A judge in Missouri has upheld the state’s ban on gender-affirming care for transminors and on restrictions for the treatment for adults.
Judge Robert S. Carter of the Cole County, Mo., Circuit Court ruled Monday that the law did not violate the Missouri constitution and wrote that there is “an almost total lack of consensus as to the medical ethics of adolescent gender dysphoria treatment.” This comes even though every major medical organization supports such care.
The bans are contained in Senate Bill 49, which Republican Gov. Mike Parson signed into law in June 2023. The law took effect in August of that year after another judge refused to block enforcement of it while the lawsuit against it proceeds.
The suit was brought in July 2023 by the families of three transgender people, Southampton Community Healthcare and two of its medical providers, and two organizations, PFLAG and GLMA: Health Professionals Advancing LGBTQ+ Equality. They are represented by Lambda Legal, the American Civil Liberties Union of Missouri, and Bryan Cave Leighton Paisner LLP. Gov. Parson is named as defendant. The suit is known as Noe v. Parson, Noe being one of the anonymous plaintiffs.
The law indefinitely bans gender-affirming surgeries for trans minors (genital surgery, however, is almost never performed on minors) and temporarily bans the administration of puberty blockers and cross-sex hormones. The latter ban is set to expire in August 2027, and young people who were already on the treatment when the law was enacted are allowed to stay on it. Gender-affirming treatment is still legal for cisgender youth for conditions such as early-onset puberty or a disorder of sex development. The law also bans Medicaid funding for gender-affirming treatment for the purpose of transition, even for adults, and gender-affirming surgeries for incarcerated people.
The statute violates the Missouri constitution’s guarantee of equal protection of the law, similar to that provided in the U.S. Constitution, according to the lawsuit, and interferes with parents’ right to manage their children’s health care. Trans minors in Missouri will suffer irreparable harm under the law, the suit states.
Missouri Attorney General Andrew Bailey, a Republican, issued a press releasepraising Carter’s ruling and calling gender-affirming care “child mutilation.”
“The Court has left Missouri’s law banning child mutilation in place, a resounding victory for our children. We are the first state in the nation to successfully defend such a law at the trial court level,” Bailey said in the release. “I’m extremely proud of the thousands of hours my office put in to shine a light on the lack of evidence supporting these irreversible procedures. We will never stop fighting to ensure Missouri is the safest state in the nation for children.”
Before the legislature acted, Bailey had issued an emergency rule to severely restrict gender-affirming care. He withdrew it when lawmakers passed SB 49 and sent it to Parson, saying it was a stopgap measure until the legislature acted. But his rule had been blocked by a St. Louis County judge while a lawsuit against it proceeded.
Bailey has been in a legal battle with a medical center in St. Louis, as he has sought release of unredacted records on gender-affirming care. The center has refused, and a judge has sided with it. He has won release of documents from three other health care providers.
Lambda Legal and the ACLU of Missouri said they will appeal Carter’s ruling. His decision is “largely copying a brief submitted by the State and ignoring thousands of pages of a transcript not yet provided to the parties that reflects nine days of testimony in the case,” which was heard in September and October, says a press release from the groups.
“We are extremely disappointed in this decision, but this is not the end of the fight and we will appeal. However, the court’s findings signal a troubling acceptance of discrimination, ignore an extensive trial record and the voices of transgender Missourians and those who care for them, and deny transgender adolescents and Medicaid beneficiaries from their right to access to evidence-based, effective, and often life-saving medical care,” Lambda Legal and the ACLU of Missouri said in the release.
“Despite heartfelt testimony from parents of transgender youth, transgender adults who’ve benefited from this care at various stages of life, a transgender minor, and some of Missouri’s most dedicated health care providers, the state has prioritized politics over the well-being of its people,” the organizations added. “This ruling sends a chilling message that, for some, compassion and equal access to health care are still out of reach.”
On World AIDS Day, we unite to remember those we’ve lost, support those living with HIV, and renew our commitment to ending the epidemic. Raising awareness is vital to breaking stigma, promoting testing, and advancing treatment. Together, we can make a difference.
Join us in spreading the word, educating others, and standing up for a future free from HIV/AIDS. Together we can make a difference.
For over 40 years, Face to Face has been at the forefront of compassionate care and innovative responses to emerging health crisis here in Sonoma County. Our journey began in 1983 as a grassroots organization responding to the devastating impact of the AIDS epidemic. Since then, we have expanded our services to meet the evolving needs of our community, from HIV prevention and support to addressing the opioid overdose epidemic, housing insecurity, and the rising mental health crisis.
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Join the Fight Against AIDS December 1st is World AIDS Day—a day to unite in the fight against HIV, show support for those living with the virus, and remember those who have lost their lives. This year, let’s raise awareness, promote testing, and break the stigma surrounding HIV/AIDS. Together, we can work toward a future without AIDS.Aids Prevention
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Half of people with HIV in the United States are living in places that are vulnerable to extreme weather and climate disasters, according to a new analysis from the left-leaning Center for American Progress (CAP).
The report from CAP released Wednesday finds that the areas of the country where HIV is being diagnosed at disproportionately high rates are also places most at risk of disasters. The analysis used data from the Ending the HIV Epidemic in the U.S. (EHE) program, a federal program that aims to reduce the rate of new HIV infections, and the Federal Emergency Management Agency (FEMA) national risk index. FEMA’s tool takes into account the frequency of disasters, but also the vulnerability of the population, accounting for certain at-risk demographics like low-income and socially disadvantaged people.
Fifty locations, including 48 counties, Washington, D.C., and San Juan, Puerto Rico, have been designated by EHE as high-priority areas to combat HIV because they are where more than 50 percent of new HIV cases occur. On average, those places had a national risk index score of 96.8 out of 100.
“It is not surprising that those most at-risk live in areas particularly vulnerable to extreme weather and climate events. That is true for many other climate-sensitive health outcomes,” said Kristie Ebi, professor of global health at the University of Washington, who reviewed the analysis. “The poor and marginalized are generally at higher risk and often live in less desirable locations that are less desirable because of vulnerability to extreme weather and climate events.”
Haley Norris, policy analyst with CAP and author of the report, said what stood out to them was the variability in threats faced by the different parts of the country. On the West Coast, wildfires cause issues for people with HIV because many develop lung conditions that are exacerbated by wildfire smoke. In the South and Northeast, flooding and hurricanes pose unique health issues for people with HIV by making it more difficult to access medical care. All three of these types of climate disasters are becoming more destructive due to climate change.
“We’re seeing extreme weather and climate events that are quite far outside of historic experience,” Ebi said, pointing to flooding in Asheville, North Carolina, as one recent example.
For those with HIV, those extreme events are making it harder to stay on track with their medications, which stop the disease from progressing to AIDS and prevent transmission to others.
Vatsana Chanthala is director of the New Orleans Health Department’s Ryan White HIV/AIDS Program, a federal initiative that provides funding for clinics and treatments that support low-income people. New Orleans is located in one of the priority jurisdictions to combat new HIV infections.
After Hurricane Ida in 2021, her team surveyed patients in the program to gain a better understanding of how the disaster may have disrupted their care or access to medications. HIV treatment involves taking antiretrovirals daily or bimonthly injections to suppress the virus and keep it at a level that prevents it from spreading. After Ida, pharmacies closed due to damage; electricity was also out for nearly two weeks in parts of the city, making it difficult to contact pharmacies to refill lost prescriptions or others that had run out, Chanthala said. The high cost of the drugs means some pharmacies were hesitant to fill prescriptions, worried that people wouldn’t come to pick them up.
The cost of the drugs was also an issue for those who evacuated: Many did not know that they could use their insurance to cover medication out of state, so they did not attempt to purchase the medication due to out-of-pocket costs, Chanthala found. Of the 194 patients surveyed, 30 percent of those who evacuated said they had trouble accessing care, and of those who stayed in New Orleans, 32 percent also had trouble accessing care.
Another barrier to taking medications is the stigma surrounding HIV. In times of disaster, many people evacuate to the homes of family and friends, and some people in the survey said their family was unaware they had HIV.
“There’s still a lot of fear with HIV and so many clients don’t disclose their status,” Chanthala said. “And so they find ways to hide their medications, and if they’re around people, they’re less likely to take those medications out.”
Norris, the author of the CAP report, said one study on HIV care and wildfires in California also found that people expressed fear of disclosing they had the disease.
“These are people who are going through extremely stressful, life-destroying situations and they have to do the emotional calculation of, ‘will disclosing this make me less safe?’” they said. “That is the hardest part of the puzzle for us to figure out. It is not just about access, it is the reality that HIV stigma is still very alive and well and still very powerful.”
The risk associated with not taking medications is high for people with HIV. If someone stops taking their antiretrovirals, also known as ART, or if they run out of medication, their viral load will go up over time, said Dr. Paula Seal, who works at the HIV Outpatient Clinic at the University Medical Center New Orleans. The length of time it would take for that to happen depends on the individual patient and when they were diagnosed with HIV.
But Seal said they stress the importance of patients staying on their medication.
“When you have trouble is when patients are running out of medications because if they don’t have enough medicine, then they start skipping doses to make it last longer, that’s when we run into problems, and then the virus can become resistant to those medications,” Seal said.
To offset those risks, Seal and other providers follow a hurricane preparedness protocol, talking with patients every year before hurricane season hits and urging them to refill their prescriptions. In many instances, people can get up to 90 days covered by insurance, which could last through a hurricane season. Seal also provides numbers to pharmacies they can contact if something happens to their medication.
This October, the Biden administration updated its guidelines for providers who are treating people with HIV who have been displaced, Norris said. The new guidelines walk providers, who might not have expertise in treating HIV, through how to assess and prescribe medication for new patients who otherwise may have disruption in their care. “Providing ART is very complex, it’s really really good that they were able to get that out when they did,” they said.
One way that the Ryan White Program could become more nimble is by having its services follow the enrolled patients, Chanthala said. Currently, patients at the Ryan White clinics have access to wrap-around services, like transportation and help with housing, but they lose that support if they evacuate.
“Medications are important, and adherence is important. But if a person needs food, needs a place to stay, that’s going to be first on their minds,” she said.
Currently, these supports are not provided through money directly, but Chanthala thinks that in disaster situations having that flexibility to provide funds for people with high medical needs could also help: “If they can’t afford gas to get out of the area, they aren’t going to evacuate.”
During a live newscast on Washington, D.C.’s NBC affiliate WRC Thursday evening, anchor Jim Handly referred to DelawareCongresswoman-elect Sarah McBride as “congressman.” The moment, during the station’s News 4 at 6 newscast, happened as Handly reported on a new policy from Republican House Speaker Mike Johnson barring transgender people from using restrooms that align with their gender identity in the House-controlled sections of the U.S. Capitol complex.
Handly, a veteran broadcaster who is gay, quickly corrected himself, using McBride’s proper title and pronouns in subsequent references during the same segment.
A spokesperson for WRC addressed the incident in response to The Advocate’srequest for comment.
“An anchor momentarily lost in the script during a live news segment misread the word ‘Congresswoman.’ The anchor used the proper title and pronouns in several subsequent references to the Congresswoman-elect during the same news segment,” the spokesperson said. They did not indicate whether an on-air correction would be made.
McBride, who will be sworn in this January as the first out transgender member of Congress, represents a historic milestone in LGBTQ+ representation. Yet, even as the station downplayed the error, advocacy organizations such as GLAAD and the Trans Journalists Association urged media organizations to view this as a moment for correction, reflection, and growth.
A teachable moment
GLAAD, which works with newsrooms to improve their coverage of LGBTQ+ issues, emphasized that mistakes like this, even when unintentional, carry weight. Misgendering — whether accidental or deliberate — perpetuates societal biases and reinforces the marginalization of transgender people.
Misgendering (verb, noun): The act of using gendered words that are inappropriate or the wrong pronouns for someone, intentionally or unintentionally. – Trans Journalist Association
A GLAAD spokesperson told The Advocate that the organization would connect with WRC to learn more about the incident and offer the station guidance.
“Mistakes happen on the air and in everyday conversation, and the best course is to apologize, correct, and move on, then work to not repeat it,” GLAAD president and CEO Sarah Kate Ellis told The Advocate in a statement.
She described McBride’s election as an opportunity for newsrooms to review their protocols and language conventions to ensure respectful and accurate reporting.
“GLAAD’s general guidance for reporters is to ask for and use the names, pronouns, and titles of people they are covering,” Ellis said. “This is accurate and respectful journalism that builds trust with those sources as well as viewers and readers from marginalized communities.”
The Trans Journalists Association offered additional guidance, advising that corrections should address errors as with any incorrect information and that the wrong information shouldn’t be repeated.
“In the correction, it may be appropriate to briefly mention that the person’s name, pronouns, or gender have been incorrectly identified in past articles, but do not restate the incorrect information. Take care to correctly identify the person’s gender going forward,” the TJA advises.
Misgendering in context
McBride’s misgendering reflects a more extensive, systemic issue within the media and society. Women, including transgender women, who step into leadership roles traditionally dominated by men often encounter linguistic habits that struggle to catch up with the times. GLAAD points to the persistence of terms like “chairman” or “congressman,” even when describing women, as a vestige of a deeply male-centric view of authority.
For transgender women, the stakes are even higher. According to GLAAD, misgendering doesn’t just misrepresent — it questions the validity of a person’s identity. McBride’s case highlights the challenges she will face in an institution that has historically excluded people like her.
Moving forward
Advocates argue that media organizations are responsible for learning from incidents like the one at WRC and improving their coverage of marginalized communities.
GLAAD recommends that newsrooms take active steps to improve how they report on McBride and other transgender people. This starts with training staff to ask for and use accurate names, pronouns, and titles in every story. Hiring transgender journalists and involving members of the transgender community in discussions about newsroom practices can help build understanding and foster more thoughtful coverage, the group says. GLAAD notes that it’s also important to include transgender voices in stories beyond topics specifically tied to their identities.
The group urges media outlets to keep covering these issues. The group notes that some newsroom managers express fear about “getting it wrong,” but GLAAD stresses that avoiding coverage entirely is the real mistake. Newsrooms should lean into their curiosity, consult experts, and learn from those with lived experience. The goal is to report with care, accuracy, and confidence, not to shy away from important stories.
While the economic challenges of the last few years have tested organizations of all stripes, Black-owned businesses closed their doors at twice the rate of other businesses during the pandemic. Studies show that less access to the financial system and lack of family wealth to draw from – both key avenues of financial security during economic slowdowns – are partly to blame.Consumer spending habits are another major challenge for Black-owned businesses, which can struggle to scale up because of a misperception that their target market is a narrow demographic. Minority-owned businesses, however, are often marketing to broader audiences who never consider them.I have personally experienced how convenient it is to visit the website of a prominent retailer and locate a significant portion of my shopping list in a single location. However, in order to contribute to the advancement of Black-owned enterprises in the United States, UK, Ireland, and the Netherlands, I have assembled an extensive roster of more than 450 Black-owned businesses spanning various sectors. Please take a moment to explore the list provided below!
Texas wasted no time escalating its attacks on transgender people as the state GOP prefiled 32 anti-trans bills on the first day of the 2025 legislative session’s prefiling period. In recent years, Texas has become a hotbed for anti-trans legislation, with each session delivering harsher crackdowns. Last session alone, the state passed six anti-trans laws, including a criminal ban on drag (currently enjoined in court), sports bans, a youth healthcare ban, and DEI restrictions. Following a national ad campaign which saw hundreds of millions poured into demonizing transgender people, Republican-controlled states are now under scrutiny over their future plans for transgender residents. Texas GOP lawmakers have made their intentions clear: the next wave of crackdowns is on its way.
The bills filed by Texas Republicans target transgender people in nearly every aspect of their lives. One such measure, HB1123, would impose stricter laws on sports by requiring every athlete in the state to undergo a chromosome test—an invasive and costly procedure that could wreak havoc on high school and college athletics. Many people are unaware they have atypical chromosomes, making this requirement particularly problematic. A similar guideline was used at the 1996 Olympics, where mandatory chromosomal testing of female athletes revealed that eight women had XY chromosomes without knowing it, due to unknown intersex conditions. The discovery led to widespread backlash as intersex athletes faced threats of removal and the emotional toll of learning their genetic status. Chromosomal testing was subsequently discontinued, deemed deeply violating, unfair, and unworkable as a standard.
Other bills take aim at transgender people’s use of bathrooms. House Bill 239mirrors Florida’s adult bathroom ban, and would bar transgender individuals from using facilities in any publicly owned building in Texas. This sweeping measure wouldn’t stop at the Texas Capitol or courthouses—it extends to park bathrooms, rest stops, schools, state-run hospitals, and even major airports like Dallas-Fort Worth, a critical hub for American Airlines. Texas has already garnered attention for Odessa’s “bathroom bounty” law, which allows cisgender individuals to sue transgender people for using the restroom, promising a minimum $10,000 payout for successful claims.
Bounty bills also resurface in the latest wave of filings. Texas HB 1075 would allow any individual performing in drag to be sued for a $5,000 bounty. The bill’s definition of “drag” and “perform” is alarmingly broad, labeling anyone “exhibiting a gender that is different from the performer’s gender recorded at birth using clothing, makeup, or other physical markers” as being in “drag.” This definition clearly encompasses transgender people. Should a bill like this become law, transgender performers would undoubtedly be targeted. In Montana, under a similar drag ban, the first person targeted wasn’t a drag performer but a transgender public speaker discussing transgender history at a library. Additionally, such a measure would almost certainly force the cancellation of Pride parades across Texas, where transgender people and drag performers dance, lip-sync, and otherwise celebrate.
Multiple bills take aim at transgender people in schools, as well as books about queer and transgender individuals. Among the most troubling is Senate Bill 86, which would require parental permission for high school students to join a Gay-Straight Alliance or any club that “promotes themes of sexuality, gender, or gender identity.” According to Lambda Legal, this requirement violates the Equal Access Act, which mandates that rules apply equally to all student groups and prohibits singling out GSAs for restrictive policies.
Many bills aim to strip transgender Texans of legal recognition of their gender identity entirely. Senate Bill 84, for example, mandates that government documents classify individuals based on their “biological reproductive system,” defining “female” as “an individual whose biological reproductive system is developed to produce ova.” The bill notably fails to address how it would handle intersex individuals or those with congenital conditions that prevent them from producing gametes. The same bill specifies that “biological differences between the sexes are enduring,” and says that those differences “warrant the creation of separate social, educational, athletic, or other spaces.”
With Texas as the first state to unleash a torrent of anti-transgender legislation, 2025 is shaping up to be a brutal year for transgender people nationwide. Emboldened by the Trump administration, Republican-led states are poised to escalate their attacks, expanding the ways they target transgender communities. Nationally, similar bills could gain traction, while some political pundits and even a few Democratic politicians argue that accepting such laws is a price worth paying for political victories. But the real cost is borne by transgender individuals themselves—those most at risk, facing a future stripped of rights and dignity. Texas has made its stance clear, and it serves as a chilling preview of what lies ahead.
As vaping’s popularity endures, a report issued by the surgeon general’s office Tuesday shows that LGBTQ Americans are among those helping to keep smoke shops in business.
The surgeon general’s 837-page report on tobacco use found that 37.8% of gay, lesbian and bisexual U.S. adults have tried electronic cigarettes, compared with just 16.5% of their straight counterparts. Electronic cigarettes, also known as e-cigarettes, include e-cigars, e-pipes, e-hookahs, vaping pens and hookah pens.
When broken down further, the data, collected from 2019 to 2021, found nearly half of bisexual adults have tried e-cigarettes, compared with 31.8% of gay men and 26.7% of lesbians. The authors noted that figures on transgender Americans’ tobacco use were not widely available for analysis in all areas of the report.
The report found similar disparities exist among the nation’s youths and young adults: Over 42% of young adults and 56% of high school students who identify as gay, lesbian or bisexual reported trying e-cigarettes, compared with 30.3% and 49.8% of their straight counterparts.
“Tobacco use is a singular health threat to LGBTQAI+ communities,” said Kristy Marynak, a senior science adviser at the Centers for Disease Control and Prevention and a co-editor of the report. “This report finds that nearly 1 in 5 of all deaths in the United States are caused by tobacco, and it shines a light on the disproportionate burden borne by certain communities, including LGBTQAI+ communities.”
Marynak noted that the study — and the federal government more broadly — considers products containing nicotine, including e-cigarettes, to be tobacco products. The exceptions, she said, are therapeutic products, like nicotine gum and patches.
Long-term research on the health outcomes of e-cigarettes is not available because the products are relatively new. However, there is clear scientific consensus concerning the adverse effects of some of the chemicals commonly found in e-cigarettes.
E-cigarettes produce a number of dangerous chemicals — including acetaldehyde, acrolein and formaldehyde — that can cause lung and heart disease, according to the American Lung Association.
Nicotine is also commonly found in e-cigarettes. Not only is nicotine addictive and likely to fuel anxiety or depression, it also can harm brain development, which occurs until age 25, according to the CDC.
Dr. Scott Hadland, the chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School, said he’s observed greater e-cigarette use among gay, lesbian and bisexual youths. He said that LGBTQ people use tobacco products at higher rates largely because of “long-standing stigma” within health care settings.
“LGBTQ+ people might be afraid to present for care to help support their quit attempts,” Hadland said. “They might be afraid to talk to their doctor about it because they’re afraid to go to the doctor in general.”
LGBTQ adults are twice as likely as their non-LGBTQ counterparts to report having had negative health care experiences over the last three years, according to a report published this year by KFF, a health care research nonprofit formerly known as the Kaiser Family Foundation.
Hadland also attributed higher e-cigarette use among LGBTQ Americans to marketing tactics, as is noted in the report.
Tobacco companies marketed directly to the LGBTQ community in the mid-1990s, including through “Project Scum,” which advertised Camel and Red Kamel cigarettes to “consumer subcultures” in San Francisco, according to the study.
Today, tobacco companies advertise in queer magazines and donate to organizations focused on promoting LGBTQ rights and Pride events, the report noted.
In 1964, the surgeon general’s office released its first report on the hazards of smoking and has since then dedicated vast resources to combat cigarette use. The new report shows that those efforts have largely been successful, as only 11.5% of U.S. adults reported being cigarette smokers in 2021, compared with 42.4% in 1965.
Still, 36 million U.S. adults and 760,000 middle and high school students smoke tobacco products, according to the report. Since 2014, the most commonly used tobacco product among U.S. youths and young adults is e-cigarettes.
“These and other noncombustible tobacco products such as nicotine pouches have the potential to undermine overall progress in preventing and reducing young people’s use of tobacco products,” the authors stated.
In June, the Justice Department and Food and Drug Administration announcedthey will create a federal multiagency task force to combat the illegal distribution and sale of e-cigarettes.
U.S. Sen. Roger Marshall, a Kansas Republican, has introduced a bill to deny transgender identity.
Marshall Wednesday introduced the Defining Male and Female Act of 2024, which a press release from his office calls “a bill to codify legal definitions of male, female, and sex to ensure they are based on biology rather than ideology.”
It would write a binary definition of sex into federal law. “In human beings, there are two — and only two — sexes: male and female, which refer to the two body structures (phenotypes) that, in normal development, correspond to one or the other gamete — sperm for males and ova for females,” the legislation says.
“Every individual is either male or female” and “an individual’s sex can be observed or clinically verified at or before birth,” it continues. “Rare disorders of sexual development are not exceptions to the binary nature of sex. In no case is an individual’s sex determined by stipulation or self-identification.” Gender should not be used as a synonym for sex or shorthand for gender identity or expression, the bill says.
Separate restrooms, locker rooms, and other single-sex facilities according to sex assigned at birth, plus separate sports teams and leagues organized in this fashion, “do not constitute unequal treatment under the law,” it goes on.
Marshall pointed to his experience as a medical doctor as justification for the bill. “As a physician who has delivered over 5,000 babies, I can confidently say that politicizing children’s gender to use them as pawns in their radical woke agenda is not only wrong, it is extremely dangerous,” he said in the press release. “I didn’t think we would need legislation to tell us that there are only two sexes: male and female, but here we are. We must codify the legal definition of sex to be based on science rather than feelings. With our legislation, we can fight back against the Biden–Harris Administration’s assault on our children.”
Actually, transgender identity is recognized as real by major medical and mental health organizations.
Marshall’s bill will likely go nowhere in the Senate, as Democrats still control the chamber until January. U.S. Rep. Mary Miller, an Illinois Republican, introduced a similar bill in the House of Representatives in July. It was referred to the House Judiciary Committee, and there has been no further action. However, such legislation may be a harbinger of what’s to come in the new Congress, with Republican majorities in both chambers under Donald Trump’s presidency. Marshall’s bill has the backing of right-wing groups Heritage Action for America (a sister organization of the Heritage Foundation, the group behind the anti-LGBTQ+ Project 2025), Concerned Women for America, the Family Research Council, and the Alliance Defending Freedom.
This is not Marshall’s first attack on trans people or LGBTQ+ people in general. In 2023, he introduced a bill to ban gender-affirming care for trans minors nationwide and one to ban federal funding for such care for trans people of all ages. Neither bill passed. He put out similar, equally unsuccessful, bills in 2021. In 2022, he led an effort to police LGBTQ+ content in children’s TV programs, which also went nowhere, as did his plan the same year to block school meal funding in protest of the Biden administration’s support for LGBTQ+ rights.
The introduction of his latest bill came on Transgender Day of Remembrance, an annual observance that commemorates trans people lost to violence.
West Virginia advocate Ash Orr said he’s rushing to legally change his name and update the gender marker on his passport.North Carolina lawyer Katie Jenifer is trying to prepare one year’s worth of estrogen for her transgender daughter. Oregon comedian and writer Mx. Dahlia Belle is focused on advocating for immigrants and people with disabilities.
This trio is among nearly a dozen transgender Americans, plus the parent of a trans teen, who talked to NBC News about how they’re readying themselves for the second administration of a president-elect who has promised to restrict their ability to modify identity documents, receive transition-related health care, enlist in the military and participate on sports teams, among other things.
Though trans people told NBC News they have a variety of concerns about President-elect Donald Trump’s campaign promises regarding trans people, nearly all shared a similar message: They are better prepared than they were eight years ago.
Heron Greenesmith, the deputy director of policy at the Transgender Law Center, who uses they/them pronouns, said they felt “clear-eyed” the day after the election, whereas in 2016 they were crying and felt devastated by the election results and the effect that Trump’s policies would have on marginalized communities, including trans people.
“This time around is not going to be any different,” Greenesmith said, “but this time around, I know what to do.”
Even though trans people had their rights targeted under the first Trump administration, Greenesmith added, “we also thrived.”
“We provided safety for ourselves and mutual aid, we defended ourselves from criminalization and got ourselves out of jail when we needed to — and provided health care for folks who needed it.” said Greenesmith, who is based in Massachusetts. “We’ll do the same thing again. We got us.”
Day 1 promises
During his campaign, Trump and his supporters spent nearly $60 million on eight anti-trans network-TV ads, one of them in Spanish, between Sept. 19 and Nov. 1, according to AdImpact, a firm that tracks political ad spending.
He has supported a number of policies targeting transgender people, who make up less than 1% of adults in the U.S. At campaign rallies over the summer, he promised to take at least two actions regarding the trans community on his first day in office: undo Biden administration Title IX protections that allowed trans students to use the school bathrooms that align with their gender identities, and cut federal funding for schools “pushing critical race theory, transgender insanity and other inappropriate racial, sexual or political content onto the lives of our children.”
Trump also promised to reinstate a policy enacted during his first term that barred trans people from enlisting in the military and to institute a new policy barring transition-related care for minors nationwide. The agenda on his websitesays he would declare that any hospital or clinician that provides transgender care to minors would “no longer meet federal health and safety standards for Medicaid and Medicare — and will be terminated from the program immediately.”
The president-elect’s agenda also includes issuing guidance to federal agencies to define sex only as one’s sex assigned at birth, which would make it harder for trans people to change the gender markers on federal documents such as passports.
Plans for IDs, moving and medical care
The State Department began offering the gender-neutral “X” marker on passports, in addition to the standard “M” or “F,” in April 2022, but a new federal definition of sex could end that policy, legal experts say. If the Trump administration still allows trans people to change the gender marker on their passport, Greenesmith said, it might require them to provide proof of gender-reassignment surgery, putting gender-marker changes out of reach for the majority of trans people.
As for those who already have a passport with an “X” gender marker, if the Trump administration discontinues issuing new “X” passports, the future of those existing identity documents is unclear, according to both Greenesmith and Sasha Buchert, the director of the nonbinary and transgender rights project at Lambda Legal, an LGBTQ legal advocacy organization. There is no existing policy that would allow the government to require people to turn in “X” passports, for example.
“In response to what needs to be done in this moment, now is always a good time to update any identity documents that you need to update,” Buchert said.
A person fills out a passport application with an X gender marker at their home in Virginia in 2022.Stefani Reynolds / AFP via Getty Images
Ash Orr, who lives in Morgantown, West Virginia, and is the press relations manager for Advocates for Trans Equality, the nation’s largest trans rights organization, said the election prompted him to legally change his name. His name-change hearing is scheduled for Jan. 15, and he plans to apply to update his passport as soon as his name change is complete.
He also plans to leave his home state by the spring as a result of the election, and because West Virginia’s state politics have become increasingly conservative in recent years. He declined to share the state he and his partner are moving to due to safety concerns, noting he has received an increasing number of threats over the past two years.
“West Virginia is my home, and it has always been my home, and I’ve had to come to the realization that your home isn’t always a place where you can thrive,” Orr said, adding that he’s struggled with the feeling that he’s abandoning his community and the trans people in the state who can’t afford to leave.
Finn Franklin, a 20-year-old who is finishing his associate’s degree at Rogue Community College in Grants Pass, Oregon, said the election has affected where he plans to apply to finish a four-year degree.
“I was looking at some rural schools because I like the smaller school size,” Franklin said. But after the election, “I’m not going to be applying to schools outside of the West Coast because I don’t want to live somewhere that is not Washington, Oregon or California for the next four years. I think I want to be in a metro area because of the typical politics difference between urban and rural areas, and access to health care.”
Finn Franklin, 20, said the election has affected where he plans to apply to finish a four-year college degree.Courtesy Finn Franklin
Franklin said he receives his testosterone through telehealth offered by Oregon Health & Science University Hospital, which is in Portland, about five hours north. He’s worried about how the incoming administration could affect that treatment, as well as a top-surgery consultation he has scheduled in October 2026, because he receives health care through the Oregon Health Plan, the state’s Medicaid program. OHSU Hospital, which has a program that provides gender-affirming services to children and teens, could be affected if Trump follows through on his promise to cut Medicaid funding for hospitals that provide transition-related care to minors.
“If the funding for those kinds of things goes away, then it kind of becomes utterly inaccessible, and that’s definitely very scary,” Franklin said.
North Carolina lawyer Katie Jenifer said she is trying to secure a year’s worth of estrogen for her 17-year-old daughter, Maddie, in case Trump does issue federal restrictions that could curtail access to transition-related care for minors nationwide. Her daughter’s doctor prescribed her enough medication for a year, but their insurance will only cover one month at a time. Out of pocket, the medication costs $109 a month, but Jenifer received a coupon from the pharmacy that brings the cost down to $49 per month.
Katie Jenifer and her transgender daughter, Maddie, at the White House for a Pride Month celebration in June.Courtesy Katie Jenifer
Jenifer previously told NBC News that she had plans to move with Maddie out of the state or out of the country depending on the election outcome.
“If I can get enough medication on hand to get Maddie to 18, then we will try to stay through high school graduation in June and continue to monitor and make plans to exit soon after or before if necessary,” Jenifer said Tuesday. “If we cannot get the needed meds, then we will probably try to leave mid- to late January. Where we go will depend on my job search.”
Advocates say the election is already having an effect on LGBTQ young people, in particular. The Trevor Project, an LGBTQ youth suicide prevention and crisis intervention organization, saw a 700% increase in crisis contacts in the 24 hours after the election compared to weeks prior. About one-third (30%) of the contacts identified as LGBTQ young people who are Black, Indigenous or people of color, and more than 40% were trans or nonbinary young people, a spokesperson told NBC News.
Organizing within community
Some trans people told NBC News that after the election, they immediately started organizing with local community groups.
Orr, for example, said he planned to volunteer with Holler Health Justice, a reproductive health organization led by queer people of color, to deliver emergency contraception and other reproductive health supplies across West Virginia.
Bennett Kaspar-Williams, an entertainment lawyer based in Los Angeles who is skilled in martial arts, said he is working with other local activists to organize self-defense classes for LGBTQ people and women in response to increased fears of violence given Trump’s rhetoric about trans people.
Bennett Kaspar-Williams is organizing self-defense classes for LGBTQ people and women in Los Angeles.Courtesy Bennett Kaspar-Williams
Ahead of the 2020 election, he said, he volunteered for Democrats because at the time he was pregnant, and, as a trans man, he was afraid of what the future would look like for his child if Trump were re-elected.
“If you had told me that in four years he’s going to win again, I definitely would not have believed you,” he said. “I feel really scared for the generation of people who were waiting until they were old enough to be able to start a medical transition, who are now facing the possibility of never being able to do that at all, and what that means for them.”
Many trans people also mentioned giving directly to mutual aid groups, specifically those that support trans people of color.
Aldita Gallardo is the the director of the Action for Transformation Fund, a partnership between the Transgender Law Center and the Emergent Fund, a national rapid response fund that supports groups led by LGBTQ people of color. The $1 million Action for Transformation Fund was a pilot effort to move funds directly to trans activists working within their local communities. Gallardo noted that foundations that provide money to LGBTQ communities allocated less than 4 cents per $100 of their total giving to U.S. trans communities and issues, according to a 2021 report by Funders for LGBTQ Issues.
Gallardo, who is based in Oakland, California, said the Action for Transformation Fund, which launched in September and just made its first round of grants, wasn’t previously thinking about long-term fundraising, but that changed after the election.
“Now we see it as an opportunity to bring more dollars for the increasing amount of need,” Gallardo said. “We know that things will escalate in the four years of the administration.”
Some of the groups that were supported by the fund’s first round of grants include House of Tulip, which provides housing to trans people of color in Louisiana; Transgender Advocates Knowledgeable Empowering, or TAKE, which provides services to trans people of color in Birmingham, Alabama; and the Unspoken Treasure Society, a Black, trans-led organization in Jacksonville, Florida.
Mx. Dahlia Belle, a comedian and writer based in Portland, Oregon, who also works as a peer support operator for a trans nonprofit, encouraged trans people to support those outside of their immediate community as a second Trump administration begins. She fears her job with the trans nonprofit could “cease to exist” if Congress passes a bill that would allow Trump to target nonprofits’ tax-exempt status. If that were to happen, she could lose access to health care. Still, she said she still feels comparatively safe and privileged.
Mx. Dahlia Belle said she’s focused on advocating for immigrants and people with disabilities.Courtesy Dahlia Belle
“We as a community are facing a very real existential threat,” Belle said. However, she added, “in the grand scheme of things, the threat we are facing pales in comparison to the immediacy and severity that will be faced by immigrants and people with disabilities and people who may be in need of reproductive care.”
She acknowledged that trans people and LGBTQ people more broadly fit into all of these categories and said it’s “those intersections of identity where I feel our advocacy is most needed and needs to be focused.”
Donald Trump is reportedly planning to reinstate his trans military ban through executive order on his first day in office. Reports say the president-elect will not only bar trans people from joining but also that he plans to medically discharge the 15,000 trans personnel who are currently serving.
If carried out this way, the ban will be significantly harsher than the first time he banned trans people from the military in 2017, when trans people already serving were allowed to remain in their positions. Because the military is already experiencing recruitment issues, experts are worried the policy will significantly impair military readiness.
“These people will be forced out at a time when the military can’t recruit enough people,” an anonymous source told The Times.“Only the Marine Corps is hitting its numbers for recruitment and some people who will be affected are in very senior positions.”
“Should a trans ban be implemented from day one of the Trump administration, it would undermine the readiness of the military and create an even greater recruitment and retention crisis,” added Rachel Branaman, executive director of Modern Military Association of America, “not to mention signaling vulnerability to America’s adversaries.”
“Abruptly discharging 15,000-plus service members, especially given that the military’s recruiting targets fell short by 41,000 recruits last year, adds administrative burdens to war fighting units, harms unit cohesion, and aggravates critical skill gaps,” she continued. “There would be a significant financial cost, as well as a loss of experience and leadership that will take possibly 20 years and billions of dollars to replace.”
A trans officer in the U.S. Air Force who also chose to remain anonymous expressed worry about filling highly skilled positions. “There are very few members of my career field with this experience, and in the event of a large-scale contingency, it would be difficult to replace the level of experience that I bring to the table.”
Trump-Vance transition spokesperson Karoline Leavitt denied that Trump has any concrete plans to ban trans military members. “These unnamed sources are speculating and have no idea what they are actually talking about. No decisions on this issue have been made. No policy should ever be deemed official unless it comes directly from President Trump or his authorized spokespeople.”
The Obama administration opened up military service to transgender people in 2016, but in 2017, Trump announced a trans military ban via tweet. “Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail,” Trump declared.
How the ban would be implemented was unclear, since Trump had given the Pentagon no heads up that his tweet was coming.
Trump consulted no military experts before announcing the ban. Though he claimed that trans healthcare was too expensive for the military, it was revealed that the military spends $41.6 million annually on the erectile dysfunction medication Viagra, around five to 20 times what it costs to fund trans-related healthcare.
President Joe Biden reversed the ban when he took office in 2021.
