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Previewing LGBTQ public health under new Trump administration

Experts discuss everything from PrEP access to blood donation

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1 year ago

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Recent years have seen major inroads in the fight against HIV, including through the development of new preventative medicines that have become more affordable and accessible thanks in part to government interventions like the Affordable Care Act’s federal health insurance coverage and cost-sharing mandates.

Over the past four years under the Biden-Harris administration and U.S. Health and Human Services Secretary Xavier Becerra, health policy has focused to a significant extent on health equity, including for LGB and trans or gender diverse populations.

President-elect Donald Trump’s record from his first administration, plans laid out in the Heritage Foundation’s Project 2025 governing blueprint, and the policies championed by voices closest to him offer a roadmap for how the federal government is likely to approach public health issues important for the LGBTQ community in the second term.

Speaking about these matters with the Washington Blade earlier this month were two experts from the Human Rights Campaign, Torrian Baskerville, who serves as director of HIV and health equity, and Matthew Rose, the organization’s senior public policy advocate.

Appointments  

The discussion happened before Trump’s nomination of Robert F. Kennedy Jr. to serve as HHS secretary, Dave Weldon for director of the Centers for Disease Control and Prevention, and Marty Makary to lead the Food and Drug Administration.

“HHS will be very important for us,” Rose said. “Who they put at the Office of Civil Rights at HHS will be incredibly important for us. The assistant secretary for health has, under Democratic administrations, and in Republican administrations, been a champion for us, sometimes” like Trump 1.0’s Assistant Secretary for Health Admiral Brett Giroir, who “did what he could for us.”

He continued, “This is the first time that CDC requires, will require, a Senate-confirmed person, and so that is going to be something to watch. I’m not as concerned about NIH always, unless they find someone really, really crazy to take over. FDA is a worry because it could change just how we view drugs and drug regulations and how those get approved.”

Rose added that he is “always watching OMB, because the people who make the budget decide how money gets spent” and it remains unclear whether the new administration will see a new director of the Office of National AIDS Policy.

Concerns

“I know a lot of people, particularly LGBTQ folks, who are like, ‘oh, shit. We are in trouble,'” Baskerville told the Blade. “And what does that mean for my care? What does that mean for” people who are saying, “I’m a Black trans woman who’s living with HIV — these proposals that folks are talking about, particularly out of Project 2025 and Trump, and the rhetoric — how does that impact me?”

“While we are desiring and hoping for the best,” Baskerville said, “the reality is that things that we have seen, at least the rhetoric, hasn’t been hopeful. And so we’re just hoping that there are guardrails in place that help to maintain and control as best as possible some of the things that may be going on.”

He added, “As a community, we’re really just thinking like it’s going to be a shit show, but what does that mean for us? How do we persevere through and what do we need to do to hold him accountable, hold his administration accountable, and continue the fight of advocacy?”

Baskerville said his biggest concern is “safety” and the ways in which the “Trump administration is going to challenge folks’ ability to feel safe” whether based on their immigration status or gender or sexual identity.

“Trump, in his rhetoric, has emboldened folks with different ideals and opinions to really lean into some of the hatred and the bigotry and the things that challenge and impose difficulties on folks’ safety,” he said. “If folks aren’t feeling safe at home, if they’re not feeling safe in their communities, they’re not going to access any of the health care, or any of the other things, and feel like they’re empowered to do that.”

In the case Braidwood v. Becerra, the Biden-Harris administration has defended the principle that the U.S. Preventive Services Task Force can make coverage determinations about preventatives like pre-exposure prophylaxis (PrEP), which is taken to reduce the risk of HIV transmission.

Under the next Trump administration, “We’re actually very concerned about the government reversing its role,” Rose said, which could jeopardize coverage mandates for contraceptives, too. “Changing the position on Braidwood is pretty quick and easy for them to do. They can pull out of that pretty fast.”

“It’s a whole sweep,” he said. “Like, the argument is that the U.S. Preventive Services Task Force is not an assigned body and voted on and thus they should not have prescribing authority to set standards, and that whole piece has been sent back to the district court” from the U.S. Court of Appeals for the Fifth Circuit.

“Nobody wants to pay for preventative medicine, is what they are trying to say,” Rose explained. “And that the government doesn’t have a right to tell us what the preventive medicine is. And then they asked [for the court to strike down] the whole ACA, which was just fantastical. But it’s still an active case, and we don’t know what’s going to happen if the U.S. government switches its position on it. I imagine that state attorneys general, who have been tracking the case, would step in, but we’ll have to see what their capacity looks like.”

“Our argument has always been that if you want to have your religion, that’s fine, but you don’t get to use government dollars to discriminate,” Rose said. “And if you want to have the government plan, and you want a government support, you can’t discriminate against people. If you wanted to set up your own private system, that’s on you, but you don’t get to take public dollars and do that with them.”

With respect to PrEP as well as other public health matters, Rose noted some other reasons for concern — including “some things in Project 2025” that indicate there will be “greater deference to all things like religious exemptions and conscience clauses and whatnot,” though he said it is unclear how far the next administration would be able to take this.

Trump 1.0

“Some of their biggest health people aren’t all anti-PrEP,” Rose said. “The HIV community has continuously reminded Republicans that Donald Trump did create the Ending the HIV Epidemic initiative that has helped move the needle. And so there is some promise there. They aren’t all full-on, like, anti-PrEP all the time, but they are wary of it.”

He added that while officials in Trump 1.0 were not “the biggest fans of the CDC,” they were “fighting so many other battles” that they were unable to substantially reorient the public health agency.

“They didn’t go back to some of the regressive years of, like, no promo homo, where you could not talk about gay people or anything that made gay life seem like a good thing,” Rose said.

“There were more Bush people back then,” he said, a lot of whom “still have the legacy of doing PEPFAR with the president,” like Giroir, who “worked on pediatric AIDS as part of his career, and so he was willing to push for some things that we wouldn’t have seen otherwise.”

Rose added that “that’s how he” and longtime National Institute of Allergy and Infectious Diseases Director Anthony Fauci “got together and worked to create, with the Trump people, the Ending the HIV Epidemic initiative.”

“At the same time, those same people who said, ‘wow, these HIV numbers are really bad and we should do something about it’ we’re like, ‘but we hate all these LGBTQ people and their health, and so we’re not going to have any non-discrimination [rules], and we don’t care if we kick them off their health care, and we don’t care if they’re invisible in society,” Rose said.

This is a problem, he said because “given where the epidemic has always been in the community, it’s hard to end the HIV epidemic without talking about LGBTQ people and the resources that we use in the community, and the lives that we live, and the lives that we have.”

“And so, it ends up being this weird place of like, you have these religious, fundamentalist nationalists who want one thing; you have these quasi-public health people who are like, ‘oh, the private sector can help;’ and you have these government people who are like, ‘we’re not spending any new money,'” Rose said.

“I will say that, despite his saying he was supportive, every budget produced by [Trump] when he was in office decimated funding for the CDC and HRSA and HHS in all of the HIV line items,” Rose said. “So, he didn’t wholesale eliminate anything, but he shaved those things down to bare bones.”

Timing

Asked whether the FDA under Trump would be likely to consider rolling back the expanded guidelines on blood donation for men who have sex with men, Rose said no.

“One, it’s very small potatoes for them,” he said. Plus, “because it was done through formal rule making, it would take a lot of effort to roll it back” and the guidelines — while they are substantially better than the categorical ban on blood donation by gay and bisexual men that persisted for decades — are not exactly perfect.

At HRC, Rose said, “we would say [the policy is] still not in a perfect place, because it still requires a level of deferment that is not the same for heterosexuals who engage in the same sexual activity, where data could just tell you and you’re going to test the blood anyway.”

More broadly, Rose said, “I think about what levers can they pull when. Like, dismantling the Affordable Care Act is going to take a while. He has ‘concepts of a plan,’ but until he gets rid of concepts and actually has a plan, no one’s buying that.”

The proposal for “block granting Medicaid” is also unlikely, Rose said. “Medicaid is one of the largest payers of HIV services, both for treatment and prevention, because there’s just a lot of low-income people on Medicaid and the poverty tracks are similar to the HIV tracks. So changes to the Medicaid program, I worry about like things like work requirements, which they’ll try again. That will happen faster than block granting.”

Timing-wise, Rose said, “For health, there’s just a lot of regulation to get through” so, “we’ll have less acute pain than some of the immigration stuff” where the administration will “hit the ground running on day one.”

At the same time, he added, for people living with HIV who are in mixed-status families, or who are undocumented, there will be a “chilling effect” that “will happen really soon, or could happen really soon,” which is “something I worry about the most, right away.”

PrEP

Changes to America’s healthcare governance come as the outgoing administration has pushed to expand access to preventative medicine for reducing the risk of HIV transmission, which follow major advancements in drug discovery.

“There is a new version that Gilead Sciences is putting up, lenacapavir,” Rose said, which is administered twice per year with a subcutaneous self-injector. The drug ” will have a different name when it comes to market, just like cabotegravir became Apretude,” he said.

“The coverage determination that the administration just released last month covers all PrEP products,” Rose said. “It happens to cover all three of them right now. Technically, it’s just a clarification of the existing rule already.”

He continued, “The ACA already required that you provide any Grade-A rated, preventative service at a zero cost sharing. And this clarification just says, ‘Hey, you were supposed to be doing this. We heard some of you aren’t doing this. If you want to sell in the marketplace, you have to do this.’ We saw the same [thing] with contraceptives also had to have this clarification.”

PrEP enjoys the rare distinction of being a drug regimen that is covered along with preventative services like mammograms, Rose added.

“In the early days of PrEP, we made the case to insurance companies that they should cover it,” he said, because “from a financial standpoint, at the time it was $16,000 a year for Truvada, which now has gone down with the generic. It’s around $18,000 for Descovy, but that is still cheaper than the overall cost of [HIV] treatment a year, which is, you’re looking at $62,000 plus additional medical expenses and costs.”

“Without guidance from the government, it was kind of a free range and the insurance companies said, ‘well, we’re going to put in prior authorizations to cost-control this,'” Rose added.

Baskerville detailed how HRC will continue to serve populations impacted by HIV.

“One of our biggest initiatives around wellness and action is our HIV self-testing kit program, understanding that there is a group of communities who will not go into a brick and mortar house and get tested,” he said. “And so providing them with another option” is important, and so on this initiative “we partner with seven community-based organizations across the U.S. mainland, and Puerto Rico, to distribute testing kits throughout the country.”

“In that partnership we have also worked with CVS Health,” Baskerville added. “What’s different with our program than other self-testing kit programs is that all of our partners also work to do a follow-up, so a navigation piece, once they distribute a testing kit, following up with them to see one, have they taken the test? If they have not taken the test, figuring out what barriers are in place, to get them to take the test and addressing those barriers. And then if they have taken the test, figuring out what their result was, and then connecting them to either care, if it was a reactive test, or connecting them to PrEP services if it was non-reactive.”

Baskerville continued, “We also have our leadership development program where we work with different populations over a course of six months to educate them around health equity, HIV, to then empower them to go into their communities, to help them be spokespeople and be advocates for HIV and help their community get the services that they need. This year, we particularly work with Black, sexually minoritized men living with HIV at the intersection of mental health, understanding that post-coming out of COVID, there have been a lot of issues with mental health things and depression and anxiety among populations.”

Additionally, “we have our public education sexual health platform, which is our My Body My Health” portal, Baskerville said, “where we provide all sex-positive, body-positive sexual health education as well as resources.”

“We’re currently developing what we call an HIV service provider index, and that is to assess service providers and their quality of service provision as it relates to providing HIV services to individuals, particularly Black and Latin LGBTQ community folks,” he said. “And so we’re utilizing that because we hear stories all the time around folks going to their providers and being denied PrEP or being told they can only get one particular version of PrEP when they want something different. It should be completed and developed by the end of February 2025, with implementation expected to happen kind around May – June.”

“We are constantly working with our federal partners to ensure that community’s perspective and the voice of community is is a part of the conversations when they’re thinking through policies and procedures,” Baskerville said.

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Federal Government

Texas Children’s Hospital reaches $10 million settlement with DOJ over gender-affirming care

Clinic specializing in detransition care will be established

Published

6 days ago

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May 19, 2026

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Justice Department in D.C. (Washington Blade photo by Joe Reberkenny)

The Justice Department announced May 15 that it has reached a settlement with Texas Children’s Hospital, one of the nation’s top pediatric hospitals.

Under the agreement, the hospital will pay more than $10 million in damages and civil penalties related to its provision of gender-affirming care and will establish a clinic specializing in detransition care.

The DOJ partnered with Texas Attorney General Ken Paxton’s office to resolve allegations that the hospital submitted false billings to public and private insurers to secure coverage for pediatric gender-affirming procedures. The department alleges the conduct violated the Federal Food, Drug, and Cosmetic Act, the False Claims Act, and federal fraud and conspiracy laws.

The settlement was reached out of court, meaning neither party formally admitted wrongdoing. Both the DOJ and Texas Children’s Hospital denied liability.

“The Justice Department will use every weapon at its disposal to end the destructive and discredited practice of so-called ‘gender-affirming care’ for children,” Acting Attorney General Todd Blanche said in a DOJ press release. “Today’s resolution protects vulnerable children, holds providers accountable, and ensures those harmed receive the care they need.”

The DOJ’s hardline stance on gender-affirming care sharply contrasts with the positions of major medical organizations, transgender healthcare advocates, and human rights groups, which broadly support gender-affirming care as an evidence-based treatment for gender dysphoria.

Adrian Shanker, former Deputy Assistant Secretary for Health Policy and Senior Advisor on LGBTQI+ Health Equity at the U.S. Department of Health and Human Services under during the Biden-Harris administration, told the Washington Blade the settlement could have sweeping consequences for trans youth and healthcare providers nationwide.

“The Trump administration’s framing of gender-affirming care is wildly inaccurate, scientifically implausible, and frankly, just mean-spirited,” Shanker told the Blade. “What’s really clear is that the science hasn’t changed, the evidence hasn’t changed — it’s only the politics that have changed. Unfortunately, the people that lose out the most with a settlement like this one are the patients that are denied access to care where they live.”

According to Shanker, the agreement also requires Texas Children’s Hospital to revoke privileges for physicians involved in providing gender-affirming care, potentially limiting their ability to practice elsewhere.

“This is a weaponized Department of Justice doing absurd investigations against providers that are providing care within the established standard of care,” he said. “They’ve come up with an absurd remedy in their settlement to require a so-called ‘detransition clinic’ to open at Texas Children’s. It’s harmful to science, it’s harmful to trans people, and it’s harmful to the medical profession.”

Shanker argued the case reflects a broader politicization of trans healthcare.

“Every American should be concerned about the weaponized Department of Justice and their obsession with trans people and their access to care,” he said. “These hospitals that provide gender-affirming care, the providers of gender-affirming care, have done nothing wrong. They followed the standards of care that are well established and followed the mountain of evidence.”

Karen Loewy, senior counsel and director of constitutional law practice at Lambda Legal, echoed those concerns.

“For Texas Children’s to capitulate to this pressure campaign of both Paxton and the Trump administration and end this care, and go after physicians who had been lawfully and faithfully taking care of their patients, it’s hard to see that as anything other than bending the knee in the face of political pressure,” Loewy told the Blade. “That’s not putting your mission above politics. Your mission is to provide health care for kids that need it.”

Loewy said the settlement reflects years of efforts by Paxton and the Trump-Vance administration to target gender-affirming care providers. Paxton has pursued investigations into providers across Texas since 2022 and supported a 2023 law banning gender-transition-related medical care for minors. Meanwhile, the Trump-Vance administration moved quickly in its second term to restrict trans healthcare access, including through Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation.”

“This is a perfect storm of Ken Paxton’s own mission to stigmatize and target trans young people and their healthcare in Texas with the Trump administration’s targeting of trans people and gender-affirming medical care,” Loewy said. “It is the two of them together. Without that, you wouldn’t have had this settlement.”

Loewy also emphasized that the settlement is part of a broader legal strategy targeting providers nationwide.

“You can’t view this one in isolation from all of the other administrative subpoenas that have been sent to hospitals or other kinds of medical providers that have provided gender-affirming medical care to trans adolescents,” she said. “It is all part and parcel of the same direct line from the executive orders that were issued in the first days of this Trump administration.”

“Every court that has considered those subpoenas has found them illegitimate and issued for an improper purpose, or at least narrowed them really dramatically,” she added. “Courts agree these hospitals didn’t do anything wrong. It’s the DOJ that has the problem here.”

Shanker also criticized the settlement’s requirement that the hospital establish a detransition clinic, arguing the move contradicts existing medical evidence.

“The irony shouldn’t be lost on anyone that the Trump administration is claiming that gender-affirming care lacks a scientific basis, and then is requiring the opening of a so-called detransition clinic, which certainly lacks a scientific basis,” Shanker said. “There’s less than a 1% regret rate when it comes to gender-affirming care. That’s lower than knee surgery, lower than bariatric surgery, lower than childbirth, lower than breast reconstruction, and lower than tattoos.”

Loewy was similarly blunt in her criticism.

“This is the most craven, political, ridiculous elevation of ideology over evidence,” she said. “They are creating a program built on an outcome that almost never happens. It is unprecedented and politically mandated rather than healthcare mandated.”

She said the settlement’s broader effect will be to intimidate providers and further marginalize trans people.

“The real effect here is to further stigmatize trans people and intimidate healthcare providers,” she said. “This is about sending a message nationwide that the DOJ is coming after the doctors. These are committed, faithful, law-abiding physicians and healthcare providers who just want to provide the healthcare their patients actually need.”

Both Loewy and Shanker warned that restricting access to gender-affirming care could deepen health disparities for trans people.

“We know that when transgender Americans lack the care that they need, we end up with higher rates of depression, higher rates of anxiety, higher rates of self-harm and suicidal ideation,” Shanker said. “We know that gender-affirming care is a medically appropriate, scientifically grounded form of care that resolves these challenges and leads us toward health equity. It’s unfortunate that the Trump administration has politicized not only transgender medicine, but the very basis of public health.”

Shanker said the restrictions are already prompting some trans people to relocate in search of care.

“We’re already seeing medical refugees leave states that have restricted access to care to move to states where it’s still available,” he said. “Frankly, we’ve already seen some trans people go to other countries to receive care or maintain access to care.”

Loewy said the DOJ’s recent subpoenas targeting hospitals, including those issued to NYU Langone Health in New York, suggest the administration is escalating its legal strategy.

“We’ve seen the DOJ escalate this by convening a grand jury and issuing grand jury subpoenas to hospitals,” she said. “That is going to be the next front in this fight.”

In addition to , there has been as large increase in anti-trans legislation in the past few years — with 126 federal pieces of legislation introduced this year and 26 state level policies passed across the country.

Still, Loewy pointed to recent court victories as evidence that challenges to these policies can succeed.

“Just yesterday, a state court in Kansas struck down that state’s ban on gender-affirming medical care in one of the most meticulous recognitions of the medical consensus and the harm of denying care to trans young people,” she said. “When courts actually look at the science and the impacts on trans people, they still can rule the right way.”

Asked whether there is any optimism to be found amid the ongoing legal battles, Loewy said she continues to draw hope from advocates, families, and community organizers fighting back.

“The solidarity of the community is really what brings hope,” she said. “There are incredible lawyers, advocates, families, and organizations fighting every day to protect these kids and their privacy and safety. It is that community strength and collaborative effort that continues to give me hope.”

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Bureau of Prisons declines to reconsider transgender inmate policy

Democratic lawmakers raised concerns this week, lawsuit filed

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2 weeks ago

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May 14, 2026

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(Photo by Andrushko Galyna/Bigstock)

Following a letter sent Monday by several Democratic senators raising concerns about the Federal Bureau of Prisons’ updated transgender inmate policy, the BOP responded to a request for comment from the Washington Blade, saying it does not plan to reverse the changes implemented earlier this year.

The policy was revised in 2025 to comply with President Donald Trump’s Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.”

In a statement to the Blade, BOP spokesperson Donald Murphy said the updated policy is rooted in medical guidance and data-driven decision making.

“The BOP implemented the February 2025 policy to ensure that inmates with gender dysphoria are properly diagnosed and treated consistent with best medical practices,” he said. “Unlike the prior administration’s one-size-fits-all approach, the BOP’s new policy ensures individualized assessments and treatments. And while the previous administration’s policies on treating inmates with gender dysphoria was driven by radical ideology, the BOP’s current policy is based on medical studies, medical expert opinions, state correctional policies, caselaw, and penological concerns. Absent court order, there are no plans to reconsider or revisit the policy.”

U.S. Sens. Ed Markey (D-Mass.), Jeff Merkley (D-Ore.), and Mazie Hirono (D-Hawaii) signed the letter, arguing that the policy change fails to adequately prioritize the safety of trans inmates — protections they say are guaranteed under the Constitution.

This inquiry comes days after a federal lawsuit was filed against the Justice Department specifically on the concern that trans inmates are not receiving adequate care.

Earlier this month, the National Center for LGBTQ Rights, a legal organization focused on LGBTQ rights since 1977, filed a lawsuit in District Court of the District of Columbia against the Trump-Vance administration in collaboration with GLAD Law, Lowenstein Sandler LLP, and Wardenski P.C.

The suit, filed on May 6, alleges the administration is “ignoring federal protections” designed to prevent sexual abuse of incarcerated trans people.

“Transgender people in prison are sexually abused or assaulted at nearly 10x the rate of the general prison population,” the press release announcing the lawsuit states, adding that federal legislation was enacted to address those risks.

The plaintiff in the lawsuit, Paulina Poe, is a trans woman currently incarcerated in a men’s facility. According to the complaint, she has been “propositioned, groped, sexually harassed, and assaulted” by male inmates and subjected to strip searches by male officers — circumstances the Prison Rape Elimination Act regulations were intended to prevent.

The lawsuit also argues that the policy changes violate constitutional protections and deny trans inmates medically necessary care.

“The Eighth Amendment requires prisons and jails to provide ‘adequate medical care’ to incarcerated people which includes adequate treatment for people diagnosed with gender dysphoria,” says the Transgender Law Center. “‘Adequate medical care’ should be delivered according to accepted medical standards, such as WPATH’s Standards of Care. Some courts have said that in some circumstances ‘adequate medical care’ for gender dysphoria includes providing gender-appropriate clothing and grooming supplies, and the ability to present yourself consistent with your gender identity.”

GLAD Law Staff Attorney Sarah Austin also issued a statement when the lawsuit was announced, saying those responsible for the policy changes — and the rollback of protections under the Prison Rape Elimination Act — will be “held accountable for this egregious and lawless action.”

“The federal government’s unlawful attempt to roll back binding Prison Rape Elimination Act regulations is an especially dangerous step in its ongoing campaign to strip transgender people of legal protections,” Austin said. “The targeting of transgender incarcerated people is a deliberate choice to put vulnerable people in harm’s way simply because of who they are.”

The Justice Department has not responded to the Blade’s request for comment.

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Federal Government

Senate Democrats press DOJ over anti-trans prison directives

Markey joins other lawmakers in demanding reversal of policies

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2 weeks ago

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May 11, 2026

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(Photo by Andrushko Galyna/Bigstock)

U.S. Sen. Edward Markey (D-Mass.) is urging acting Attorney General Todd Blanche and William Marshall III, director of the Federal Bureau of Prisons, to reverse a policy affecting transgender inmates that lawmakers say is “endangering” their “health and safety.”

Markey, along with U.S. Sens. Jeffrey A. Merkley (D-Ore.) and Mazie K. Hirono (D-Hawaii), sent the letter that the Washington Blade verified on Monday.

The letter is a direct response to a change in prison policy that went into effect in February 2025, rolling back Biden-era protections for trans inmates. The senators described how President Trump’s Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” forced a policy shift they argue is rooted more in political rhetoric than in medical research or evidence-based correctional practices.

In the letter, the lawmakers wrote “On Feb. 21, 2025, the BOP issued a memo to implement President Trump’s EO, requiring BOP staff to ‘refer to individuals by their legal name or pronouns corresponding to their biological sex,’ banning the use of funds for any ‘items that align with transgender ideology,’ and suspending clothing accommodations, pat search accommodations, and support programs offered to transgender individuals.”

“In a second memo, issued one week later, the BOP banned the use of federal funds for ‘any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.’ These changes have resulted in the denial — or threatened denial — of hormone treatment and gender-affirming accommodations for transgender individuals in BOP custody.”

“On Feb. 19, 2026, the BOP escalated its attacks, issuing a program statement titled, ‘Management of Inmates with Gender Dysphoria.’ It prohibits incarcerated people from receiving gender-affirming care, even if paid for with private funds. This practice forces incarcerated people to discontinue care, regardless of medical recommendations.”

The senators continued, “The agency has repeatedly enacted policies that strip transgender individuals of their gender identity and dignity. This includes requiring staff to refer to transgender individuals by pronouns that ‘align with their biological sex’ rather than gender identity and to confiscate gender-affirming items, such as undergarments, clothing, cosmetics, and wigs.”

“These policies risk triggering mental health crises, including increased suicidality, among incarcerated people with gender dysphoria. The BOP’s repeated guidance to roll back gender-affirming protections — despite a federal court order finding that the BOP’s actions to discontinue gender-affirming care are likely unlawful — generate confusion about the current state of regulations and convey the BOP’s indifference to court orders and the rule of law.”

“By stripping away appropriate medical and psychiatric care, safety protections, and measures to provide dignity, the BOP is exposing transgender individuals to significant harm.”

The Marshall Project, a nonprofit newsroom focused on the U.S. criminal justice system and immigration enforcement through data-driven reporting, also reported on the policy change. The outlet spoke with Shana Knizhnik, an attorney with the American Civil Liberties Union, about the impact of the changes.

“It’s clear that this new policy is a ban on gender affirming healthcare,” Knizhnik, who works for the nationwide chapter of the ACLU said. “This is a policy that disregards the medical needs of our plaintiffs.”

The letter also asked the BOP and the DOJ specific questions regarding why the policy went into effect, as lawmakers suggested the changes appear politically motivated rather than based on new medical evidence regarding treatment for trans inmates.

The senators requested answers to these trans policy-specific questions by May 21, including:

“Does the BOP plan to monitor and assess the impacts of recent policies that eliminate gender-affirming medical and psychiatric care?”

“Since January 20, 2025, how many transgender, nonbinary, intersex, and gender-diverse individuals have been transferred to a different facility to meet the EO’s goal of housing individuals ‘according to their biological sex?’”

“Given that the BOP has stopped enforcing Prison Rape Elimination Act regulations related to gender identity and collecting data on gender identity, how will the BOP protect the physical and emotional health and safety of incarcerated transgender individuals?”

“How does the BOP plan to monitor and assess the impact of eliminating protections against sexual violence for this population?”

“Does the BOP plan to institute a specific process by which transgender individuals may seek assistance or lodge complaints regarding harms they experience from the recent BOP policies and actions implementing President Trump’s EO?”

“Describe the specific criteria the BOP intends to use to determine whether it will allow a ‘social accommodation’ for gender dysphoria.”

Markey also included a personal statement to the Blade explaining why he is using his position on Capitol Hill to push for more information and advocate for reversing the policy.

“This administration continuously shows their contempt for trans people and a total disregard for their rights and humanity. As part of this cruel campaign, the Bureau of Prisons has systematically stripped health care access and basic protections from trans people, abandoning its duty to the people in its custody. I won’t stop fighting until this administration’s hateful anti-trans policies are reversed and trans people’s rights are secured.”

The Blade reached out to the DOJ and the BOP for comment but had not received a response at press time.

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