2025 Pride Month begins amid federal rollbacks on LGBTQIA+ rights and healthcare

The Buzz This Week

2025 Pride Month kicks off during a time when the rights of the LGBTQIA+ community are being challenged, and access to safe and equitable healthcare for the community is becoming increasingly difficult and restricted. The transgender community has been especially impacted in recent months as the Trump Administration implements legislation to deny their existence and limit their healthcare.

On the first day of the new administration, President Trump signed an executive order stating that “the United States recognizes only two sexes, male and female” and directed the federal government to “enforce all sex-protective laws to promote this reality” and “take all necessary steps, as permitted by law, to end the federal funding of gender ideology.”

Since then, researchers and scientists studying LGBTQIA+ health have received letters from the National Institutes of Health (NIH), informing them that some existing grants from the federal government were terminated, effective immediately, as their research no longer supported the agency's priorities. A fact sheet released by the White House in April said the Department of Health and Human Services (HHS) had terminated approximately 200 grants since January, totaling more than $477 million in research or education on gender-affirming treatment.

An additional executive order signed in January directs federal agencies and programs to work toward limiting access to gender-affirming care for people under the age of 19. The World Health Organization defines gender-affirming care as encompassing a range of “social, psychological, behavioral, and medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth.

In May, the Centers for Medicare & Medicaid Services (CMS) sent a letter to select hospitals that offer gender-affirming care services to children, requesting that they “provide details on how they obtain informed consent for pediatric patients, updates to clinical guidelines, documentation requirements for adverse outcomes and financial information, including facility- and provider-level revenue and profits.”

This letter came on the heels of a 400-page HHS review citing a “lack of robust evidence” supporting interventions like puberty blockers, hormone therapy, and the rare surgeries to treat gender dysphoria in minors. It instead advocates for psychotherapy to treat the condition.

Additional actions taken in recent months toward limiting healthcare access for the LGBTQIA+ community include:

A proposed rule aiming to change the Affordable Care Act coverage of gender-affirming care
Termination of staff at federal agencies focused on sexual and gender minority research
Removal of requirements that electronic health records include fields for patients’ sexual orientation and gender orientation
Termination of multiple HIV vaccine studies

The Supreme Court of the United States also agreed to review a case regarding whether local governments can enforce laws banning conversion therapy, interventions purported to alter same-sex attractions, or an individual’s gender expression with the specific aim to promote heterosexuality as a preferable outcome. The case is set to be argued in October.

Why It Matters

Experts in LGBTQIA+ health and research are concerned by the administration’s recent initiatives. In response to the HHS report, Susan J. Kressly, MD, President of the American Academy of Pediatrics, said her organization is “deeply alarmed” by its findings. She said the report “misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”

The American Academy of Child & Adolescent Psychiatry has said that evidence shows conversion therapies inflict harm on young people, including elevated rates of suicidal ideation.

The termination of valuable research projects and funding will only exacerbate health disparities in the community. Alex Keuroghlian, MD, an associate professor of psychiatry and LGBTQIA+ researcher said, “Research like this is crucial for building an evidence base that can allow doctors, policymakers, and sexual and gender minority people to work together to design better health care systems and to improve the health and well-being of everyone in our communities.”

LGBTQIA+ individuals experience higher rates of health disparities and are less likely to have a regular healthcare provider than the rest of the population. However, working with culturally competent, LGBTQIA+-affirming providers is associated with higher rates of annual checkups, flu shots, HIV tests, colorectal cancer screenings, and management of a chronic mental health condition. Access to gender-affirming care is associated with improved mental health outcomes for transgender people, including lower chances of depression and suicidality.

Currently, 26 states have banned gender-affirming care for minors, and 15 states strictly define sex based on reproductive anatomy, chromosomes, or hormones. Iowa became the first state in the country to rescind nondiscrimination protections for trans people. Federal court orders have blocked certain executive orders and other legislation from being fully enacted, and litigations are ongoing in some states with bans.

But efforts to limit access to and quality of care for these vulnerable populations continue. Such efforts stand to further compromise individuals already at increased risk for a multitude of health conditions.

Despite care restrictions, layoffs, funding cuts, and pending legislation, practitioners and researchers in the field remain dedicated to this community. Tara McKay, PhD, an associate professor and LGBTQIA+ researcher, said this field is more resilient than it might have been 10 years ago, and researchers are going to find a way to keep the science going.

Health systems and hospitals face difficult decisions based on the new rules and restrictions. Consequently, gender-affirming care may become concentrated in states that support it, leaving many community members with few local options and increased cost burdens to access care.