Amid the wave of conservatism currently present in the United States, one major focus of the Trump administration has been to restrict freedoms and limit access to gender-affirming healthcare for transgender Americans. Between executive orders, rising sentiments of hate, and doctors refusing to accept new patients for transgender healthcare, many U.S. citizens are scared for their rights, their safety and their lives.
Medical care bans for transgender youth as of April 29, 2025. From lgbtmap.org.
At the end of January, President Donald Trump signed Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation,” on January 28. According to the Center for Reproductive Rights, “The order specifically asks agencies to ensure that hospitals, medical schools, and other institutions receiving federal research and education funding stop providing such care to minors.” Interestingly, the order restricts gender-affirming healthcare for Americans 19 and under, despite the fact that Americans are legally adults at 18.
Previously, President Trump had signed a series of executive orders targeting transgender Americans. Within hours of returning to the White House, he signed Executive Order 14168, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” which stated that the federal government would only recognize binary sex as assigned at birth. He also reinstated the previous ban on transgender individuals serving in the military.
“It is arguably one of the worst times to be trans in the USA since the AIDS epidemic in the 80s.”
H
Restrictions on healthcare could have massive impacts on the physical and mental health and wellbeing of millions of Americans.
Hormone Replacement Therapy, known colloquially as HRT, is a lifeline for many people who do not feel at home in the sex they were assigned at birth. A study conducted by the Trevor Project found that between 2018 and 2022, “anti-transgender laws significantly increased incidents of past-year suicide attempts among transgender and nonbinary youth by as much as 72%.”
Study Links U.S. Anti-Trans Legislation and Suicide Attempts. From Statista.
A student at Virginia Tech, who has asked to be referred to as H, said “The illegalization of trans medicine will cause the deaths of trans people from mental health. It’s proven that HRT is the #1 way to decrease trans depression and suicide rates. Think of it as a proven medicine to help the known illness of Gender Dysphoria. By eliminating this, you risk the lives of millions.” H also shared their experience being trans at this point in history, saying “it is arguably one of the worst times to be trans in the USA since the AIDs epidemic in the 80s.”
“82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth,” according to the National Library of Medicine. When attitudes shift against the LGBTQ+ community, studies have also shown an increased murder rate of transgender individuals. According to a 2022 article by CBS News, between 2017 and 2021, during Trump’s first term as president, “there was a 93% increase in tracked homicides of trans and gender-nonconforming people in the United States and Puerto Rico.” Around three quarters of these homicides were made up of Black transgender women, despite only 13% of the trans community being estimated to be Black.
Despite the executive order not actually making it illegal to provide gender-affirming healthcare, many healthcare providers rolled back these services immediately out of fear. Virginia Commonwealth University (VCU), the University of Virginia (UVA) and the Children’s Hospital of Richmond have all stopped taking new patients, though they have continued treatment of existing patients. Other providers have cut off prescriptions and other care to all transgender patients indefinitely.
Planned Parenthood and healthcare providers in various states have continued to provide care, although access to these resources may become limited as the Trump administration and various conservative state governments continue to push for further restriction.
These restrictions and the president’s actions concerning immigration point towards potential criminalization. H stated that her “biggest fear is [the government] criminalizing HRT and making it something you can be arrested, deported, or killed over… We have seen in the past few weeks that this administration is not opposed to violating our constitutional rights and strip US citizens of their privileges as American citizens. By criminalizing HRT and making it an offense similar to addictive drugs, you create an easier path to deport undesirables.”
This is not the first time that moves against transgender healthcare have been seen as a jumping off point for more extreme measures. In Germany in 1933, a group of youth who supported the Nazi movement broke into the Institute of Sexology and burned every book in the library. According to an article by Erin Reed, “the institute housed tens of thousands of books, research notes, and data documenting the first decades of scientific study on transgender and queer people.” Members of the LGBTQ+ community have seen the simultaneous moves against birthright citizenship and against LGBTQ+ identities as an echo of the past and a warning of what could follow.
“We have seen in the past few weeks that this administration is not opposed to violating our constitutional rights and strip US citizens of their privileges as American citizens. By criminalizing HRT and making it an offense similar to addictive drugs, you create an easier path to deport undesirables.”
H
H sees it as the Trump administration “trying to make the act of being Transgender illegal. They are trying to do the most spelled out bigoted end of transphobia… this is pretty clearly an attempt to eliminate all trans people.”
Many transgender people are worried about being targeted for being themselves in public or speaking up about their fears. H is anonymous here for that exact reason–to avoid the potentially deadly repercussions of sharing her experience being trans.
The fact that this executive order defines “minors” as people 19 and under also has members of the LGBTQ+ community concerned. While this could be due to the fact that some states have higher ages of adulthood than the federal government, some are worried that it is being used as a stepping stone towards banning gender-affirming care for transgender adults as well.
Overall, this is a volatile time for healthcare for transgender Americans. These restrictions, as well as the fear of new ones, will have a negative impact on the health and wellbeing of millions of Americans. Despite this, the community holds strong. H says that “there is an increased sense of community that comes out of hard times like this,” and that being around a community of other trans people is what “makes living through these times bearable.” In the midst of growing uncertainty and fear, this resilience and unity may provide some hope, as well as a reason to keep going despite the administration’s efforts otherwise.
Recently there has been a major push towards health and sustainability, including a shift towards organic, locally grown food. This has positive implications for people’s health and for the environment.
As they get further into young adulthood, many Virginia Tech students find it difficult to manage their finances. The university is working to provide resources for students looking to improve their financial wellness, including classes on financial literacy and financial planning, and workshops through Hokie Wellness.
Among the many difficulties faced by rural communities, one that often goes unnoticed and under-discussed is the prevalence of substance use and abuse. In many cases, the resources that could help are few or non-existent, and life’s circumstances leave people defeated and more likely to turn to drugs or alcohol.
Why it matters:
According to the Rural Information Health Hub (RIHH), “substance use disorders can result in increased illegal activities as well as physical and social health consequences, such as poor academic performance, poorer health status, changes in brain structure, and increased risk of death from overdose and suicide.”
These problems perpetuate existing difficulties within many rural communities, and in many cases people in these areas are held back from improving themselves and their lives because of them.
The vicious cycle of substance abuse and other compounding problems holds these communities back and makes them a place to get out of, rather than a home to be proud of.
The big picture: RIHH states that “factors contributing to substance use in rural America include:
Low educational attainment
Poverty
Unemployment
Lack of access to mental healthcare
Isolation and hopelessness
A greater sense of stigma”
Screenshot from Rural Information Health Hub website.
Alcohol and nicotine are the most notable offenders.
According to the RIHH chart on Rural and Urban Substance Use Rates in youths age 12-20, youths in non-metro areas use and abuse alcohol at similar rates to youths in metro areas, but use cigarettes, smokeless tobacco and methamphetamine at significantly higher rates.
Zoom in: The New River Valley is very rural, with over 15% living below the poverty line and nearly 25% considered cost-burdened.
Photo by cottonbro studio from Pexels
A 2021 New River Valley Community Health Assessment by Carilion Clinic on the overall health of the NRV community found that “rates of drug overdoses higher than the national and state average [were] present in the New River Valley—especially in Pulaski and Wythe County.”
As may be expected, those two counties also have the highest percentages of their population living below the poverty line – 24% and 21% respectively as of 2021.
In addition to substance abuse problems, the New River Valley also sees a large portion of the population experiencing other health problems.
Chronic disease rates are higher than the Virginia average, including chronic lower respiratory disease, coronary heart disease and high blood pressure.
Carilion Clinic also reports that much of the population lives in food deserts, and that “23.8% of adults report no leisure time physical activity.”
These are the situations that lead people to use and abuse substances.
An updated 2024 New River Valley Community Assessment by United Way of Southwest Virginia found that rates of death by drug overdose have been climbing since 2018, with an increase of 105% in the past five years.
What is being done: Various organizations in the New River Valley are working to provide the resources that are often lacking in rural communities.
NRV Road to Wellness provides many similar services, as well as resources for vaccination and immunization, international travel, environmental health and family planning.
The existence of any resources is a major step forward.
Yes, but: Despite the efforts of these organizations, rates of addiction and health issues in the New River Valley remain high.
Even though resources are present, greater effort will be needed to connect people with those resources and decrease the stigma of asking for help.
Time and the next NRV Community Assessment will tell how effective these resources truly are and what more is needed to free the New River Valley community from the shackles of substance addiction.
In January, the Virginia General Assembly voted “yes” on a constitutional amendment that will bring hope to hundreds of thousands of Virginians.
Since 2006, the Constitution of Virginia has stated that “only a union between one man and one woman may be a marriage valid in or recognized by” the Commonwealth of Virginia. Although the U.S. Supreme Court’s decision in Obergefell v. Hodges overruled this and similar lines in state constitutions, many are concerned that the Trump administration and overwhelmingly conservative Supreme Court will attempt to overturn this precedent, which would leave each state to decide whether to allow same-sex marriage.
Senate Joint Resolution 11 (SJ 11), which was first introduced in January 2024, amends Section 15-A of Article I of the Constitution of Virginia, repealing the prohibition of same-sex marriage and affirming the right to marriage. If SJ 11 is passed, the Constitution will now state that “the right to marry is a fundamental right inherent in the liberty of persons, and marriage is one of the vital personal rights essential to the orderly pursuit of happiness.” The amendment protects the rights of Virginians to marry legally, regardless of sex, gender, or race. SJ 11 is moving through Virginia’s General Assembly right on time, as members of the Republican party are actively calling for a reversal of the previous decision on same-sex marriage.
If made into law, this amendment could improve the mental and physical health of the approximately 300,000 Virginians who are part of the LGBTQ+ community. According to a study published shortly after Obergefell v. Hodges, “LGBT persons experience higher rates of anxiety, depression, and substance abuse because of repeated experiences of social stigmatization.” This only worsens when the LGBTQ+ community is denied freedoms such as marriage to the person they love. A 2010 study on mental health of lesbians, gay men, and bisexuals in states with marriage equality versus those without showed that “LGB persons living in states with bans had a nearly 37% increase in any mood disorder, 248.2% increase in generalized anxiety disorder, 41% increase in alcohol use, and 36% increase in any psychiatric co-morbidity.”
Delegate Rozia Henson of Virginia’s 19th House of Delegates district stated that “especially with the current climate in Washington and the extreme right Supreme Court,” the potential threat to marriage equality “provides uneasiness and burdens people’s state of mind.” His hope is that the bill brings to Virginia’s LGBTQ+ community “the peace of mind that they will know that no matter what happens in Congress, you can marry who you love in the Commonwealth of Virginia, and [if Obergefell v. Hodges is overturned], you know the position the Commonwealth is in, and what we’re willing to do to fight for our constituents.”
The physical wellness of LGBTQ+ Virginians will also be impacted if SJ 11 is passed. Many studies have shown that “chronic stress can produce long-lasting changes in the brain, including structural changes and loss of brain volume in some regions, that are linked with anxiety, depression, and substance abuse.” Additionally, long-term stress can lead to physical problems, including digestive issues, sleep problems, and increased risk of heart disease, heart attack, high blood pressure and stroke.
Beyond general physical health, researchers found that there was a 14% decrease in suicide attempts among LGBTQ+ youth when their states legalized same-sex marriage ahead of Obergefell v. Hodges. Despite the growing tension and fear as attitudes towards the LGBTQ+ community shift, Virginia may serve as a safe haven for its citizens, leading to a lower suicide rate than in states where same-sex marriage will become illegal if Obergefell v. Hodges is overturned.
Although it has been passed by both houses of the 2025 General Assembly, SJ 11 is far from the finish line. In order to become part of the Constitution of Virginia, it will have to be passed again by both houses of the 2026 General Assembly. If the amendment makes it through the second round of General Assembly voting, then it will be on the ballot in 2026 for Virginians to vote on whether or not it becomes part of the constitution. Although Virginia will elect a new governor in 2026, this will not affect the amendment’s prospects, as the Governor of Virginia plays no role in the process of amending Virginia’s Constitution.
Virginia is a highly divided state politically, with the majority of the state being rural and Republican, while Richmond and Northern Virginia overwhelmingly vote Democrat. This may present a challenge for SJ 11 to be voted into law, particularly with the current political climate of extreme views and divisiveness.
Despite this, Delegate Henson says that SJ 11 currently has strong bipartisan support from Virginia’s lawmakers, and that he is hopeful for its chances of passing the next few barricades and being voted into law.
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