Imagine going to the doctor and being told that the medication you’ve been taking for years is now illegal to prescribe to you. The doctor can give it to other people who are different from you — people experiencing depression, for example, or women going through menopause, or cancer patients — but it’s no longer allowed for people like you.
Given no other options, you go home. After a few days, you start feeling the initial effects of living without that medication. Your brain gets foggy and you start dissociating. A few months in, your body starts to change. If you’re a woman, that means thick, coarse hair starts sprouting on your arms, chest and face. Everything gets affected; the way you smell, the way your body distributes fat, the way the hair on your head grows, or doesn’t grow.
After a few days, you start feeling the initial effects of living without that medication. Your brain gets foggy and you start dissociating.
The people in your life stop recognizing you and everyone else in society no longer sees you as you really are. The only way out of this new reality is likely getting your meds on the black market — or dying, because your body can’t produce a hormone you need.
That is the gutting choice facing more than 275,000 transgender people who are on Medicaid if Trump’s “Big Beautiful” budget passes the Senate and gets signed into law.
Late Wednesday night last week, news broke of a manager’s amendment to the budget that changed what was initially a ban on gender-affirming care for youth on Medicaid into a ban on adult transition care on Medicaid. A change to one line in the budget bill removed a distinction between youth and adults, thus expanding the ban to hundreds of thousands more people. Plus, the ban not only covers gender-affirming surgery, but also includes a ban on coverage of hormone replacement therapy.
Coupled with the Medicaid ban is a further provision no longer requiring that Affordable Care Act health insurance plans cover gender-affirming care for adults as an essential health benefit, which would allow individual health insurance companies that sell market plans to potentially drop their trans-related coverage.
For those who have already had bottom surgery and depend on hormone replacement therapy to produce the sex hormones they need to survive, the situation would literally be life or death, because no one can live without a dominant sex hormone. The Republican budget would make it illegal for a post-op trans person to access the hormone that affirms their gender, but they would be able to be prescribed the hormone associated with their birth sex. So for example, estrogen would be denied for trans women, but testosterone would be allowed, and vice versa for trans men.
The message, therefore, is clear: Either detransition or potentially die. That’s the decision this Republican government would be forcing upon post-op trans people who rely on Medicaid, unless they can manage to pay for treatment themselves or access illegal and unregulated sources for the hormones their bodies rely on to function.
Trans people who haven’t yet completed genital reconstructive surgery face a similar choice, though being forced off lifesaving hormone replacement therapy is potentially deadly in another way. When denied gender-affirming care, trans people are at an elevated risk of suicidality.
A more chilling thought is whether this might suit Republicans’ purposes just fine, given years of measures taken to push trans people out of society.
My question to everyone reading this is: When is enough enough? We’ve moved well past any well-meaning “reasonable concerns” and into genuine life-threatening government quashing of trans life. Trans people like me, of course, understood that this was always the end game. The far-right Family Research Council said as much when it laid out its blueprint for using the government to mandate trans people out of society in 2015, in which it proposed a serious of policy changes on everything from passports to health care to legally define trans people out of existence. This was always where conservatives (and many gullible centrist pundits) were headed as they peddled panic over trans youth transitioning and spreading outright lies about trans athletes. If we don’t say anything about this, or take any steps to fight back, or even start questioning the right-wing rhetoric on trans issues, one day you all will wake up and realize there are no more trans people living publicly around you. Today, I’m thinking about my good friend in New Hampshire who is trans and on Medicaid. She works hard at her jobs but doesn’t make much. She has struggled for years with accessing gender-affirming care and now a small group of jerks in Washington want to go on a power trip and rip that away from her and hundreds of thousands of other people. It’s time to put a stop to this. Keep the government out of the private lives and medical decisions of trans people. Our lives depend on it.
Katelyn Burns is a freelance journalist based in New England. 
