A transgender college student, 18, faced obstacles when refilling her estrogen prescription at Northwestern Medicine in Chicago. She had to wait until her 19th birthday. In Texas, a 37-year-old U.S. Army veteran encountered service cuts at a Department of Veterans Affairs hospital for gender-affirming care. In Colorado, a federal scientist found her insurance stopped covering transition surgery. A decade ago, federal support for transition care was strong. This changed with the Trump administration’s directives restricting treatments for gender dysphoria.
Supporters of these restrictions, such as President Donald Trump, claim protection of trans youth who might not understand the long-term effects of treatments. However, these actions affected thousands of adults, including veterans and older teens, by blocking necessary healthcare. Trump’s executive order prohibits transition services with federal funding for anyone under 19, affecting many legal adults.
The Department of Veterans Affairs stopped transgender care for new patients, and the Department of Health and Human Services removed gender-affirming care from being an essential health benefit under the Affordable Care Act. Federal employee coverage was limited, with plans to end it entirely by next year.
Advocates argue that medical care related to gender expression is similar to other gender-specific treatments. Despite federal restrictions, many private insurance plans still cover gender-affirming care. NBC News investigated these policies’ effects through interviews with trans adults, treatment providers, and advocates.
Trans adults reported lost access to treatment, canceled procedures, and necessary cost-saving measures, leading to mental health struggles. Academic research confirms treatment access improves mental health, reducing suicidal thoughts. Trans individuals began stockpiling hormones due to restricted access concerns.
Kacey Garner, a Postal Service clerk, faced challenges with insurance changes, leading to financial stress over hormone therapy and possible facial feminization surgery costs. This added to her stress of passing in public.
Federal restrictions continue a conservative-backed effort over the years, as seen in policies by groups like the American Principles Project. This included redefining legal sex as immutable. The Heritage Foundation has influenced the federal changes, supporting limited federal funding for transition care. Beyond federal law, several conservative states followed suit, restricting transition care for adults.
National organizations note similarities to anti-abortion strategies, aiming to complicate accessing care. They assert restrictions target trans people beyond safety concerns. The Trump administration’s actions reportedly aimed to remove trans presence from public life.
Trump often speaks against ‘transgender mutilation’ in public, maintaining a broad definition of childhood to include 18-year-olds. This impacts legal adults eligible for other adult rights. Aleksandra Vaca, transitioning in Illinois, experienced denial due to the executive order, recalling emotional struggles from Texas’ restrictive environment.
The Department of Veterans Affairs phased out gender dysphoria care, reducing services except for existing hormone therapy patients. Many veterans feel underserved and confused about what’s covered. VA officials claim minimal criticism of their policies, deeming them aligned with public opinion.
The Trump administration’s policies expanded to exclude gender transition treatments under major federal programs. Studies suggest such care has minimal financial impact on employers. In Colorado, a federal employee considered switching to higher-cost marketplace plans for coverage.
State-level restrictions, combined with federal policies, created widespread compliance challenges for providers. Twelve states block Medicaid from covering transition-related treatment, and 14 restrict state employee health plans. Some universities, like the University of Florida, ceased offering transition services due to evolving laws.
Dr. Izzy Lowell, running a telehealth clinic, noted Florida’s stringent requirements, forcing patients out of the state for care. Increasing state restrictions across the U.S. mirror federal moves, with laws affecting reporting, access, and potential bans on transition care.
Private clinics like Pride Health Clinic in Omaha navigate complex regulations across multiple states to continue providing care. Despite obstacles, many providers maintain their commitment to serving trans patients in response to the restrictive landscape.