Transgender veterans will no longer be provided hormone therapy through the Department of Veterans Affairs, unless they were already receiving such care through the department or the military, the VA announced Monday.

The reversal of the decade-old policy comes just days after the VA rescinded a 2018 directive that required the department to treat trans veterans “with respect and dignity.” The directive required coverage of mental health care, hormone therapy, pre-surgery evaluation and care after surgery as medically necessary. The VA has never covered gender-affirming surgery for veterans. 

The rescinded directive also required health care providers to address veterans by their gender identity, which included using their requested pronouns and preferred name.

According to Monday’s announcement, trans veterans who weren’t already receiving treatment for gender dysphoria, which is the medical term for the severe emotional distress caused by the misalignment between one’s gender identity and birth sex, will not be able to access it through the VA. 

“I mean no disrespect to anyone, but VA should not be focused on helping Veterans attempt to change their sex,” VA Secretary Doug Collins said in a statement Monday, adding that the “vast majority” of veterans and Americans agree, though he did not point to any data that supports that claim.

“All eligible Veterans — including trans-identified Veterans — will always be welcome at VA and will always receive the benefits and services they’ve earned under the law,” Collins said. “But if Veterans want to attempt to change their sex, they can do so on their own dime.” 

Any money saved by curtailing treatments for gender dysphoria “will be redirected to help severely injured VA beneficiaries — such as paralyzed Veterans and amputees — regain their independence,” the VA said.

In addition to ending coverage of hormone therapy for veterans who weren’t already receiving it, the VA will also no longer provide gender-affirming prosthetics, wigs or letters of support for veterans to access transition-related surgery outside of the VA.

Veterans who receive care in VA facilities will also be required to use “intimate spaces,” such as bathrooms and locker rooms, in accordance with their birth sex, the VA announced.

Kelley Robinson, president of the Human Rights Campaign, the nation’s largest LGBTQ advocacy group, condemned the VA’s announcement. 

“Transgender veterans share the same commitment and the same love of country as all other veterans,” she said in a statement. “They made the same sacrifices and are owed the same respect and care after their service. Despite this, the VA has decided to turn its back on transgender veterans who committed their lives to serving in our armed forces—complying with an Administration hellbent on harming and scapegoating the transgender community.”

The policy change was brought on by President Donald Trump’s executive order declaring that there are only two, unchangeable sexes, the VA said. The executive order has resulted in sweeping changes regarding trans people across the federal government, from government web pages that mention trans people to passport policies. 

The VA has been providing treatment for gender dysphoria for more than a decade, according to the department’s announcement, which added that the Veterans Health Administration estimates indicate that less than one-tenth of 1% of the 9.1 million veterans enrolled in VA health care are trans, which would be about 9,100 veterans. That number is far lower than previous research has found. The Williams Institute at UCLA School of Law estimated in 2014 that about 134,300 trans people are veterans or are retired from the Guard or Reserve, though it’s unclear if they would all be eligible for VA health care. 

Trump also issued an executive order prohibiting trans people from serving or enlisting in the military. The policy requires all trans people who are currently serving to be separated from the military by next month. Several trans service members and trans people who planned to enlist filed a lawsuit in January to block the policy, and a judge is expected to issue a decision in the case this week.

A majority of Americans, 58%, favor allowing openly trans people to serve in the military, though support has declined, from 66% in 2021 and 71% in 2019, according to Gallup data released last month. The drop was driven primarily by Republican survey respondents, Gallup found. 

In recent years, Republicans have increasingly supported policies that target transgender people, particularly trans youth, by prohibiting trans students from playing school sports on the teams that align with their gender identities and barring them from accessing transition-related health care.