Cruel Intentions
By Jaimie Seaton
“I feel like a political pawn, because there’s so much talk about trans people and so much legislation passed around it, and it just feels like we’re being used as a scapegoat and just someone to put the blame on and hate on in society,” said Romana, in an online forum for transgender youth hosted by Uncloseted Media in June.
The virtual event gave Romana and four other transgender teens and young adults an opportunity to discuss the recent Supreme Court ruling which upheld a Tennessee ban on gender-affirming care (GAC) for minors. GAC includes social, medical, behavioral and psychological interventions that help transgender individuals align their gender identity with their physical bodies.
The case, United States v. Skrmetti, focuses on Tennessee, but the ruling effectively upholds bans on puberty blockers, hormones and transition surgery for youth in 25 other states. (Bans in Arkansas and Montana have been halted permanently by court order.)
Transgender people, particularly youth, are under attack by their government. If that sounds hyperbolic, consider this: In 2021, 144 anti-trans bills were introduced in state legislatures, making it a record year. So far in 2025, a staggering 972 bills have been introduced in 49 states—and 121 of them have already passed.
In addition, President Trump has signed four executive orders specifically targeting trans people and seven targeting the LGBTQ+ community at large. Perhaps most heinous, in June, Trump shut down special services for LGBTQ+ youth, which was part of the national Suicide and Crisis Lifeline—a move that seemed to be purposely cruel.
“This is part of a systemic effort to push trans people out of civic life,” says Harper Seldin, senior staff attorney for LGBTQ+ issues at the American Civil Liberties Union, who is trans himself. “It is a playbook [used with abortion] that is now being followed by some states, and the federal government to try to decrease people’s ability to access this care.”
The state and federal assault on trans people’s rights has caused widespread fear, uncertainty, upheaval and anger in the trans community. Adults and families with children seeking GAC have moved from tightly restricted states to those with more lenient laws and attitudes—though even those states are rolling back access to care—and some have fled the country entirely.
Social workers can provide invaluable, possibly life-saving support to trans people and their families as they learn to navigate a newly hostile terrain that wasn’t exactly hospitable to begin with. But they need to tread carefully—especially if they work across state lines—given the fluid nature of the laws.
A Nefarious Promise Fulfilled
Trump’s actions are fulfilling a campaign promise to go after the transgender community, and his executive orders touch every sphere of life. This includes recognizing only binary male and female genders, including on all public documents (such as passports); prohibiting the use of federal funds for GAC for minors; banning trans girls and women from participating in women’s sports at public schools and universities; abolishing diversity, equity and inclusion protections; ending funding for any nongovernmental organization that supports (directly or indirectly) care for trans individuals, and rescinding several President Biden-era executive orders that protected transgender rights on numerous fronts, including health equity and access to GAC by young people.
“Gender is no longer a protected class,” says Nomi Ostrander, PhD, MSW, an associate professor at the University of Minnesota, and a therapist who is trans and works with transgender clients, including families with trans children. “So if you are transgender, you lose any type of protection from discrimination, and the federal government has suggested it will not pursue any discrimination cases for trans folks,” Ostrander says.
On Trump’s first day in office, he also banned transgender people from serving in the military, an order that was upheld by the Supreme Court in May. Another blow was dealt in August, when the Air Force said it would deny early retirements to all transgender service members with 15-18 years’ service—effectively denying them benefits. The members can quit or be forced out of service, with a lump-sum separation payment offered to junior troops.
Other government agencies also are using their power to deprive the rights of transgender people and those who care for them. In July, the U.S. Department of Justice issued subpoenas demanding confidential patient information from more than 20 doctors and hospitals that provide gender-related treatments to minors. The official reason given was to investigate possible health care fraud and other illegal activity, but Attorney General Pam Bondi’s statement—“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice”—belies that explanation.
Families with the means are moving to states or countries to get what their transgender child needs. In 2023, Amy*, her husband and two children moved from Iowa to Portugal for their transgender daughter, Eliza*, who was 6 years old at the time. That year, the Iowa state legislature passed a bathroom bill for schools, meaning students had to use the bathroom of their gender assigned at birth. Eliza was in kindergarten and presented as a girl, and though the school was very supportive, Amy says it was a wake-up call.
“We hoped we were overreacting, and we hoped our fears wouldn’t come true. And it looks like they are coming true,” Amy says. “We moved to escape what we saw coming down the road. It’s a horrifying human rights crisis that is doing massive harm for the sake of consolidating power by scapegoating a vulnerable population.” She added that she’s privileged to be able to work remotely, and that her husband, who is a social worker, gave up his career to move.
A Mishmash of Laws
Many of the orders and actions to limit the rights of the LGBTQ+ community are being challenged in court, but that doesn’t mean they aren’t having a chilling effect. Trump’s executive order threatening to take away federal funding for institutions that provide GAC for youth was temporarily blocked by a federal judge in February, but many institutions across the country have ended the care preemptively.
The closings lead to “deserts,” where it’s difficult or impossible to get care as a minor and increasingly as an adult, which will create pressure on the existing states where GAC remains legal as they try to serve overflow populations. In August, 16 states and the District of Columbia sued the Trump administration for what they called an “unconstitutional pressure campaign” to stop hospitals and doctors from providing GAC to minors.
The U.S. is currently a checkerboard of states with full, partial or no regulatory bans on GAC for minors. States with additional protections are known as “sanctuary” states, but that name can be deceptive, and the pieces are always moving.
Minnesota
In 2023, an executive order was issued in Minnesota protecting GAC, and legislation was passed protecting trans people, including those from other states who access GAC in Minnesota. Karen Goodenough, PhD, MSW, LGSW, executive director of NASW’s Minnesota Chapter, says that in much of the state, including the Twin Cities, an abundance of institutions and providers are willing to offer GAC to adults and youth, and school districts are setting up policies to be supportive places for transgender kids.
She emphasizes that there is a lot of trans advocacy in Minnesota, but adds, “Just because we are a ‘trans refuge state’ does not mean that every part of Minnesota and every person in Minnesota agrees with this.”
Lior Effinger-Weintraub, MSW, LICSW, a clinical social worker in Minnesota who is transitioning, had a recent “horrible” experience at their pharmacy, when the staff refused to use Effinger-Weintraub’s correct name or give them the information they needed about their medications.
“I’ve been working with his pharmacy for years. They never treated me like this when I picked up any other medication, but when I went to pick up my testosterone, they were cold and rude and dismissive in a way that was really painful.”
Though the state is not universally welcoming, Goodenough says that people—including social workers—have been moving from surrounding states where laws are not trans-supportive to Minnesota as a refuge.
“I’ve talked to many social workers who have moved to Minnesota because they are trans folks and want to be in a space that is supportive … so we’re not just talking about their clients,” Goodenough says.
She notes that one of the challenges for Minnesota as a refuge state is a lack of resources. Children’s Hospital of Minnesota, for example, which offers GAC for minors, has a significant waiting list. “So, it’s not like we’ve opened our doors and said ‘come on in’ and we have this unlimited capacity,” Goodenough says.
Arizona
In contrast to Minnesota is Arizona, which has a ban on doctors performing sex-reassignment surgeries on people under 18, and a Republican legislature that has repeatedly passed anti-trans legislation ultimately vetoed by Democratic Governor Katie Hobbs. In February, responding to Trump’s executive order, Arizona Children’s Hospital—which was the largest provider of GAC in the state—said that it would “pause” care, including puberty blockers and hormones. Following that announcement, a number of other, smaller facilities stopped providing the same care.
Brandie Reiner, MSW, the NASW Arizona Chapter executive director, says many families with kids who were using puberty blockers became worried about the medical effects of suddenly stopping treatment. “We’ve heard from parents whose teenagers were trying to find hormone therapy online and have it shipped to them from other states, which is really dangerous in that you don’t know where it’s coming from,” Reiner says. “It’s not being prescribed by a doctor, but a lot of adolescents were really fearful and wanted to make sure that they could continue with their hormone therapy even if these health care facilities weren’t going to issue it anymore.”
Reiner says that some parents take their children to other states to receive GAC and/or bring hormone therapies back to Arizona.
This is an issue that social workers who use a compact license need to be cognizant of. Goodenough says social workers can expand their services across state lines, including via telehealth, but when working with trans individuals, they need to know the laws of the states they’re working in.
How to Support the Transgender Community
Viewed together, Trump’s executive orders and anti-trans restrictions nationwide resemble both death
by a thousand cuts and an impenetrable monolith.
“Often, coverage of transgender rights is siloed into one particular area. So, you’ll see, it’s just about passports or just about sports or just about medical care or just about schools, but when you look at the totality of what is happening for transgender people in the United States at this moment, it is a full central assault on our ability to exist in society,” says the ACLU’s Seldin. “These are attempts to make it harder to be a trans person at your doctor’s office, when you travel, when you go to school, when you go to the bathroom, when you simply exist in public spaces.”
Not surprisingly, trans people currently are experiencing an enormous amount of stress in the U.S., so even a trans person who is doing relatively well wakes up every day to news articles about attempts to roll back their rights and isolate them in society. In the last 10 to 15 years, there was tremendous progress for the transgender community and we’re now seeing a backlash against that. But that’s not really anything new. Throughout the history of the U.S., there have been periods of time where trans people were targeted for discrimination and social isolation.
The transgender community itself can be a valuable resource for other trans people, and social workers can help trans people connect with each other, especially trans youth. “Even in these difficult social circumstances, especially for young people and people who are young in their transition, connecting with the trans community and trans elders to learn about that history of joy and resistance … can provide a lot of the support—both material and emotional—that folks will need to get through this moment,” Seldin says.
While social workers can be instrumental in letting trans people in their community know they are not alone, parents also can be crucial lifelines to trans children or teens. “One of the things I’m always reminding [parents of] is that so much gender-affirming care can happen in the home in terms of affirming their children with their pronouns or their chosen name or attire, says the University of Minnesota’s Ostrander. “A supportive home has a really big protective factor for mental health outcomes for their children.”
Seldin says it’s important to remember that, even though the material circumstances for trans people, especially trans youth, are becoming more difficult, trans youth wake up every day and go to school and live their lives. “So, supporting trans people in their ability to continue to live meaningful lives is also something that needs to continue—because, in fact, trans lives can be full of joy and resilience.
Jaimie Seaton is a New England-based journalist with 30 years of experience. Her work appears in multiple publications, including Scientific American and Smithsonian Magazine.
* Amy and Eliza are pseudonyms to protect privacy.
Resources
NASW Practice: socialworkers.org/practice/LGBTQIA2S
NASW Code of Ethics: socialworkers.org/about/ethics/code-of-ethics
The Trevor Project: thetrevorproject.org
Human Rights Campaign: hrc.org
ACLU: aclu.org/issues/lgbtq-rights
GLMA: Health Professionals Advancing LGBTQ Equality: glma.org
PFLAG: pflag.org