The Trump Administration Threat To Transgender Adult Care Is Growing At Lightning Speed

Anti-trans organizations have floated raising the age limit for care to 25 for years, and GOP architects of youth care bans have been explicit: the real goal is to eliminate gender-affirming care entirely. Donald Trump himself has vowed in the past to target trans healthcare “at any age.” Now, with a new letter from the Centers for Medicare and Medicaid Services (CMS) circulating to clinics nationwide, the first formal warning shots have been fired. Transgender adults should take notice—and prepare. The infrastructure to strip their care is already being built.

According to a recent CMS letter, clinics across the country are being warned against providing gender-affirming care to individuals under the age of 21. “Federal financial participation (FFP) is strictly limited for procedures, treatments, or operations for the purpose of rendering an individual permanently incapable of reproducing and, under 42 C.F.R. 441.253(a), is specifically prohibited for such procedures performed on a person under age 21,” the letter reads, citing a 1978 regulation restricting federal funding for sterilization. But gender-affirming care for adults rarely meets that definition. Many transgender men and women retain the ability to have children after temporarily stopping hormone therapy, and fertility counseling is routinely offered. When sterilization does occur, it is not the goal of the care—it is an incidental outcome of treatment meant to alleviate gender dysphoria.

More troubling is the use of this decades-old regulation to pressure health care centers into dropping transgender care for adults. The expansion of restrictions to include people up to the age of 21 follows a recent Trump executive order barring gender-affirming care for anyone under 19—a category that includes legal adults. Although that order has been blocked in multiple courts, hospitals have still used it to justify halting care for this population. Now, the CMS letter is having a similar chilling effect: Planned Parenthood of Arizona has “paused” gender-affirming care for all adult patients. This is a deeply alarming development, especially considering that Planned Parenthood is the largest—and often the only—provider of transgender adult healthcare in many parts of the country.