically appropriate and supported by all the major medical associations. This change means that as of July 1, 2026, doctors, nurses, and staff at any hospital, university, or nonprofit that provides gender-affirming care to minors will lose access to loan forgiveness. (By the way, it also applies to hospitals that provide care to undocumented immigrants, or don’t actively cooperate with ICE.) You might be asking yourself, “Wait, loan forgiveness? I’m still paying off student debt from decades ago…who cares if their loans aren’t forgiven?” Here’s the deal. The Public Service Loan Forgiveness (PSLF) program says that healthcare providers who work in nonprofit and safety-net settings for 10 years and make qualifying payments on their student loans for that whole time can then have the remainder of the federal student loan debt forgiven, in acknowledgement of their public service. The average medical student in the US graduates with more than $200,000 in debt, and most then complete residencies where they work extraordinarily long hours for extraordinarily poor pay. Given that, you can imagine that after residency many doctors seek employment in fancy private practices where they can quickly pay off that debt and start buying nice things for themselves as a reward for all that hard work. The problem is, a heck of a lot of people in this country need medical care and only can access it through public hospitals in rural or underserved areas, where the pay for healthcare providers isn’t good. (Traditionally these settings have relied heavily on foreign doctors, who now largely aren’t able to provide care here due to the Trump administration’s new rules making H1 visas cost prohibitive.) Since there’s a projected nationwide shortage of up to 86,000 physicians by 2036, we desperately need people willing to become doctors who will work in these regions of the US. The PSLF is the key to that. So, this rule is yet one more effort to effectively ensure that trans youth who rely on hospitals in rural or poor areas for their medical care won’t be able to access gender-affirming care. There’s lots of redundancy built in here.
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It’s not all about the youth, though. The Trump administration is working hard to erase trans people entirely, and deny they ever existed. How? I’ll give you three ways, though there are many more:
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Starting in 2026, the Trump administration will require U.S. cancer registries that receive federal funding (which is most of them) to classify patients’ sex as male, female, or unknown. The new policy says that trans and non-binary patients should be categorized according to their sex assigned at birth, and when that information is not available, they must be counted as “unknown” gender. As I’ve said before, when you don’t collect data on health disparities, that doesn’t make them go away. It makes them invisible, and therefore makes them worse. As in, more trans people will die of cancer. This is avoidable, but this administration doesn’t want to avoid that outcome.
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It doesn’t just stop with cancer registries: the Trump administration is trying to prevent all federal surveys from collecting data related to sexual orientation and gender identity, except in their prescribed, ideologically (aka not scientifically) based ways. These federal surveys are hugely important to our understanding of the health of various groups of people in the US, on everything from sleep quality to crime victimization. And—say it with me now—if you don’t collect data on trans people, it makes health disparities worse. More trans people will be sick, injured, or killed by these moves. That’s the point.
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I’ll end on one that’s especially petty and heinous: earlier this month the Trump administration changed the name on the official portrait of Admiral Rachel Levine, Biden’s assistant secretary of health, and the first trans person ever to win Senate confirmation. Admiral Levine is a four-star admiral and under Biden led the Commissioned Corps of the U.S. Public Health Service. Trump’s HHS removed her name and replaced it with her deadname. That’s a disgusting move. It’s literal erasure.
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OK, but aren’t minors too young to know whether they need gender-affirming care, anyway?
No.
I’m guessing that when you were 17, 15, 12, and even 10 years old, you had a pretty good sense of your own gender, the genders of those around you, and where you felt like you fit in and where you didn’t. Gender shapes so much of our experiences, and we are all keenly aware of that from a very, very young age. Think back to your childhood—you know that’s true. Journalist Erin Reed (Erin in the Morning) already reported this so well I’m just going to share her words: “Gender-affirming care saves lives. A Cornell review of more than 51 studies found that such care significantly improves the mental health of transgender people. One major study reported a 73 percent drop in suicidality among trans youth who began treatment; another found a 40 percent reduction in actual suicide attempts in the previous year. Research published in the Journal of Adolescent Health in April 2024 showed puberty blockers sharply reduced depression and anxiety. Abroad, a German review backed by 27 medical organizations endorsed gender-affirming care for youth, and a recent French medical consensus did the same. The evidence has driven a historic resolution from the American Psychological Association—representing 157,000 members—formally condemning bans on trans care.”
But what about safety for women in bathrooms? Protecting women in sports?
Once again, I can’t say it better than some who’ve already written about this, so I’m going to share some excerpts from a great piece by Ryan Cooper at The American Prospect:
For many years now, conservatives, along with an influential group of centrists and liberals, have presented a certain narrative regarding trans people in this country: They are Concerned. They’re worried, they say, about trans women in bathrooms—what if a male predator leverages trans rights systems to pretend to be a woman and ambushes victims in the bathroom? They’re worried, they say, about people getting transition care too easily—what if gender clinics and endocrinologists start bum-rushing children into transition surgery? Above all, they say, they are outraged about trans women in sports—what if a man pretends to be a woman so he can win first place easily?
This narrative is and always has been a lie. What these people actually have is a seething, obsessive hatred of trans people. They want them either back in the closet or dead.
Trans rights don’t have anything to do with the possibility of men invading women’s bathrooms. A man could already do that by dressing up regardless of what rights trans people have, and in any case, toilets are a pretty unusual and risky location to try to harass or assault someone. Studies show allowing trans people to use the correct bathroom doesn’t have any effect on safety.
On the sports question, if an adult man were to claim to be a woman solely so he could compete in a women’s competition, that at least would theoretically be unfair. The problem is that this does not happen. Sports leagues that still allow trans competitors require some proof of having undergone hormone therapy, and studies demonstrate this largely erodes any physical advantage from undergoing male puberty.
In any case, the numbers involved here are microscopic. Precisely one (1) trans person has ever competed in the Olympics, and they did not win a medal. As of a year ago, there were fewer than ten trans athletes in all of American college sports, and their record isn’t that great either. Notable transphobe Riley Gaines somehow parlayed a career out of tying a trans woman for fifth place in a college swim meet.
Bottom line: Don’t get sucked in by the fear-mongering talking points. They’re intentionally playing on your emotions to get you to climb over to their side of the fence. There’s no data to support what they’re saying. Don’t fall for it. You’re better than that.
So, what can I do?
1. Contact your U.S. Senators.
Tell them to oppose H.R. 498 and H.R. 3492 if they reach the Senate floor, and to defend access to gender-affirming care for youth in any way they can.
2. Contact your health care system and providers.
Make it clear that the HHS rule to withhold Medicare and Medicaid funds from hospitals providing gender-affirming care is still a proposed rule, not a requirement. Gender affirming care remains protected under the laws of California (where I live) and many other states. Tell your healthcare system that you will not stand for pre-compliance with the Trump administration’s efforts to roll back gender-affirming care. Find flyers, messages, and contact info here. (By the way, there’s evidence that this works! Your words do matter!)
3. Stand up for trans kids.
Share this post, or one of the articles cited here, with friends or family who have fallen for the fear-mongering talking points. Keep in mind that any parents you know who have trans or non-binary kids are probably having an extremely hard time right now; ask if there’s any way you can support them, or at the very least make a little effort during this holiday season to show them you’re thinking of them, and you care. And no matter how hard it is for you, make sure you’re using the right pronouns for the trans people in your lives, whether they’re adults or children. Not sure what pronouns are the right ones? You can just ask.