A few weeks after Donald Trump won the United States presidential election, Wesley Hiester and his mother went to see Hiester’s doctor to ask about stockpiling a larger supply of testosterone.
The 17-year-old, who started hormone therapy when he was a high school first-year, was concerned restrictions could be placed on the gender-affirming treatments he received. He wanted to be prepared.
This week, Trump issued an order barring federal funding of gender-affirming care for people under the age of 19.
The executive order directs agencies to halt grants and other funding that could be used for hormone therapy, puberty blockers or surgeries for transgender children. It also directs the US Department of Health and Human Services (HHS) to review the terms of publicly funded coverage under Medicare, Medicaid and the Affordable Care Act to shrink gender-affirming care.
The order would prevent those recipients from being able to receive the treatments and have a chilling effect on providers willing to offer gender-affirming care, doctors and legal experts said.
It is beginning to be challenged by lawyers and lawmakers nationwide, including New York and California.
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“Going into Trump’s presidency, we all knew what his agenda was,” said Hiester, who lives in West Chester, Pennsylvania.
“I wasn’t shocked, but the worst is he raised the age to 19, so I have another year to worry about this. I’m a senior. I’m committed to college. I should be enjoying every single moment, but, first with the election and now this, it’s really hard to focus on the good things.”
Hiester has private health insurance and believes he will still have access to his hormone therapy for now – but he and others in the transgender community are concerned the order, depending on how it is interpreted, will threaten that access. The larger effect Hiester and others have stressed is the mental and emotional toll as Trump’s directives pile up.
One of Trump’s most vocal promises on the campaign trail was to end gender-affirming care. On his first day in the White House, he declared his administration would recognise only two genders. A slew of executive orders targeting transgender people followed.
The order about minor care – titled “Protecting Children From Chemical and Surgical Mutilation” – describes widely medically approved transgender care in inflammatory and misleading language, claiming children are being “maimed” and “sterilised”.
While the order suggests this medical treatment is routine, very few minors undergo surgery to affirm gender, and only a tiny percentage of the adolescent population seek gender therapies.
Gender-affirming care for children and adolescents has been deemed medically appropriate by the American Academy of Pediatrics and other major US medical and mental health organisations. Research shows young people with gender dysphoria suffer higher rates of suicide, self-harm, depression and anxiety.
Gender-affirming care broadly refers to medical services intended for people whose gender identity does not match the gender they were assigned at birth. Care could range from voice coaching and hair removal to hormone therapy and surgery.
Trump’s order applies explicitly to chemical – such as hormonal treatments – and surgical therapies. Conservative lawmakers’ defence of gender-affirming care bans often argues some therapies are irreversible and could come with side effects such as the risk of fertility loss.
But researchers and medical professionals say there needs to be more research to confirm the accuracy of any side effects, and LGBTQ advocates note that de-transitioning is extremely rare.
“His order has the potential of making gender-affirming care very difficult, near-impossible, to get even for adults and more specifically for adults who are financially or otherwise already underserved and already marginalised,” said Shanin Gross, a family medicine doctor in South Jersey who specialises in gender-affirming care.
A primary concern is that medical institutions providing care to transgender youth could lose federal funding for research or education grants.
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Gross worries the order’s restrictions on Medicaid and Medicare could discourage doctors from providing gender-related care through the government-funded programmes that provide health coverage for low-income children and families, people with disabilities, and seniors.
“I think the goal behind the executive order and its intentionally broad and vague writing is to frighten as many health systems and individual providers as possible into thinking that they will lose funding or otherwise be unable to conduct business,” Gross said.
“And the implication of government officials with no medical training controlling what medical treatments we are allowed to have is terrifying and something we all should want to avoid.”
As Trump ends his second week in office, Hiester is trying to focus on school, playing tennis and his job as a lifeguard. In autumn, he’ll head to college in Washington, where he wants to study education. He is inspired by teachers who supported him over a tough last four years.
“The larger impact of all this is just how much hatred there is … that can have such an effect on, especially, younger trans people,” Hiester said. “People who are just trying to live their lives.”
