Gender-Affirming Care, Explained and the Importance to the Health Care System for All Americans

Lately we’ve heard a lot in the media and from politicians about gender-affirming care. This is the latest in a steady stream of attacks targeted at specific communities in this country, in this case targeting the trans community. And while it seems that gender-affirming care would only affect the trans community, this attack on evidence-based health care will impact much more than just one community of people.

Every health care consumer should have the right to access the services they need without fearing discrimination or attacks on their mental and physical well-being, and every health care consumer should be concerned about these efforts to limit access to the care they need.

What is gender-affirming care?

Many trans and nonbinary people seek out services that are generally referred to as “gender-affirming care” by medical experts and advocates for the LGBT community.

Gender-affirming care is a broad umbrella that includes medical treatments ranging from psychotherapy to hormone treatment to gender-affirming surgeries. Trans and nonbinary people access these treatments for a variety of reasons related to their physical and emotional health. Virtually all authorities and medical associations in the United States agree that gender-affirming care is medically necessary and life-saving for trans and nonbinary people.

How might these threats impact all health care consumers?

These attacks to trans health care will have devastating impacts not just on trans and nonbinary people, but also on the health care options for everyone.

Trump’s January 2025 Executive Order defines gender-affirming care as “the use of puberty blockers, sex hormones, such as androgen blockers, estrogen, progesterone, or testosterone, and surgical procedures that attempt to transform an individual’s physical appearance to align with a [gender] identity.”

However, all of these treatments are regularly used by endocrinologists, gynecologists and oncologists to treat a wide variety of conditions in individuals of all ages and all gender identities.

For example, puberty and hormone blockers are used for treatment of premature puberty and certain hormone-sensitive cancers, such as prostate cancer, which impacts 1 in 8 men in America, with more than 300,000 new diagnoses every year, according to the American Cancer Society.

Estrogen, progesterone and testosterone treatments are commonly prescribed for conditions ranging from distressing symptoms of menopause (such as hot flashes), decreased bone density and reduced sexual function.

Even gender-affirming surgeries, such as mastectomies and breast reconstruction, are often advised for people with breast cancer. Limiting access to care and insurance coverage for these necessary treatments sets a dangerous precedent for allowing politicians to interfere with the personal health care decisions that should remain between individuals and families and their doctors. Enforcement of gender-affirming care bans could even involve intrusive investigations into the gender identity and care received by breast cancer and prostate cancer patients.

A health care system that protects the health of trans and nonbinary people is a system that protects all people — our right to make informed decisions, to access medically necessary care, and to be treated with respect.

What are the threats to these kinds of care?

The Trump Administration has explicitly targeted the health care options of trans and nonbinary people in many ways (the list below is not comprehensive — a more comprehensive list can be found here):

• Executive Orders: The Trump Administration issued several Executive Orders in January and early February that seek to limit the availability of gender-affirming care for trans and nonbinary youth (though many provisions in these Orders are currently being litigated)
• Regulatory and Legislative actions: On March 10, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that (among other provisions) would regulate how insurers on the Affordable Care Act (ACA) marketplace can provide gender-affirming services. Insurers on the ACA marketplace are subject to federal requirements that require them to designate a set of Essential Health Benefits (EHB) that all plans must provide. In its new rule, CMS proposed that beginning in plan year 2026, these insurers could not include services that the agency refers to as “sex-trait modification” as EHB.
  • This rule is codified in the budget reconciliation bill that passed the House of Representatives on May 22 and is currently being debated in the Senate.
• Letters to State Medicaid agencies: On April 11, the Centers for Medicare and Medicaid Services (CMS) sent letters to state Medicaid agencies asserting that Medicaid programs may no longer cover certain hormone treatments and surgical procedures for youth.
• HHS Report: In early May, the Department of Health and Human Services released a poorly substantiated report on health care for trans youth that contradicts the scientific and professional consensus on treatment options for this population.

What can you do about it?

As new threats emerge, and the policy landscape evolves, you or your organization should look for opportunities to support the work of and engage with leading gender-affirming care experts and advocacy organizations. We are stronger and more powerful together and policymakers need to know that attacks on gender-affirming care are attacks on the entire health care system.