The federal war on trans healthcare mirrors that of abortion

On January 13, UW Health announced that it will no longer provide puberty blockers, hormone replacement therapy, and other services to transgender minors in response to the Trump administration’s recent threats against hospitals providing these services. With Children’s Wisconsin’s Milwaukee Campus following suit, no more hospitals in Wisconsin offer gender affirming care for minors.

Patients and their parents are now scrambling to fill in the gap.

C, the parent of a trans child who wished to remain anonymous for this article, says that they found out that they would no longer be receiving medical care in a Signal screenshot, not from their doctor.

“I sat down immediately and pulled up my chart and shot off a message to my child’s provider, like ‘hey I’m seeing this screenshot going around, what is the reality of the situation?'” says C. “There was no heads-up to parents before this happened.”

They were not the only family who found out this way. Immediately following the news, impacted families took to social media to express their dismay and confusion.

Thad Schumacher, owner of Fitchburg Family Pharmacy, found himself pushed into action. On Facebook, the pharmacy made a post promising the continuation of trans youth healthcare and filling of prescriptions.

“We found out about [the policy change] about a week before it came out to the public,” says Schumacher. “Our patients in the pharmacy told us they received phone calls from their provider explaining that they weren’t going to be there for them anymore. That prompted me to make a statement on social media, letting people know that there are other providers in the community that would take care of them.”

Schumacher noted the influx of new pharmacy patients after the news. Though the clinic currently has only one physician on staff, they’re prepared to scale up if need be.

“We are determined to meet whatever need comes along,” says Schumacher. “The thing that’s holding us back from a larger group of providers, is the amount of patients we have. So if we have more patients, we have more providers. We have room to grow for sure.”

Trans community aid

While Fitchburg Family Pharmacy is not the only private clinic in Dane County offering gender-affirming care for minors, according to Schumacher, many of the clinics do not take insurance, and instead operate on a health membership system. It goes without saying that patients who are on a Medicaid plan might not have much, or any money at all, to spend on healthcare.

“We are lucky,” says C. “We are privileged to have really good insurance, so it’s not cost prohibitive to us. [For others] there are funds being collected by Community Pharmacy and other groups.”

The last decade has seen the flourishing of both formal and informal trans community aid networks. Parents share information and resources with each other and provide support when state and federal governments fall short.

“[This has had a toll] especially on the kiddos,” says Schumacher. “They’re constantly bombarded with negative stuff; for a group that’s less than one percent of the population they’re in 99% of the conversation.”

The question is why healthcare organizations are complying with an increasingly illegitimate and unpopular administration. The playbook being used by opponents of transgender healthcare is one we’ve seen before.

Harm of the Hyde Amendment

With the overturning of Roe v. Wade in 2022, the entire ecosystem of abortion clinics was thrown into disarray as previously existing laws that heavily restricted abortion went into effect. Some Republican-controlled states immediately passed laws to tighten them even further. The existing clinics in states where abortion remained legal were met with an influx of patients from neighboring states, those who could afford to make the journey.

The clinic system that exists today is because of the Hyde Amendment, a 1977 law that prevents federal funds being used for abortion. Upheld in 1980 by the U.S. Supreme Court, it has shaped natal care in this country. Patients on Medicaid are often unable to obtain coverage for abortions except in cases of rape or incest; states are able to freely ban Marketplace plans from providing coverage. Laws against abortion are designed to punish those who have the least amount of resources, the ones who can’t afford to take time off to cross state lines.

Wisconsin found some relief last year when the Wisconsin Supreme Court ruled that an 1849 state law did not in fact ban abortion. A huge victory for abortion rights advocates, but the question of whether or not the law is constitutional still remains.

The minefield of state laws

The parallels between the current political situation and the history of abortion access in the country aren’t just noticed by progressive advocates—they’re explicitly invoked by conservatives. When House Republicans pushed for a nationwide ban on the use of federal funds for gender-affirming care, Texas Republican representative Dan Crenshaw affectionately referred to it as “the new Hyde Amendment.”

“I am familiar with reimbursement, and the way I view it is that they’re pitting two vulnerable populations against each other,” says C. “Our family is from Kentucky. There are a ton of rural hospitals that have closed in my home state. They know that if these large healthcare centers lose Medicaid, Medicare reimbursement will tank these entities. And, ultimately, those are the folks who will suffer, in addition to trans kids that are losing care.”

Trans people are also intimately familiar with this country’s patchwork of state laws, with recent pushes for anti-trans legislation creating an exodus of trans people from conservative states to more progressive cities. Wisconsin’s status as a quasi-refuge for transgender people only lasts as long as it has a governor who’s willing to veto what comes out of the legislature.

“It’s been our policy that we tell our kids what’s going on, we tell them about what’s happening,” says C. “You know, they’re online they’re looking stuff up, but they do ask us, ‘I’m seeing this; is it true?'”

C’s youngest child transitioned at an age when puberty blockers were ineffective; if they’d want to start testosterone, they would have to go to a different state. Up until last year, their youngest identified as non-binary.

“Last summer, my youngest put together a PowerPoint [coming out] and set it down on the kitchen table,” says C. “They showed it to me and I was like, ‘OK, cool! How do you want to approach this?’ Of course at the same time I was like, ‘I don’t know what’s going to happen here.'”

With the grim political backdrop, C’s child is still going through the process of deciding who they are.

“It was in the back of my mind when they did decide to come out,” says C. “When [Trump] was elected, I knew there was going to be trouble.”

Despite a strong network of aid and advocacy, the present situation surrounding abortion rights remains just as tenuous as in 2022. Or in 1980. They reflect the shambolic state of natal healthcare in the United States in general–when funding for care is divested, and patients become victims of austerity politics. The United States has among the highest maternal mortality rates for ranking among the world’s wealthiest countries. It’s a place where your class and race determine the quality of care you receive, in all too many cases, and whether you live or die.

We all deserve better. Our children need not inherit the system we grew up in.

The U.S.’ regressive system

The common refrain from allies is that cisgender children undergoing precocious puberty still have access to blockers; puberty in these situations is acknowledged as distressing for these patients, but the same logic is not extended to transgender youths, many of whom already deal with the dysphoria that worsens with the onset of puberty. This misses the crux of the issue; reactionaries don’t actually care about medical interventions on children, as long as the children match the sex that was “intended” for them. Intersex children are operated on, then lied to and betrayed by their parents, a violation of bodily autonomy.

The fact that this practice is still commonplace today should be an indictment of the system. Instead of righting this wrong, the fact that this government pushes conversion therapy and pseudoscience should tell you all you need to know.

Crenshaw’s amendment in the One, Big, Beautiful Bill Act explicitly makes an exception to “rectify early puberty, genetic disorders, or chromosomal abnormalities” or “reverse prior gender transition procedures.” Intersex children are free to be “corrected” by their parents through medical means, but those same children have no recourse for what was done to them except to wait for adulthood.

This amendment never made it into the final bill, but it is a clear indication of where things are heading. Those who are opposed to the liberty of gender non-conforming people will use every tool at their disposal to cause harm.

Preventing puberty in transgender or non-binary adolescents is considered an “off-label” use of the medication. Of course, so is the use of HRT for gender-affirming therapy generally, in both minors and adults. Trans people are at the mercy of a mercurial medical system that often treats the patient as untrustworthy; every trans person, adult or youth, could tell a story about a doctor wielding enormous power over their lives. Even well-intentioned doctors make mistakes. It is an environment ripe for discrimination and abuse, and if nothing fundamentally changes, it will remain that way.

Shortly after Schumacher’s post became popular on Facebook, his clinic briefly became the target of far-right influencer Libs of TikTok, an account operated by propagandist Chaya Raichik, notorious for promoting harassment toward LGBT people and their allies. Thankfully, the attention was short-lived.

“It’s like a five-second cycle with that group of people,” says Schumacher. “[The response] has been overwhelming[ly] positive online. We’ve had people send us thank-you notes in the mail. We’ve had other providers send us thank-you notes.”

Abortion and trans rights are interconnected

There are those who will say that abortion rights and the rights of transgender people are incompatible, separate political issues. Those same people put the rights of women and transgender people in opposition with each other, who cheer on the systematic oppression of transgender people while their own rights disappear into vapor. They’re not separate issues. All people, children and adults, are the arbiters of their own bodies and should not be forced into a box to fit someone else’s design.

“I think it’s important to tell the story that the entities that are choosing to stop providing care are doing that on their own,” says Schumacher. “No one is making them do it, and the community knows that there are other providers out there who are willing to take care of them.”

Transition, much like abortion, evokes some of the same strong responses about what is natural and how people are and aren’t allowed to care for their own bodies. It is doubly complicated in a culture that often treats children like the property of their parents; an unwanted transgender or queer child is a defective good. The path of medicalization and puberty blockers is already a compromise in an unjust system, much like mail-in mifepristone and cross-state abortion funds. They’re stopgap solutions to profound deprivation.

“Who are you to get to make these choices for my child and for their body?” says C. “My child is not your property; my child is not my property. They are their own being, and it is their right to determine who they are, and it is our job to help them get to who they want to be.”