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Trump’s anti-trans attacks harm federal employees

Inserting politics into the patient-doctor relationship

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President Donald Trump (Washington Blade photo by Michael Key)

The Trump administration continued its avalanche of mean-spirited attacks on transgender Americans with a recent policy announcement at the Office of Personnel Management. OPM, the agency charged with federal workforce policy, announced that Federal Employee Health Benefits (FEHB) will end coverage for most forms of medically necessary gender affirming care for adults beginning in the next plan year. The new policy allows continued coverage for counseling and “case by case” continuity for people currently receiving certain types of care.

Frankly, the Trump administration is wrong about a lot of things when it comes to LGBTQI+ health and wellbeing. They have been on a seemingly unabating war path to eliminate access to care for transgender people nationwide. And despite the current president falsely claiming (without evidence) that his predecessor weaponized government agencies against him for political purposes, this is exactly what the Trump administration has done to harm transgender Americans. Politicized discrimination against transgender people is coming fast and furious from across the government. The attacks range from a bogus Federal Trade Commission workshop on “false claims fraud” that targets life-saving gender affirming care for minors, to subpoenas issued by the Department of Justice to clinics and doctors who provide care for trans people. The U.S. Department of Health and Human Services published a junk-science anti-trans report, and far-reaching regulatory proposals from the Centers for Medicare and Medicaid Services threaten to withhold Medicare and Medicaid reimbursement to hospitals nationwide if they continue providing gender affirming care. And this is just a partial list, so it may seem small in comparison that the Office of Personnel Management has joined the Trump Administration’s anti-trans crusade, but it’s not small – this action by itself cuts off access to care for the entire federal civilian workforce, and all their covered family members.

More than eight million Americans – federal employees, retirees, and their dependents – receive their healthcare through FEHB. FEHB has historically enabled the federal government to attract and retain top talent, offering a range of affordable plan choices to fit the specific healthcare needs of enrollees and their family members. As the largest employer sponsored health benefits program in the U.S., FEHB is critical to the health and financial security of millions of Americans. 

The Trump administration has gone to great lengths to single out transgender medical care. The OPM memo, like many of the administration’s other actions, specifically states that care is only precluded for transgender people, and not for the same interventions when medically necessary for in-vitro fertilization, cancer care, or endometriosis. This is facially discriminatory, and flies in the face of legal bases and prior OPM guidance prohibiting exactly this type of sex-based discrimination in healthcare. The decisions on what counts as medically necessary care have historically been determined by medical professionals, not politicians. And the medical and scientific consensus is clear: every major medical and mental health organization in the U.S. recognizes the medical necessity for gender affirming care.

OPM’s action doesn’t save any significant amount of tax dollars either. A 2022 study published in the Journal of Law, Medicine & Ethics looked at the utilization and cost of gender affirming care in commercial insurance plans. The study found that “the impact of gender-affirming care on payer budgets has remained nominal even as national trends in coverage policies have made this care more accessible to transgender people.” The total cost of gender affirming care in the broader FEHB program wouldn’t even register in an actuarial study. But the coverage is critical and life-saving to the individual program participant, and the lack of coverage is tragic. 

In the Biden-Harris administration, the U.S. Department of Health and Human Services and the Office of Personnel Management advanced evidence-based policy to strengthen access to medically necessary healthcare for transgender Americans. At HHS, the agency promulgated strong rules on healthcare discrimination that specifically protected trans people’s access to care and provided recourse if insurers discriminated against trans patients by denying coverage for the same procedure as they cover for other health challenges, which is exactly the carve out the Trump Administration just finalized. OPM during the Biden-Harris administration also finalized changes to FEHB plans to bring them more in line with private insurance coverage of gender affirming care. 

The science and evidence undergirding transgender medicine has not changed. What has changed is the politics. And for a political party that historically espouses limited government, it is wild how the Trump administration has inserted politics into the patient-doctor relationship through anti-trans healthcare restrictions at numerous federal agencies. We all must call out the bold-faced lie the Trump administration continues to parrot – that gender affirming care is somehow harmful or radical. Let’s be clear: gender affirming care is healthcare. Gender affirming care is within the standards of care. And gender affirming care is life-saving and life-sustaining. We cannot afford to let politically motivated junk science remove the decades of medical science that supports equitable health coverage for transgender Americans. And we must ensure that our own government’s healthcare remains a shield, not a weapon, for our public servants and their families, and stand up for their access to medically necessary healthcare.


Adrian Shanker served as Deputy Assistant Secretary for Health Policy and Senior Adviser on LGBTQI+ Health Equity at the U.S. Department of Health and Human Services in the Biden-Harris administration and is principal of Shanker Strategies LLC. Mahri Stáinnak served as Deputy Director for Diversity, Equity, Inclusion, and Belonging, and Director of the Talent Innovation Group at the U.S. Office of Personnel Management.

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Opinions

New research shows coming out is still risky

A time of profound psychological vulnerability

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(Photo by Iryna Imago/Bigstock)

Coming out is often celebrated as a joyful milestone – a moment of truth, pride, and liberation. For many LGBTQ+ people, that’s exactly what it becomes. But new research I co-authored, published in the journal Pediatrics this month, shows that the period surrounding a young person’s first disclosure of their sexual identity is also a time of profound psychological vulnerability. It’s a fragile window we are not adequately protecting.

Using data from a national sample of lesbian, gay, and bisexual people, our study examined what happens in the years before and after someone comes out to a family member or a straight friend. We weren’t looking at broad lifetime trends or comparing LGBTQ+ youth to heterosexual peers. Instead, we looked within each person’s life. We wanted to understand how their own suicide risk changed around the moment they first disclosed who they are.

The results were unmistakable. In the year a person came out, their likelihood of having suicidal thoughts, developing a suicide plan, or attempting suicide increased sharply. Those increases were not small. Suicide planning rose by 10 to 12 percentage points. Suicide attempts increased by 6 percentage points. And the elevated risk didn’t fade quickly. It continued in the years that followed.

I want to be very clear about what these results mean: coming out itself is not the cause of suicidality. The act of disclosure does not harm young people. What harms them is the fear of rejection, the stress of navigating relationships that suddenly feel uncertain, and the emotional fallout when people they love respond with confusion, disapproval, or hostility.

In other words, young LGBTQ+ people are not inherently vulnerable. We make them vulnerable.

And this is happening even as our culture has grown more affirming, at least on the surface. One of the most surprising findings in our study was that younger generations showed larger increases in suicide risk around coming out compared to older generations. These are young people who grew up with marriage equality, LGBTQ+ celebrities, Pride flags in classrooms, and messaging that “it gets better.”

So why are they struggling more?

I think it’s, in part, because expectations have changed. When a young person grows up hearing that their community is increasingly accepted, they may expect support from family and friends. When that support does not come, or comes with hesitation, discomfort, or mixed messages, the disappointment is often devastating. Visibility without security can intensify vulnerability.

Compounding this vulnerability is the broader political environment. Over the last several years, LGBTQ+ youth have watched adults in positions of power debate their legitimacy, restrict their rights, and question their place in schools, sports, and even their own families. While our study did not analyze political factors directly, it is impossible to separate individual experiences from a climate that routinely targets LGBTQ+ young people in legislative hearings, news cycles, and social media.

When you’re 14 or 15 years old and deciding who to tell about your identity, the world around you matters.

But the most important takeaway from our study is this: support is important. The presence, or absence of family acceptance is typically one of the strongest predictors of whether young people thrive after coming out. Research consistently shows that when parents respond with love, curiosity, and affirmation, young people experience better mental health, stronger resilience, and lower suicide risk. When families reject their children, the consequences can be life-threatening.

Support doesn’t require perfect language or expertise. It requires listening. It requires pausing before reacting out of fear or unfamiliarity. It requires recognizing that a young person coming out is not asking you to change everything about your beliefs. They’re asking you to hold them through one of the most vulnerable moments of their life.

Schools, too, have an enormous role to play. LGBTQ+-inclusive curricula, student groups, and clear protections against harassment create safer environments for disclosure. 

Health care settings must also do better. Providers should routinely screen for mental health needs among LGBTQ+ youth, especially around the time of identity disclosure, and offer culturally competent care.

And as a community, we need to tell a more honest story about coming out. Yes, it can be liberating. Yes, it can be beautiful. But it can also be terrifying. Instead of pretending it’s always a rainbow-filled rite of passage, we must acknowledge its risks and surround young people with the support they deserve.

Coming out should not be a crisis moment. It should not be a turning point toward despair. If anything, it should be the beginning of a young person’s journey toward authenticity and joy.

That future is possible. But it depends on all of us – parents, educators, clinicians, policymakers, and LGBTQ+ adults ourselves – committing to make acceptance a daily practice.

Young LGBTQ+ people are watching. And in the moment they need us most, they must not fall into silence or struggle alone.


Harry Barbee, Ph.D., is an assistant professor at the Johns Hopkins Bloomberg School of Public Health. Their research and teaching focus on LGBTQ+ health, aging, and public policy. 

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Candidates should pledge to nominate LGBTQ judge to Supreme Court

Presidential, Senate hopefuls need to go on the record

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U.S. Supreme Court (Washington Blade photo by Michael Key)

As soon as the final votes are cast and counted and verified after the November 2026 elections are over, the 2028 presidential cycle will begin in earnest. Polls, financial aid requests, and volunteer opportunities ad infinitum will flood the public and personal media. There will be more issues than candidates in both parties. The rending of garments and mudslinging will be both interesting and maybe even amusing as citizens will watch how candidates react to each and every issue of the day.

There is one particular item that I am hoping each candidate will be asked whether in private or in public. If a Supreme Court vacancy occurs in your potential administration, will you nominate an open and qualified LGBTQ to join the remaining eight?

Other interest groups on both sides have made similar demands over the years and have had them honored. Is it not time that our voices are raised as well? There are several already sitting judges on both state and federal benches that have either been elected statewide or approved by the U.S. Senate.

Our communities are being utilized and abused on judicial menus. Enough already! Challenge each and every candidate, regardless of their party with our honest question and see if honest answers are given. By the way … no harm in asking the one-third of the U.S. Senate candidates too who will be on ballots. Looking forward to any candidate tap dancing!

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Opinions

2026 elections will bring major changes to D.C. government

Mayor’s office, multiple Council seats up for grabs

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(Washington Blade file image by Aram Vartian)

Next year will be a banner year for elections in D.C. The mayor announced she will not run. Two Council members, Anita Bonds, At-large, and Brianne Nadeau, Ward 1, have announced they will not run. Waiting for Del. Norton to do the same, but even if she doesn’t, there will be a real race for that office. 

So far, Robert White, Council member at-large, and Brooke Pinto, Council member Ward 2, are among a host of others, who have announced. If one of these Council members should win, there would be a special election for their seat. If Kenyon McDuffie, Council member at-large, announces for mayor as a Democrat, which he is expected to do, he will have to resign his seat on the Council as he fills one of the non-Democratic seats there. Janeese George, Ward 4 Council member, announced she is running for mayor. Should she win, there would be a special election for her seat. Another special election could happen if Trayon White, Ward 8, is convicted of his alleged crimes, when he is brought to trial in January. Both the Council chair, and attorney general, have announced they are seeking reelection, along with a host of other offices that will be on the ballot.  

Many of the races could look like the one in Ward 1 where at least six people have already announced. They include three members of the LGBTQ community. It seems the current leader in that race is Jackie Reyes Yanes, a Latina activist, not a member of the LGBTQ community, who worked for Mayor Fenty as head of the Latino Affairs Office, and for Mayor Bowser as head of the Office of Community Affairs. About eight, including the two Council members, have already announced they are running for the delegate seat.

I am often asked by candidates for an endorsement. The reason being my years as a community, LGBTQ, and Democratic, activist; and my ability to endorse in my column in the Washington Blade. The only candidate I endorsed so far is Phil Mendelson, for Council chair. While he and I don’t always agree on everything, he’s a staunch supporter of the LGBTQ community, a rational person, and we need someone with a steady hand if there really are six new Council members, out of the 13. 

When candidates call, they realize I am a policy wonk. My unsolicited advice to all candidates is: Do more than talk in generalities, be specific and honest as to what you think you can do, if elected. Candidates running for a legislative office, should talk about what bills they will support, and then what new ones they will introduce. What are the first three things you will focus on for your constituents, if elected. If you are running against an incumbent, what do you think you can do differently than the person you hope to replace? For any new policies and programs you propose, if there is a cost, let constituents know how you intend to pay for them. Take the time to learn the city budget, and how money is currently being spent. The more information you have at your fingertips, the smarter you sound, and voters respect that, at least many do. If you are running for mayor, you need to develop a full platform, covering all the issues the city will face, something I have helped a number of previous mayors do. The next mayor will continue to have to deal with the felon in the White House. He/she/they will have to ensure he doesn’t try to eliminate home rule. The next mayor will have to understand how to walk a similar tightrope Mayor Bowser has balanced so effectively. 

Currently, the District provides lots of public money to candidates. If you decide to take it, know the details. The city makes it too easy to get. But while it is available, take advantage of it. One new variable in this election is the implementation of rank-choice voting. It will impact how you campaign. If you attack another candidate, you may not be the second, or even third, choice, of their strongest supporters. 

Each candidate needs a website. Aside from asking for donations and volunteers, it should have a robust issues section, biography, endorsements, and news. One example I share with candidates is my friend Zach Wahls’s website. He is running for United States Senate from Iowa. It is a comprehensive site, easy to navigate, with concise language, and great pictures. One thing to remember is that D.C. is overwhelmingly Democratic. Chances are the winner of the Democratic primary will win the general election. 

Potential candidates should read the DCBOE calendar. Petitions will be available at the Board of Elections on Jan. 23, with the primary on June 16th, and general election on Nov. 3. So, ready, set, go! 


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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