'I Would Feel Failed By the Medical Community Entirely': Transgender Americans' Calls for Advocacy From Health Professionals in a Care-Restricted World.

BACKGROUND

Gender-affirming care (GAC) improves the mental health, quality of life, and social functioning of gender-diverse patients. In spite of this, GAC in the United States (as elsewhere) has become a major focus of debate, with several federal policy changes enacted through Executive Orders and legislation creating major restrictions on transgender (trans) Americans' ability to obtain the care they need.

OBJECTIVE

We aimed to understand how trans Americans are responding to the anticipated changes in their access to GAC and to provide healthcare professionals with strategies to support this population in an environment of restricted access.

DESIGN

We surveyed trans people in the United States to elicit their concerns and planning considerations. We used descriptive statistics to characterise coping strategies and content analysis to describe support strategies that the trans community requested from the healthcare community.

SETTING AND

PARTICIPANTS

We recruited participants from December 2024 through March 2025 using snowball sampling and direct outreach to LGBTQ+ organisations. Participants self-identified as trans and were 18 or older.

RESULTS

Of 157 respondents, 96.2% (n = 151) expressed concern about access to GAC. We describe five strategies for healthcare support: mental health support/suicide prevention, financial support, connections with community organisations/mutual aid, GAC education, and advocacy.

DISCUSSION: The current politicisation of transgender healthcare is affecting trans people, with the vast majority concerned about barriers that will make this care unattainable. It is essential for clinicians to understand the responses to these policy changes from the trans community and to act on their calls for support.

CONCLUSIONS

Healthcare providers stand at a crossroads with the trans community. If clinicians fail to stand up for the rights of trans patients, we risk irrevocably harming the medical trust and long-term health of the trans community.

PATIENT OR PUBLIC CONTRIBUTION: Patients and people with lived experience were heavily involved in the design, conduct, and analysis of this study. The authorship group included a range of gender identities and expressions, including people accessing GAC as patients and clinicians providing GAC. Analysis was guided by participant feedback and iterative discussion among the authorship group.