• Posted July 22, 2025

7/22 -- CTM DONE- Transgender Americans Braced For Loss Of Gender-Affirming Care

Just about all transgender Americans believe they’ll lose their access to gender-affirming health care during President Donald Trump’s current term in office.

As a result, despair is driving many to consider suicide or risky black-market hormones, researchers report in JAMA Network Open.

Every single participant in a 489-person poll of gender-diverse Americans aged 18 and older expects to lose their access to gender-affirming care during the next four years, researchers found.

“It was startling,” researcher Teresa Graziano, a professor of nursing at the University of Vermont in Burlington, said in a news release.

“This is a population that already feels that their access to care is constantly under threat, and so when you have somebody going into power that is campaigning on removing their access to care they believe it,” she said.

Nearly all of the participants receiving gender-affirming care (98%) said it had improved their quality of life, results show.

“HRT therapy is giving me my life back,” one participant told researchers.

About one-third (32%) said they would consider some sort of do-it-yourself hormone therapy if they lost their access to care, researchers found.

“I’d try ordering e[strogen] online,” one participant said, while another said “I’ll go underground for hormones.”

These sorts of extreme measures could jeopardize their health, Graziano said. Patients on hormones need careful blood monitoring to make sure they’re taking the right dose, or they might suffer health problems like osteoporosis.

Graziano said underground efforts could take several forms.

“This can quite literally be people's synthesizing hormones at home using kits that you can purchase online,” she said. “It may also the use of the gray or black market, especially for things like testosterone which are FDA-regulated and are controlled substances.”

Around 1 in 5 (21%) said their plight has prompted thoughts of suicide.

“I’ll kill myself. Or try to leave the country, but killing myself would be easier sooooo…,” one person said.

“Genuinely, I don’t think I will survive [being closeted] again. It is so mentally painful to imagine,” another said.

“They are saying that there is not a life worth living without being their authentic self,” Graziano said.

The study wrapped up on Inauguration Day, Jan. 20, researchers said.

Since then, Trump has issued a series of executive orders preventing the U.S. government from recognizing more than two sexes and directing federal agencies and programs to work toward banning gender-affirming care for trans youth, researchers noted.

Other orders propose prohibiting gender-affirming care as an essential benefit for patients covered under Affordable Care Act health insurance plans, researchers said.

However, Graziano noted that the orders are now being fought in the courts. In June, the U.S. Supreme Court upheld Tennessee’s ban on gender-affirming care for minors, opening the doors for other states to pursue that policy.

“I want be clear that there is no federal ban on care right now,” Graziano said.

She added that there is concern these bans could damage the trust between patients and their doctors, particularly if they acquire hormones through questionable means.

Doctors should approach patients who use black market hormones with the same harm-reduction approach used with people who have substance abuse problems, Graziano said.

“We should not be judging this community for making do with what they have,” she said. 

“We just need to partner with them to make sure they are as healthy as possible as they get through what they need to get through," Graziano continued. "And I think that as we continue having these conversations about whether or not this care should be banned, we also need to think about how this is going to affect the lives of very real human beings whose mental health is reliant upon their access to being their true self.”

More information

The Association of American Medical Colleges has more on gender-affirming care.

SOURCE: University of Vermont, news release, July 16, 2025