Attorney General Ken Paxton sued Children’s Health System of Texas and a Dallas doctor Wednesday for allegedly violating a Texas ban on gender-affirming care for minors.
The AG asked a Collin County judge for a temporary injunction to stop the two defendants from providing any gender-affirming care or filing any claims to Texas Medicaid for that care.
The suit alleges Jason Jarin, a pediatric and adolescent gynecologist at Children’s Health and associate professor at UT Southwestern Medical Center, violated the law with 19 patients. It alleges he violated a 2023 law that prevents health care providers from giving transgender youth puberty blockers, hormone replacement therapy or surgery for the purpose of transitioning — one of a number of Texas laws aimed at limiting the type of care transgender adults and children can receive.
Paxton also argues Jarin filed claims for these services with Texas Medicaid, which doesn’t cover any gender-affirming care.
“This criminal extremist not only permanently harmed children, but he also then defrauded Medicaid and stuck Texas taxpayers with the bill for this insanity,” Paxton wrote in a statement. “Experimental ‘transition’ procedures on minors are illegal, unethical, and will not be tolerated in Texas.”
Jarin told KERA News Wednesday morning he had just learned of the lawsuit, and declined to comment.
Children’s Health told KERA in a statement its “top priority is the health and well-being of the patients and families we serve.”
“We comply with all applicable local, state and federal health care laws. Due to ongoing legal proceedings, we are unable to comment further at this time,” the statement read.
Jarin became an assistant professor at UT Southwestern in 2016 and has published studies on transgender children, according to his faculty profile.
Many of the lawsuit allegations claim he intentionally prescribed extra hormones for transgender kids leading up to Sept. 1, 2023, when the law took effect, so that they could continue to get treatment.
The law, known as Senate Bill 14, did allow for prescriptions to continue for children who were “already subject to a continuing course of treatment that began prior to June 1, 2023,” and children who “attended at least 12 mental health counseling or psychotherapy sessions over a period of at least six months prior to starting treatment,” according to Paxton’s suit. But those prescriptions had to be for the purpose of weaning the patient off the drug.
Jarin is accused of violating SB 14 with 12 of the 19 patients. If found liable, he could lose his medical license — SB 14 requires the Texas Medical Board to revoke the license of any physician who provides gender-affirming care to a child.
Trans women in Massachusetts may be suffering the effects of the Trump administration’s campaign to erase transgender identity from American society, but their hospital won’t confirm or deny it.
Several trans women scheduled for vaginoplasties with a highly regarded doctor specializing in the gender-affirming procedure were informed over the last few weeks that their surgeries had been cancelled and they wouldn’t be able to reschedule them, WGBH reports.
“I’m crushed. I can’t stop crying,” said one patient identified as Avery, who used a pseudonym. “This surgery was life-changing because it finally gives me the body that’s right for me. It has been ripped away with no explanation or follow-up plan.”
Avery’s hospital is UMass Memorial Health in Worcester, Massachusetts, and her surgeon is Dr. Ashley Alford, who introduced an innovative vaginoplasty technique never before used in New England. The surgery involves utilizing abdominal tissue and robotic technology to create a more realistic and functional vagina than other common procedures produce.
Avery had spent months preparing for the surgery, including a switch to a more expensive insurance plan that would cover the procedure.
Then it was cancelled. Avery said she pressed hospital staff for answers and learned that all of Dr. Alford’s appointments had been cancelled. She received no other explanation.
Among the six patients of Dr. Alford’s that were interviewed, all said they’ve received calls in the last two weeks canceling their appointments at UMass; more are identified in a subreddit devoted to the situation, which one describes as “unbelievably confusing.”
Despite the abrupt cancellations, the UMass health system says it’s not curtailing gender-affirming care.
“Although appointments may at times need to be canceled or rescheduled due to the availability of a specific provider, nothing has changed in UMass Memorial Health’s commitment to providing comprehensive, evidence-based health care, including gender affirming care, to all members of our community,” the statement read.
Dr. Alford had no comment on the nixed appointments and procedures.
The second Trump administration has issued a wave of orders curtailing the rights of transgender people, including attempts to end gender-affirming care for minors (early with his executive order addressing so-called “Child Mutilation”) and later, in December, an announcement from Health Secretary Robert F. Kennedy Jr. that any hospital providing gender affirming care for minors would lose Medicare and Medicaid funding.
UMass’s abrupt cancellations of surgeries for trans adults conjure a nightmare scenario for older patients reliant on gender-affirming care.
Chrissi Bates, an advocate for transgender healthcare and Alford’s first patient to undergo the advanced vaginoplasty procedure, sees a hidden hand behind Alford’s sudden unavailability.
“We all love Dr. Alford. We all doubt that it’s her that wants to leave,” said Bates, who planned on seeing Alford for post-op appointments. “It’s really disheartening to hear that UMass is just caving to this unjust kind of healthcare agenda that’s being pushed by the Trump administration.”
Most of all, the UMass patients in Worcester want answers.
“If it is Dr. Alford being pushed out due to concerns from the Trump administration, who’s to say that’s not going to happen in Boston?” said Kara Earp, a North Carolina transplant who moved to Massachusetts just for the gender-affirming care. Her appointment with Alford was cancelled, as well.
“I probably won’t actually be happy until I wake up from surgery and it’s all over with,” she said.
Two of Wisconsin’s largest pediatric hospitals have stopped providing gender-affirming care for transgender youth, Wisconsin Public Radio reports.
Children’s Wisconsin and University of Wisconsin (UW) Health have ended the treatment for minors, after pressure from the Trump administration. Advocates say the end of gender-affirming medical care will lead to negative mental health effects for trans youth.
In a statement, Children’s Wisconsin cited “escalating legal and federal regulatory risk” facing providers across the nation as the reason it is “currently unable to provide gender-affirming pharmacologic care.” The hospital added that LGBTQ+ children should be treated with “support, respect, dignity, and compassion.”
The hospital will continue to offer mental health services for patients and families.
In December, the Department of Health and Human Services, under the direction of Secretary Robert F. Kennedy Jr., announced plans to end all Medicaid and Medicare funding for hospitals that provide gender-affirming care to minors.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” Kennedy said, announcing the funding threat. “This administration will protect America’s most vulnerable. Our children deserve better — and we are delivering on that promise.”
In reality, gender-affirming medications for young people are considered by every major American medical association to be safe, reversible, and essential to the well-being of trans youth.
UW Health said its hospital system will pause prescribing puberty blockers and hormone therapy for patients under 18 years old “due to recent federal actions.” The hospital remains committed to providing “high-quality, compassionate” care to LGBTQ+ patients, officials said in a statement.
“We recognize the uncertainty faced by our impacted patients and families seeking this gender-affirming care and will continue to support their health and well-being,” they said.
Steve Starkey, executive director for OutReach LGBTQ+ Community Center in Madison, said the consequences of ending the care will be grave.
“It will definitely have a negative impact on the rates of suicide, and the mental health of the trans community” in general, he said. “It affects trans adults as well, because it’s like an attack on all trans people.”
Starkey pointed to rates of suicide and suicidal ideation, which are already high for the trans community.
A 2023 study by the Williams Institute at the UCLA School of Law found that more than 80% of trans adults had suicidal thoughts, while more than 40% had attempted suicide.
“For trans people of all ages, being able to express themselves in the gender that they feel that they are is important for their mental and physical health,” Starkey said. “By not allowing trans people to do that, to have the support, it just means that they are not able to be wholly who they are.”
In the last week alone, hospitals and clinics in Orange County, Riverside, and San Diego, California — and in Tacoma, Washington too — announced plans to shutter gender-affirming care programs for trans youth.
A year ago this week, Trump issued an executive order vowing to end what he called the “chemical and surgical mutilation” of children with gender-affirming care. Republicans have used these terms to outrage people and vilify medical providers of the care, but puberty blockers and hormone replacement therapies don’t “mutilate” kids, and gender-affirming surgeries are rarely (if ever) conducted on minors.
A protester at Children’s Hospital of Orange County this week described the same care as life-saving.
“I’m a transgender woman, and I’m here to tell you that denying people this gender-affirming care doesn’t make gender dysphoria go away,” Stephanie Wade, chair of Lavender Democrats of Orange County, told LAist. “All it does is make it metastasize into suicidal depression. And I’ve been there. I dealt with this as a child. We can’t take this away from kids.”
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. The Trans Lifeline (1-877-565-8860) is staffed by trans people and will not contact law enforcement. The Trevor Project provides a safe, judgement-free place to talk for youth via chat, text (678-678), or phone (1-866-488-7386). Help is available at all three resources in English and Spanish.
Missouri’s Supreme Court upheld the state’s ban on gender-affirming care for minors this week, along with a prohibition on Medicaid coverage of gender-affirming care for anyone in the state.
As the Missouri Independent reports, the court’s unanimous decision upholds a 2024 circuit court ruling in a case challenging Senate Bill 49. The law, signed by Gov. Mike Parson (R) in 2023, bans minors from accessing any form of gender-affirming care, including puberty blockers, hormone replacement therapy, and surgeries. It also bans the state’s Medicaid program from covering gender-affirming care for people of all ages.
The challenge against the law was brought by Lambda Legal and the ACLU of Missouri on behalf of three families of transgender young people, medical providers, and LGBTQ+ advocacy organizations, who argued that the law should be subject to heightened scrutiny, a more rigorous legal standard applied to cases involving the classification of individuals by specific characteristics like gender.
According to the Missouri Independent, the state Supreme Court rejected that argument, as had the lower court. While plaintiffs had argued that the law discriminates on the basis of sex and transgender status, Judge Kelly Broniec wrote in the court’s decision that S.B. 49 “classifies only based on medical use and age.”
The court’s reasoning echoes that in the U.S. Supreme Court’s ruling last year in United States v. Skrmetti, which held that Tennessee’s ban on gender-affirming care for trans youth does not discriminate on the basis of sex or transgender status.
As the Missouri Independent notes, Supreme Court precedent allows lawmakers broad discretion when it comes to issues “fraught with medical and scientific uncertainty.”
While for decades there has been broad scientific consensus — including among all major American medical associations — that gender-affirming care is safe, evidence-based, and often lifesaving for minors experiencing gender dysphoria, conservative organizations and some American media outlets have made massive strides in recent years in sowing doubt about that consensus.
In September, Lambda Legal attorney Nora Huppert argued that the lower court’s decision upholding S.B. 49 included “legal and factual errors.” But writing for the Missouri Supreme Court this week, Broniec nonetheless said that the state had “demonstrated the ongoing debate among medical and ethical experts regarding the risks and benefits associated with the treatments at issue.”
The court also rejected arguments that the Medicaid ban violates Missouri’s constitution, with Broniec noting that adults in the state can still pay out-of-pocket to receive gender-affirming care.
Gillian Wilcox, director of litigation at the ACLU of Missouri, responded to the decision saying that it “not only allows the state to target transgender Missourians access to health care but also leaves everyone’s health care options at the whims of politicians, should certain care ever fall into the political arena.”
Two bills in Florida advanced out of committee last week that would give the state attorney general more power to investigate and press felony charges against health care professionals who provide gender-affirming care in the state, including against therapists who discuss gender issues with minor patients and pharmacists who fill prescriptions that may be used as gender-affirming care.
Last week, the Criminal Justice Subcommittee passed H.B. 743 in a 12-5 vote, Florida Politics reports. The bill would allow state Attorney General James Uthmeier to sue health care practitioners for up to $100,000 per violation for providing gender-affirming care to minors. Mainstream medical organizations support gender-affirming care for trans kids because it has been shown to be life-saving and safe.
S.B. 1010 would make it a felony for doctors, school counselors, or psychologists to advise minors on gender-affirming care or “aid or abet” another health care professional in helping minors get gender-affirming care. The bill gained near-unanimous support from the state senate’s Committee on Children, Families, and Elder Affairs, according to the Florida Phoenix.
If that version of the bill passes, medical professionals could get a $100,000 fine per violation and up to five years in prison.
“We have to uphold the principles and standards that made this country great, biblical, constitutional law, and order at all costs. And sometimes that stings,” state Rep. Taylor Yarkowsky said at last week’s hearing.
The bill’s sponsor, state Rep. Lauren Melo (R), stressed that pharmacists would be punished under her bill, something she says is necessary because, she claimed, health care professionals are “committing fraud” by prescribing gender-affirming care medications but recording the purpose of the medications as something other than gender-affirming care.
“What we’re seeing is there’s coding that’s actually being used that is becoming the problem, and hundreds of thousands of dollars is spent per child for them to transition and codes are being misrepresented where they are saying that it’s an indoctrination disorder instead of saying it’s a gender identity disorder,” she said.
Democrats stressed that the bill could have unintentional side effects. State Rep. Kelly Skidmore (D) said that the bill is not about gender-affirming care but is being pushed by state Attorney General Uthmeier to expand his power.
“It is about giving one individual and maybe his successors authority that they don’t deserve and they cannot manage,” she said, referring to Uthmeier’s involvement in the Hope Florida scandal, where state Republicans are accused of laundering money and committing fraud. “They’ve proven that they cannot be trusted. This is a terrible bill.”
State Rep. Mike Gottlieb (D) said that doctors might be scared from prescribing hormonal medications to people with severe menstrual symptoms lest a pharmacist misinterpret the reason for the prescription.
“You’re going to see doctors not wanting to prescribe those kinds of medications because they’re now subject to a $100,000 penalty,” he said. “We’re really not considering what we’re doing and some of the collateral harms that it’s having.”
Behavioral health care professional Savannah Thompson told WUSF that the bill would make it more difficult for doctors to even talk to trans patients.
“This could increase the feelings of fear from my clients who are under 18, but it also can increase the likelihood that these professionals won’t be able to talk with their clients, honestly and openly, to give them the care and the support that they deserve and need,” she said.
Utah House Speaker Mike Schultz (R) says his Republican majority intends to permanently ban gender-affirming care for minors this year. The move comes more than seven months after the release of a Utah Department of Health and Human Services (DHHS) report, mandated by a Republican-backed state law, which found that medical evidence actually supports access to gender-affirming healthcare for minors, a different result than many conservatives were hoping for.
Utah already has what former state Rep. Mike Kennedy (R) — who now represents the state’s third district in Congress — described to Deseret News as a “permanent” ban on gender-affirming care for minors. Passed in January 2023, S.B. 16 banned gender-affirming surgeries for minors — despite such surgeries being exceptionally rare — and instituted an indefinite moratorium on providing puberty blockers and hormone replacement therapy (HRT) to minors for the purposes of gender-affirming care.
Kennedy, who co-sponsored S.B. 16, admitted to Deseret News that characterizing the law’s ban on puberty blockers and HRT as a “moratorium” was essentially a tactic to win over lawmakers who wanted more data on the effects of such treatments. The ban, he said, is already effectively permanent unless Utah lawmakers act to lift it.
S.B. 16 also ordered the state DHHS to commission a review of medical evidence around puberty blockers and HRT prescribed for the treatment of gender dysphoria in minors, with the goal of lawmakers using the report’s findings to inform future policy decisions.
That review, conducted by the University of Utah’s Drug Regimen Center, was released last May, and as Mother Jones reported at the time, its conclusions “unambiguously” supported the benefits of gender-affirming care for trans young people.
However, Utah Republicans, including Schultz, Kennedy, and state Rep. Katy Hall — who co-sponsored S.B. 16 — have dismissed the report.
“Common sense is common sense,” Schultz told Deseret News. “I don’t need a report, one way or the other, to tell me that. I just firmly believe that minors should not be transitioning.”
At the same time, however, Schultz told the outlet that he agrees with a separate review of the DHHS report by anti-trans advocacy group Do No Harm. The group’s review, published early last month, claims that the DHHS report does not meet the standards of a true systematic review of medical evidence, according to Deseret News.
“Unlike true systematic reviews, it does not assess the reliability of studies and whether the research can provide guidance for weighing the risks and benefits of medical intervention for children with gender dysphoria,” Do No Harm’s report claims.
A spokesperson for University of Utah Health defended the Utah DHHS review, telling Deseret News in a statement that it was based on “an extensive body of research regarding the safety and efficacy of these treatments.”
“Our review also found that the consensus of that evidence is that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, and metabolic changes; and they are effective in terms of positive mental health and psychosocial outcomes,” the statement read, according to Deseret News.
A Colorado organization is leading two ballot measures that would restrict rights for transgender children in the state.
Protect Kids Colorado, a coalition led by prominent anti-LGBTQ activist Erin Lee, is gathering signatures for ballot measures that would prevent transgender children from participating in school sports and receiving gender-affirming surgeries. Lee led several anti-LGBTQ initiatives that the Colorado Title Board rejected ahead of the 2024 election.
The group has until Feb. 20 to submit 124,238 valid signatures from registered voters for each initiative to the Colorado secretary of state’s office. If that threshold is met, the measures would be placed on the November 2026 ballot.
Z Williams, co-director of the Denver nonprofit Bread and Roses Legal Center, said both of the issues the ballot measures seek to address are relatively minute. Williams said they have yet to see “actual validated science” that supports the need for the initiatives.
“The number of trans athletes is incredibly small, and the number of gender-affirming surgeries done for transgender youth or minors is even smaller,” Williams said. “We have two ballot measures … that are going to require hundreds of thousands of dollars, waste a lot of time, create a lot of confusion during the election over two pretty much manufactured issues.”
Protect Kids Colorado did not respond to Newsline’s request for comment on the initiatives.
Coloradans value freedom, a freedom that belongs to everyone, including transgender youth and their families.
– Cal Solverson, spokesperson for One Colorado
There isn’t clear data on the number of transgender student athletes in Colorado, and the two major hospitals that provide gender-affirming care to minors do not offer surgeries to minors.
Cal Solverson, spokesperson for LGBTQ+ advocacy organization One Colorado, said the ballot measures are ill-informed and jeopardize individual freedom. They also put transgender people, their families and health care providers across the state at risk, Solverson said.
“Coloradans value freedom, a freedom that belongs to everyone, including transgender youth and their families,” Solverson said in a statement. “The right to exist as we are extends beyond the exam room to the playing field, where every child deserves the opportunity to stay active, develop life skills, and experience the deep camaraderie of a team.”
If the measures make it to the ballot, Solverson said One Colorado trusts that Colorado voters will defend transgender youth and “ensure that freedom continues to exist for all Coloradans and not just some.”
Prohibit certain surgeries on minors
Ballot Initiative 110 would prohibit health care professionals from knowingly performing any surgery on a minor “for the purpose of altering biological sex characteristics.”
The measure would also prohibit state and federal funding including Medicaid from being used to pay for gender-affirming procedures.
Children’s Hospital Colorado and Denver Health have paused gender-affirming care for youth amid the Trump administration’s threats to pull Medicaid and Medicare funding entirely.
A document on Protect Kids Colorado’s website says that Children’s Hospital Colorado performs gender-affirming surgeries on minors, but Children’s Hospital said in a statement that it has never provided gender-affirming surgical care to patients under 18, and it stopped offering such surgeries to adults in 2023. Denver Health stopped offering surgeries to minors in early 2025.
The document also says that while the ballot measure only targets gender-affirming surgeries, the organizations has “a multi-pronged plan to outlaw puberty blockers and cross-sex hormones for minors as well.”
The language in the initiative includes medical terms that aren’t necessarily related to surgery, such as prescriptions. It also applies to health care professionals such as podiatrists, dentists and chiropractors, who wouldn’t be performing gender-affirming surgeries in the first place. That adds concern about how the measure would affect other elements of gender-affirming care, according to Mardi Moore, CEO of LGBTQ+ advocacy group Rocky Mountain Equality.
“It’s kind of like they’re throwing the spaghetti at the wall to see what’s going to stick,” Moore said. “There’s not a lot of people you can trust anymore, and I think Protect Kids Colorado is one of those groups that cannot be trusted to think they will keep all children safe.”
If the measure passes, it would lead to discriminatory practices in medical care, affecting all children, not just transgender children, Moore said.
Male and female participation in school sports
Ballot Initiative 109 would create definitions in state statute aiming to define boys and girls based on physical anatomy, excluding transgender people.
Sports teams sponsored by schools or athletic associations would be required to expressly designate those teams as for men, women or co-ed. Schools and their athletic departments would be required to adopt policies implementing the requirements of the initiative.
The measure would not affect any student’s ability to participate in co-ed sports.
The state’s commissioner of education would be tasked with enforcing the measure, and would have discretion to determine how to “take appropriate remedial action” against any school not in compliance with its requirements.
“It would mean a little 8-year-old who loves to play soccer and who happens to be trans couldn’t play anymore,” Moore said of Initiative 109.
Colorado is known to be a safe place for LGBTQ+ people, Williams said, and families have moved to the state from around the country because they share those values.
“When I was a kid, we were ‘the hate state,’ and Colorado has unequivocally disavowed that stance,” Williams said. “So I think we need to remember that these are folks that are trying to use a very marginalized community to rebuild a political ideology that’s been rejected for a very long time here.”
Protect Kids Colorado is running a third ballot measure to increase penalties for people convicted of human trafficking of a minor.
When Mara Berton and June Higginbotham imagined their future, it always included children. What they did not imagine was a $45,000 bill standing between them and the family they dreamed of building.
The Santa Clara County couple, both lesbians, discovered that while their heterosexual colleagues’ fertility treatments were largely covered by insurance, they were excluded from the same benefits. To conceive, they were forced to pay entirely out of pocket, a financial burden that reshaped their timeline, their choices and their emotional well-being.
Last week, that inequity cracked open.
In a landmark national settlement approved by U.S. District Judge Haywood Gilliam Jr., Aetna agreed to cover fertility treatments such as artificial insemination and in vitro fertilization for same-sex couples on the same terms as heterosexual couples. The agreement applies nationwide across all Aetna plans, making it the first case to require a major insurer to implement such a policy uniformly.
An estimated 2.8 million LGBTQ members will benefit, including about 91,000 Californians. The settlement also requires Aetna to pay at least $2 million in damages to eligible California-based members, who must submit claims by June 29, 2026.
“We knew it wasn’t right,” Berton said in an interview with CalMatters. “What we’re fighting for is about family building and having kids. It was really important to both of us that other couples not have to do this.”
Before the settlement, Aetna’s policy required enrollees to engage in six to 12 months of “unprotected heterosexual sexual intercourse” before qualifying for fertility benefits, according to the class action complaint. Women without male partners could only access coverage after undergoing six to 12 unsuccessful cycles of artificial insemination, depending on age, a requirement medical experts say is excessive and clinically unnecessary.
The policy, attorneys argued, treated LGBTQ members fundamentally differently and effectively denied them a benefit that can be prohibitively expensive.
“This was an issue of inequality,” said Alison Tanner, senior litigation counsel for reproductive rights and health at the National Women’s Law Center, which supported the litigation. “Folks in same-sex relationships were being treated differently.”
In an email, Aetna spokesperson Phillip Blando said the insurer is committed to equal access to infertility and reproductive health coverage and will continue working to improve access for all members.
For Berton, the policy felt personal and dehumanizing. After consulting with a fertility clinic and deciding to move forward with donor sperm, she was told by Aetna that she did not meet the definition of infertility. Multiple appeals were denied. Insurance required her to attempt 12 rounds of artificial insemination,even though her doctors recommended no more than four.
Sean Tipton, chief advocacy and policy director for the American Society for Reproductive Medicine, said policies like that are designed to discourage people from using their benefits. While many doctors recommend three to four cycles of insemination before IVF, studies also show it can be more efficient and cost-effective to move directly to IVF.
In 2023, the society updated its medical definition of infertility to explicitly include LGBTQ people and individuals without partners, a shift aimed at preventing insurers from denying claims like Berton’s.
“It takes two kinds of gametes to have kids,” Tipton said. “Regardless of the cause of that absence, you have to have access to care.”
The settlement comes as California prepares to expand fertility coverage further. A new state law taking effect in January will require most state-regulated health plans to cover fertility care for same-sex couples and single people by broadening the definition of infertility. While that law does not apply to Aetna’s national plans, advocates say the momentum is unmistakable.
And it could not come at a more urgent time.
As LGBTQ rights are increasingly rolled back across the country, from bans on gender-affirming care to restrictions on queer families in schools and public life, access to reproductive health care has become another contested frontier. Who is allowed to build a family, and under what conditions, is no longer just a medical question but a political one. This settlement affirms that queer families are not exceptions to be managed but lives to be supported.
Berton and Higginbotham ultimately moved forward without coverage, pulling together money from family and enduring the physical and emotional toll of fertility treatments, including a miscarriage. Today, they are raising twin girls who love the swings and pulling every book off the shelf for story time.
They built their family before the lawsuit concluded. Still, Higginbotham said the victory matters deeply.
“I know people who don’t have children because this isn’t covered,” she said. “The settlement is such a huge step forward that is really righting a huge wrong.”
In a moment when so much is being taken, the ruling stands as a reminder; equality is not abstract. Sometimes, it looks like a family finally being allowed to exist.
A federal judge has blocked a gender-affirming care ban for trans inmates in Georgia that has been in effect for several months. Judge Victoria Calvert agreed with the plaintiffs that the blanket ban violated the Eighth Amendment, which bars cruel and unusual punishment.
“The Court finds that there is no genuine dispute of fact that gender dysphoria is a serious medical need,” Judge Calvert wrote in her opinion. “Plaintiffs, through their experts, have presented evidence that a blanket ban on hormone therapy constitutes grossly inadequate care for gender dysphoria and risks imminent injury.”
Georgia Senate Bill 185 was signed into law in May by Governor Brian Kemp (R). The bill prohibited state funds and resources from being used to provide gender-affirming care to inmates in Georgia prisons. That included hormone replacement therapy (HRT), as well as “sex reassignment surgeries or any other surgical procedures that are performed for the purpose of altering primary or secondary sexual characteristics,” and even “cosmetic procedures or prosthetics intended to alter the appearance of primary or secondary sexual characteristics.”
The bill took effect in July, and five plaintiffs filed a lawsuit against it in August. In addition to arguing that SB 185 constituted cruel and unusual punishment, the lawsuit also claimed that it violated the Equal Protection Clause. HRT and other gender-affirming care treatments were not banned under the bill for all inmates, only for those who were trans. The bill also prohibited trans inmates from paying for the care themselves while incarcerated.
“We would never allow a state to decide that people in prison with diabetes should be cut off of insulin just because the state didn’t want to pay for it anymore,” said Celine Zhu, a Staff Attorney for the Center for Constitutional Rights, which is representing the plaintiffs. “So why would we allow Georgia to cut off medically required care for people with a similarly serious diagnosis of gender dysphoria?”
SB 185 was a blanket ban that overruled the opinions of judges, doctors, and the Georgia Department of Corrections, all of whom have previously acknowledged that gender-affirming care is medically necessary for incarcerated trans people.
While the judge’s ruling makes it clear that not every inmate is entitled to gender-affirming care, it puts those decisions back in the hands of medical professionals and the patients rather than having the legislature make medical decisions for trans people.
“The Court requires healthcare decisions for prisoners to be made dispassionately, by physicians, based on individual determinations of medical need, and for reasons beyond the fact that the prisoners are prisoners,” the judge said in her ruling.
Current estimates suggest that there are around 300 out trans people incarcerated in Georgia state prisons.
After the ruling, the Department of Corrections filed a notice of appeal with the 11th Circuit Court of Appeals.
This sort of case has been litigated for over twenty years now. In 2005, Wisconsin introduced a ban on doctors providing trans inmates with gender-affirming care, affecting inmates who had been on hormones since the early 90s. The law was overturned by the 7th Circuit Court of Appeals, and the Supreme Court declined to hear the state’s appeal in 2011.
On Friday, the Trump administration began massive layoffs throughout the Department of Health and Human Services (HHS). As part of that, they completely removed the Office of Population Affairs, which was responsible for a wealth of public health programs, including specific initiatives for the LGBTQ+ community.
“This wasn’t a budget decision — it was ideological,” a former member of the Biden administration told The Advocate. “These are the programs that centered reproductive and queer health, and now they’re gone.”
Donald Trump has welcomed the government shutdown as an opportunity to cut what he has called “Democrat Agencies” to shrink the government. The process is being led by Russ Vought, the head of the Office of Management and Budget (OMB) and key author of Project 2025, which advocated for such cuts. However, he has also tried to blame those government cuts on the Democrats.
Vought took to X/Twitter on Friday to announce the start of the “Reduction in Force,” or RIF. His office confirmed via Politico that federal employees were being permanently fired, not temporarily furloughed for the duration of the shutdown: “Can confirm RIFs have begun and they are substantial. These are RIFs, not furloughs.”
Adrian Shanker, who served as deputy assistant secretary for Health Policy during the Biden administration, told The Advocate that while the Office of Population Affairs often had its programs politicized, this is “the first time that the office itself is being cut.”
The Office of Population Affairs manages a huge range of public health initiatives. Those include Title X family planning services and grants; programs for adolescents that cover issues such as pregnancy prevention, mental health, and substance abuse; the Embryo Adoption Awareness and Services program; screenings and treatment for sexually transmitted infections and information on preventing the spread of HIV; and LGBTQ+ health initiatives, including information on gender-affirming care.
As well as restricting programming targeted specifically at the LGBTQ+ community, these cuts will restrict access to family planning programs that LGBTQ+ people are more likely to make use of to grow their families.
The cuts to the Office of Population Affairs will leave us lacking when it comes to sex education and with less support for LGBTQ+ youth, Shanker noted, saying it “leaves us more vulnerable to health inequities and worsened health outcomes.”
Wider cuts to the HHS will have broader effects as the CDC is losing over a thousand employees, including the elimination of entire departments. “CDC is over. It was killed,” said Dr. Demetre Daskalakis, the out gay former director of the CDC’s National Center on Immunization and Respiratory Diseases, after 1000 scientists, doctors, and public health officials were fired from HHS on Friday. Daskalakis, an infectious diseases expert, resigned in protest of the administration’s war on science-based public health earlier this year.
“This administration only knows how to break things. They have made America at risk for outbreaks and attacks by nefarious players. People should be scared.”
Previous federal layoffs have been litigated in court, with some resulting in court rulings that the people cannot be fired, while other courts have allowed the dismissals to proceed. That process, if it occurs here, will take time, during which public health will suffer a setback.
“Without these people in place, it’s unlikely that a lot of these programs will be able to continue even after the government reopens,” predicted Shanker.
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