President-elect Donald Trump has made attacks on transgender people a central issue in the election. His campaign and conservative groups spent tens of millions dollars in anti-trans ads. He has called gender-affirming care provided to young trans people “left-wing gender madness” and “child abuse,” and falsely claimed at rallies and events that children were undergoing surgery. gender affirmation in schools.

Now, as Trump prepares to return to the White House, gender-affirming care providers are bracing for an administration that could shake things up. evidence-based standards of care for trans people.

Although it is difficult to predict what policies the Trump administration will pursue, its agenda included a pledge stop all federal funding for gender-affirming care and kick out of Medicare and Medicaid all hospitals that provide care to minors. Trump also said he would ask Congress to pass legislation recognizing only two genders — male and female — assigned at birth.

“I think we need to take the Trump administration’s agenda at its word,” said Meredithe McNamara, an assistant professor of pediatrics at Yale who also sees patients at a local community health center. “It’s a professional responsibility to be incredibly realistic about what it will look like if our patients are continually put in the political crosshairs.”

By early Wednesday morning, McNamara had already started receiving messages from young patients who were concerned about their access to care due to gender incongruity. The Trevor Project, a suicide prevention organization for LGBTQ+ youth, told STAT that the number of calls, chats and texts to its crisis line increased by nearly 700% the day after the election, compared to previous weeks. Many people in crisis directly referenced the election results.

FOLX, a telehealth platform for queer people, saw a 75% increase in messages to its healthcare team the day after the election, as people asked about renewals and worried about their future access to care . The company also reported a 115% increase in posts on its community platform.

Before Trump takes office in January, providers and hospital systems must improve patient privacy policies, provide forensic training and prepare to work with legal experts who understand the nuances of healthcare bans, McNamara said. Even those who work and live in states with progressive policies should not assume they will always be able to continue providing care without interference, she stressed. Some states have adopted “safeguard laws” to protect both patients and providers from persecution by restrictive states. But there has yet to be a legal challenge to test the strength of these laws, McNamara said.

“Very solid blue states aren’t going to go anywhere,” said Kate Steinle, clinical director of FOLX. “They’re going to fight even harder.”

FOLX has already been tested on its ability to offer trans healthcare in restrictive states. In Florida, recent legislation requires that gender-affirming hormones for adults be prescribed in person by a doctor. When the law took effect, FOLX opened in-person clinics in five Florida cities, although it previously had no physical locations in the state. The company then saw an increase in signups from trans people who lost access to their previous providers because they weren’t doctors or telehealth prescribers. That growth has offset the costs of setting up in-person clinics, Steinle said.

“We don’t want to have to do this state by state, but we will if necessary,” Steinle said. “We’re going to follow all the rules in the (restrictive) states.”

Some providers are thinking differently about how to deliver care in the next era.

“Collective resistance is the best solution,” said Crystal Beal, a physician and founder of QueerDoc, which provides telemedicine care to queer people in 10 states. They hope the medical profession as a whole can come together to support gender-affirming care and resist bans on evidence-based care through civil disobedience. “Organized resistance is what allows individual supporters to make a frightening decision. It’s scary to break a law. It’s scary to risk losing your life and it’s scary to risk how you pay your mortgage.

A common refrain among trans communities facing discrimination is that trans people have been around forever. This will not change with a new government.

“Since 1969, we have adapted and persevered through every change in the political landscape to ensure our communities receive the life-saving, life-affirming care they deserve,” Patrick McGovern, CEO of Callen-Lorde, an LGBTQ+ community health center in New York. , said in a statement. “Our mission does not change with the political winds. »