The five public universities within the Texas Tech University System must “recognize only two human sexes” in their classroom instruction, according to a memo released Thursday by the system’s chancellor.
“Therefore, while recognizing the First Amendment rights of employees in their personal capacity, faculty must comply with these laws in the instruction of students, within the course and scope of their employment,” Mitchell wrote. “As a system, our role is to provide clarity and guidance to administration, ensuring that each university fulfills its legal obligations.”
The five universities within the system, which collectively have more than 60,000 students, are Texas Tech University, Angelo State University, Midwestern State University, Texas Tech University Health Sciences Center and Texas Tech University Health Science Center El Paso. The universities did not immediately respond to requests for comment.
Mitchell directed faculty to review all instructional materials and adjust them accordingly.
“I recognize that members of our community may hold differing personal views on these matters,” Mitchell wrote. “Regardless, in your role as a state employee, compliance with the law is required, and I trust in your professionalism to carry out these responsibilities in a manner that reflects well on our universities.”
Though the Texas law declares that “an individual is one of two sexes,” it also recognizes that people can be born with a disorder of sex development or intersex, meaning having sex characteristics that do not fit binary definitions of male or female. The Texas law says intersex people “are not considered to belong to a third sex” and should receive “accommodations” in accordance with state and federal law, but does not say what those are. The chancellor’s office did not respond to a request regarding how the Texas Tech University System’s medical and nursing schools would navigate teaching about intersex people under the memo.
Brad Pritchett, interim CEO of Equality Texas, a statewide LGBTQ advocacy organization, said in a statement that limiting what information students have access to harms them.
“Free speech is the backbone of American Democracy,” Pritchett said. “We cannot stand idly by while the lives of our trans neighbors are erased from the history books. Texas is one of the most diverse states in the country, the melting pot of ideas, faiths, and identities is what makes us great. Students deserve universities where professors fearlessly observe and question our world—limiting classroom discussion and research topics will only degrade our state’s standing in the world of academia. Freedom cannot exist in a state where even our ideas are policed.”
In the memo, Mitchell added that “recent developments at universities across Texas … have highlighted the importance of understanding these compliance obligations.” He appeared to be referring to a controversy at Texas A&M earlier this month, in which a student recorded herself objecting to an English lecture related to gender identity. The student argued that such instruction was “illegal” due to Trump’s executive order recognizing only two sexes.
After public backlash, the university removed the head of the English department and a dean from their administrative positions and fired the professor, Melissa McCoul.
When asked for comment, McCoul directed NBC News to her attorney, who said McCoul has appealed her termination and is exploring further legal action.
Texas A&M’s president, Mark A. Welsh III, stepped down days later but did not say whether the controversy was a factor.
“When I was first appointed as President of Texas A&M University, I told then Chancellor John Sharp and our Board of Regents that I would serve as well as I possibly could until it was time for someone else to take over,” Welsh said in a statement issued earlier this month. “Over the past few days, it’s become clear that now is that time.”
The battle over LGBTQ inclusion in Florida has expanded outside of the state’s classrooms to its crosswalks.
Last month, the Florida Department of Transportation began removing rainbow crosswalks, Black history road murals and other street art after it updated its guidelines earlier this year to prohibit “non-uniform traffic control devices, such as pavement markings on state and local roads.”
A rainbow crosswalk created in Orlando as part of a memorial for the 49 people fatally shot at the Pulse LGBTQ nightclub in 2016 was among the first that the Transportation Department painted over last month.
The next day, protesters gathered at the crosswalk to “re-paint” it with multicolored sidewalk chalk, and they continued to turn up to re-chalk the crosswalk after rain washed it away almost every day. Transportation officials repainted the crosswalk again last week, and Orlando police are now patrolling it 24/7.
Last weekend, four people were arrestedfor defacing a traffic device with chalk, though none have faced formal charges yet, so it’s unclear what kind of penalties they could face, according to Blake Simons, an Orlando-based lawyer who is representing them. A judge released all of them on their own recognizance, he said.
But the battle has spread beyond Orlando. City officials in Key West and Miami Beach planned to meet Wednesday to discuss resolutions regarding their cities’ rainbow crosswalks, which the state has ordered them to cover by this week. In St. Petersburg, transportation officials painted over a “Black History Matters” street mural that covered a stretch of road in front of the Woodson African American Museum of Florida. Two pastors were arrested Friday night for trying to stop officials from painting over the mural.
On Monday, St. Petersburg residents gathered at the city’s one remaining rainbow street mural. Tamara Leigh, 40, the founder of local group Tampa Bay Black Lesbians, said that about 100 people gathered at the event to create art and write messages of hope and love with chalk donated from across the country. She said that what struck her the most after the Black history mural was removed was how gray the street suddenly was.
“This is what happens when you remove diversity,” she said. “This is what happens when you don’t encourage inclusion. This is what happens when you shut people out. What’s left over is gray, and that was incredibly impactful for me. It’s just a visual representation of the things that are happening in this state, in this country.”
New state and federal guidance on ‘political messages’
Florida’s Transportation Department has said it is “ensuring roadways are not utilized for social, political, or ideological interests” and that the state is prepared to withhold funds from local governments that don’t comply with the directive to cover rainbow crosswalks and street murals.
Many cities were given deadlines in early September, though some, including Delray Beach, were extended after the city requested a hearing with the Transportation Department. Delray Beach officials have until Friday to submit supporting documents contesting the removal of a rainbow street mural, according to WPTV, an NBC affiliate based in West Palm Beach.
Tire marks across a newly unveiled Pride flag intersection in Delray Beach, Fla.WPTV
The guidance applies to a variety of street art, including a “Back the Blue” mural on the street outside the Tampa Police Department’s headquarters and a crosswalk in front of the Daytona International Speedway that looks like a checkered raceway finish line, The Associated Press reported.
“Roads are for safety, not political messages or artwork,” Duffy said in a statement at the time.
Florida Gov. Ron DeSantis has maintained a similar refrain.
“You don’t have a First Amendment right to commandeer someone else’s property,” DeSantis said Tuesday, when asked about protesters who were arrested in Orlando for chalking the rainbow crosswalk in front of Pulse. “You do not have a right to take somebody else’s property for your messaging purposes.”
‘Refuse to be erased’
Some Floridians who disagree with the Transportation Department’s new policy say its reasoning isn’t supported by data. For example, an April 2022 studycommissioned by Bloomberg Philanthropies using historical crash analysis found that roadways with asphalt art projects saw a 50% decrease in the rate of crashes involving pedestrians or other vulnerable road users, a 37% decrease in the rate of crashes leading to injuries and a 17% decrease in the total crash rate. The study also found a 25% decrease in pedestrian crossings involving a conflict with drivers, a 27% increase in frequency of drivers immediately yielding to pedestrians and a 38% decrease in pedestrians crossing against the walk signal.
An investigation by WPTV found that there have been only two crashes at the intersection where Delray Beach’s Pride mural is located since the crosswalk was painted four years ago. In contrast, there were 15 incidents at the same location in the four years beforehand.
Orlando police outside the Pulse interim memorial in Orlando on Aug. 24.Phelan M. Ebenhack / AP
Brandon Wolf, a survivor of the Pulse nightclub shooting and the national press secretary for the Human Rights Campaign, the country’s largest LGBTQ advocacy organization, said Wednesday that the state has repeatedly changed its justification for removing the street art. He pointed to data showing that vibrant crosswalks improve pedestrian safety. He also noted that in 2023 DeSantis named a road in Florida after conservative talk show host Rush Limbaugh.
“It doesn’t work to say you’re erasing political statements from the pavement, and so now you’ve gone to, ‘Well, we just want every crosswalk to be standard,’” Wolf said. “The incoherence of their own strategy tells you that they’re not sure why they’re doing this, except to visibly demonstrate that they have control and power. That is what this is about. It is about a physical demonstration of force, of power over people — a reminder that they are the people in control, and at any given moment, they can decide to erase something.”
Blake Simons, the attorney representing the four people who were arrested at the Pulse crosswalk over the weekend for using chalk on it, said that he is personally not upset about the Transportation Department’s policy. Rather, he said protesters have a right to exercise their free speech.
“As long as people are not actually damaging things, we still have the right to exercise our free speech, even through conductive actions, as long as we’re not defacing property,” Simons said, adding, “This argument that this chalk is defacing it is just ludicrous.”
Wolf said DeSantis and the Trump administration have “desecrated” the Pulse nightclub memorial, where the state approved the rainbow crosswalk in 2017. When he’s there, he said, he feels closest to his friends Juan Guerrero and Drew Leinonen, who were killed in the shooting.
He added that the protests are “a testament to the power of the people to refuse to be erased.”
“If DeSantis and Trump thought that they could silence or erase a community with one crosswalk or with one bucket of paint, they were sorely mistaken,” Wolf said.
Roughly 2.8 million Americans who are 13 or older identify as transgender, according to a new study.
The figure represents 1% of the U.S. population in that age group, according to the report published by the Williams Institute at UCLA’s School of Law, which has been estimating the transgender population size since 2011.
According to the study’s findings, transgender individuals tend to be younger than the overall U.S. population.
More than 75% of transgender people ages 13 and older are under 35, compared with 34% of the entire U.S. population in the same age group.
Jody Herman, the report’s lead author and a senior scholar of public policy at the Williams Institute, said this trend of younger generations being more likely to identify as transgender is expected to continue.
“Youth and young adults are more likely to identify as transgender due to a variety of factors, including a greater willingness among younger individuals to disclose that they identify as transgender on surveys,” Herman said in a news release.
Improvements in data collection for youth have helped provide more accurate estimates of youth who identify as transgender, according to study co-author Andrew R. Flores, a distinguished visiting scholar at the Williams Institute and an assistant professor of government at American University.
“Federal datasets that include questions about sexual orientation and gender identity have provided critical information to researchers, clinicians, policymakers, and the public,” Flores said in the news release.
The number of adults who identify as transgender has remained “fairly consistent” over time, according to the study.
The breakdown of adults who identify as transgender is almost an even split between transgender men, transgender women and nonbinary people — coming in at 34.2%, 32.7% and 33.1%, respectively.
The study also noted that the race and ethnicity distribution of transgender individuals “appears similar to that of the U.S. population.”
At the state level, Minnesota was estimated to have the highest percentage of transgender adults, making up 1.2% of the population of people ages 18 or older, while Hawaii is reported to have the highest percentage of transgender youths, comprising 3.6% of the population in the 13 to 17 age group.
Researchers used data from the Centers for Disease Control and Prevention-administered public health surveys called the Behavioral Risk Factor Surveillance System and Youth Risk Behavior Surveillance System, the study said.
More than 20 hospitals and health systems have temporarily or indefinitely rolled back transgender care for minors and some young adults this year amid threats of federal investigations and cuts to government funding, an NBC News analysis found.
In addition to those 21 hospitals, another five have removed webpages dedicated to trans care for minors from their websites this year — one said it is still providing trans care to minors, one would only say it continues “to comply with applicable state and federal laws and regulations,” and three did not respond to requests for comment. And separately, a health center in Iowa stopped providing hormone therapy to trans adults due to a Trump order that prohibits federal funds from being used to “promote gender ideology,” the Iowa Capital Dispatch reported.
The changes have come as hospitals attempt to comply with state laws, which in many instances prohibit discriminating against trans people in medical care, as well as federal guidance, which in recent months has threatened to revoke hospitals’ federal funding or charge them with civil or criminal penalties if they continue to provide trans care to patients younger than 19.
A testosterone prescription used for gender-affirming care in 2023.Rory Doyle for The Washington Post via Getty Images file
Patients and families affected by these changes in care have described the effects as devastating.
One Florida mom, who asked that her name not be published due to fears that she could face harassment or be targeted by the federal government, recently bought one-way tickets to Berlin so she and her 15-year-old trans daughter could move there next month. The mom has acquired a language-learning visa, and her daughter will be able to live with her because she is a minor.
When her daughter first sought access to transition care, Florida Gov. Ron DeSantis’ administration and state Republican legislators were trying to ban it, so in September 2021, the teen and her dad started driving 11 hours to Alabama every few months so she could access care at the University of Alabama’s gender clinic. Then, in August 2023, a court allowed a care ban to take effect in Alabama. Last July, they began flying to Washington, D.C., to receive care at Children’s National Hospital.
Last month, the hospital announced in a message on its website that “in light of escalating legal and regulatory risks to Children’s National, our providers, and the families we serve, we will be discontinuing the prescription of gender-affirming medications” effective Aug. 30.
The mom said even if she could find another doctor in the U.S. for her daughter, she fears the family might have just one visit “before the government steps in again.”
“Where can we go?” she said. “Growing up, we were always told that America is the greatest country in the world, and now we’re having to flee so that my child can get the health care she needs, and for our safety.”
‘These threats are no longer theoretical’
Since 2021, 27 states have enacted measures prohibiting access to puberty blockers, hormone therapy and/or surgeries for trans minors as part of a wider effort to restrict trans rights.
Supporters of the legislation say the care has not been adequately studied, can have harmful long-term effects and that minors cannot actually consent to it. However, doctors who treat trans youth say puberty blockers and hormone therapy have been provided to minors who are not trans for decades to treat other conditions, such as precocious puberty. In addition, nearly all major medical associations in the United States support access to transition-related care for minors and oppose restrictions on it, with the American Medical Association calling government restrictions “a dangerous intrusion into the practice of medicine.”
A study published earlier this year in JAMA Pediatrics found that less than 0.1% of adolescents in the U.S. with private insurance in the United States are trans and are prescribed puberty blockers or gender-affirming hormones. A 2024 study published by the Harvard T.H. Chan School of Public Health found that the rate of teens ages 15 to 17 undergoing gender-affirming surgery was 2.1 per 100,000.
The remaining states where care is legal — particularly California, Colorado, Oregon, Illinois, Washington, Connecticut and Pennsylvania — have seenan influx of out-of-state patients, with some parents of trans minors even relocating their families to those states to maintain care for their kids.
Parents of trans youths have seen those states — and hospitals such as the Children’s Hospital Los Angeles, which is home to one of the nation’s oldest gender clinics — as safe havens.
An emergency room nurse at Children’s Hospital Los Angeles shows a lanyard decorated with pronoun pins and buttons during a protest against the closure of the hospital’s trans youth clinic on July 3.Jae C. Hong / AP
However, in January, the Trump administration began targeting providers of trans care, including an executive order that sought to bar federal funding from going to medical schools and hospitals that provide such care to people younger than 19. In March, a federal judge blocked that part of the order, and some hospitals resumed treatments.
But then, in April, Attorney General Pam Bondi issued a memo that said the Justice Department would investigate doctors who provide transition care to minors under existing laws, including laws against genital mutilation. In July, the DOJ sent subpoenas to more than 20 doctors and clinics that provide such care. A subpoena sent to the Children’s Hospital of Philadelphia, which was made public Monday as part of a legal filing attempting to block the investigations, requested the names, birth dates, Social Security numbers, addresses and parent/guardian information of all patients who were prescribed puberty blockers or hormone therapy.
The Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the FBI and the Federal Trade Commission have also taken action to restrict care, both for minors and adults.
Children’s Hospital Los Angeles mentioned all of these actions and more in a June 12 letter to hospital staff detailing its decision to close the Center for Transyouth Health and Development, which has been running for three decades, effective July 22.
The letter, which a spokesperson for the hospital shared with NBC News, described an HHS review published in May “dismissing current evidence-based care protocols and standards of care while promoting alternative best practices for the treatment of pediatric gender dysphoria.” The HHS review “included dozens of references to CHLA and the Center for Transyouth Health and Development,” the letter said.
“Taken together, the Attorney General memo, HHS review, and the recent solicitation of tips from the FBI to report hospitals and providers of [gender-affirming care] strongly signal this Administration’s intent to take swift and decisive action, both criminal and civil, against any entity it views as being in violation of the executive order,” this hospital’s leadership wrote. “These threats are no longer theoretical. The federal government has already cut off hundreds of millions of dollars from U.S. academic and research institutions for noncompliance with executive orders, often with little to no warning.”
Earlier this month, more than a dozen states, led by New York Attorney General Letitia James, sued the Trump administration to block investigations into doctors and hospitals who provide gender-affirming care to minors.
The complaint argued that the federal government was trying to institute a national ban on such care when Congress has not passed one, violating the 10th Amendment by trying to usurp the power of states that have not passed bans. It also argued that hospitals were being forced to either defy the federal threats or comply and violate state laws against discrimination in medical care.
Taylor Rogers, a White House spokesperson, said in a statement at the time that Americans support Trump’s efforts to stop “the despicable mutilation and chemical castration of children,” using inflammatory language to describe transition care.
“The President has the lawful authority to protect America’s vulnerable children through executive action, and the Administration looks forward to ultimate victory on this issue,” Rogers said.
Protesters in Fort Lauderdale, Fla., in 2023.Jose A. Iglesias / Miami Herald via Getty Images file
Robin Maril, an assistant professor of constitutional law at Oregon’s Willamette University, said the Trump administration is attempting to restrict access to transition care through guidance issued by regulatory agencies. That guidance tells doctors and hospitals “exactly how the government is going to go after them,” Maril said.
Hospitals are weighing losing all federal funding, which could force them to close, Maril said, or standing up to the Trump administration.
“To stand up to the Trump administration at this point would result in kids losing care for all sorts of things,” Maril said.
‘That’s just not fair’
The climate created by the administration’s policies, the investigations and the legal battles have been surreal for Dr. Kade Goepferd, the chief education officer at Children’s Minnesota and a pediatrician in the hospital’s Gender Health Program, which has not ceased or paused trans care for minors.
Goepferd, who uses they/them pronouns, said their patients’ parents are scared, and the kids don’t understand why their friends can access any health care when needed, but they might not be able to access this specific type of care because they’re trans.
“They feel very singled out,” Goepferd said. “The teenagers feel a lot of hopelessness. The younger kids feel a lot of fear for what their future may or may not be like.”
Dr. Kade Goepferd.Sarah Wilmer for NBC News
Goepferd said they have several patients who have moved or plan to move out of the country due to the increasingly restrictive care landscape for trans youth, and the number of out-of-state patients they see has increased over the last few years. The clinic’s waitlist for a first appointment is about six months.
They said one of their greatest concerns “is that we are tying the ability of transgender young people to access care they need, and the ability of their parents to make medical decisions for them, to the general public’s ability to understand who they are and what their medical care is.”
“That’s just not fair,” they said. “We don’t do that with other areas of medicine. We rely on medical guidelines and expertise to make decisions. So we’re treating essential health care for transgender youth as exceptional in some way, and what I wish people knew more than anything is that it is not. I provide this type of health care the same way I provide any other type of health care.”
The waiting room at the Children’s Minnesota Specialty Center, where Dr. Kate Goepferd’s Gender Health Program is located.Sarah Wilmer for NBC News
As for the Florida mom, she said that as soon as her daughter could talk she would point to Daphne in the cartoon “Scooby Doo” and say, “I that girl.” A psychiatrist said the child was “persistent, insistent and consistent” in her gender for years, and they have supported her and spent at least $7,500 on travel to access care in other states.
But now, she said, it feels like they’re out of options, and she’ll be flying to Berlin with her daughter in September and leaving her three other children in the States with their dad.
“It was like a nice fantasy that I would live in Europe one day, but then it became this absolute necessity, and I have to leave my other kids, and I don’t even know how to explain how fearful I feel and how heartbreaking this is,” she said.
Ace’s Place, which opened in Queens this week, will offer 150 beds, services like counseling and a work-study program.Kayla Bartkowski / Getty Images
New York City opened the country’s first city-funded shelter for transgender and gender-nonconforming people experiencing homelessness.
Ace’s Place, which opened this week in Queens and will offer 150 beds, is a collaboration between the NYC Department of Social Services and Destination Tomorrow, an LGBTQ nonprofit in the Bronx.
Ace’s Place will provide transitional housing as well as other services including individual and group counseling, planning and assistance for permanent housing, referrals to medical and mental health services, support groups, life skills and financial literacy workshops and employment assistance. Destination Tomorrow is also developing a work-study program for the culinary arts for residents interested in working in hospitality and food service, according to a press release from the nonprofit.
“Ace’s Place is a community-driven answer to systemic neglect, and it’s only the beginning,” Sean Ebony Coleman, founder and CEO of Destination Tomorrow, said in a statement.Destination Tomorrow
“We couldn’t be prouder to make this historic announcement that strongly affirms our values and commitment to strengthening the safety net for transgender New Yorkers at a time when their rights are roundly under attack,” Molly Wasow Park, Department of Social Services commissioner, said in a statement. “Ace’s Place will offer Transgender New Yorkers a safe place to heal and stabilize in trauma-informed settings with the support of staff who are deeply invested in their growth and wellbeing.”
Sean Ebony Coleman, founder and CEO of Destination Tomorrow, said Ace’s Place is a “hard-fought declaration that our Transgender and gender nonconforming siblings will no longer be pushed to the margins.”
“Ace’s Place is a community-driven answer to systemic neglect, and it’s only the beginning,” Coleman said in a statement.
Trans people disproportionately experience homelessness, in part due to facing more employment discrimination. The 2022 U.S. Trans Survey, the largest nationwide survey of trans people, with more than 90,000 respondents, found that 30% of respondents reported experiencing homelessness in their lifetimes. Eleven percent of those who had ever held a job said they had been fired, forced to resign, lost the job or been laid off because of their gender identity or expression. More than one-third (34%) of respondents were experiencing poverty.
Ace’s Place is one of only two organizations in New York City that will provide housing for adults in the LGBTQ community. Nearly all of the city’s LGBTQ shelters are for people under 25.
The Department of Homeland Security will update visa policies to prevent transgender women from traveling to the U.S. to participate in elite women’s sporting events.
U.S. Citizenship and Immigration Services issued guidance Monday intended to bar trans women athletes from obtaining “extraordinary ability” visas to compete in female sports, as was first reported by the conservative news website The Daily Wire. The guidance builds off of an executive order President Doanld Trump issued during the early weeks of his presidency that intended to bar trans women from competing in female sports.
The guidance doesn’t use the word transgender or refer to trans women, but rather refers to “male athletes” who seek to compete in women’s sports.
Matthew Tragesser, a spokesperson for USCIS, said in a statement that the agency is “closing the loophole for foreign male athletes whose only chance at winning elite sports is to change their gender identity and leverage their biological advantages against women.”
“It’s a matter of safety, fairness, respect, and truth that only female athletes receive a visa to come to the U.S. to participate in women’s sports,” Tragesser said in the statement. “The Trump Administration is standing up for the silent majority who’ve long been victims of leftist policies that defy common sense.”
The policy update applies to three visa categories for individuals who possess “extraordinary ability” in science, art, education, business or athletics. It also affects national interest waivers, which allow applicants to self-petition to waive the labor certification for a green card if they can show that their work serves the national interest.
The updated guidance clarifies that USCIS “considers the fact that a male athlete has been competing against women as a negative factor” in determining whether they are among the top in the sport.
The guidance adds that it is not in the national interest of the U.S. to waive the labor certification requirement for trans women athletes “whose proposed endeavor is to compete in women’s sports.”
USCIS did not respond to a request for comment regarding how many people could be affected by the new policy or whether there are recent examples of trans female athletes traveling to the U.S. under the affected visa categories.
Within the National Collegiate Athletic Association, the nonprofit group that regulates college athletics, about 25,000 international student athletes compete in NCAA sports out of the more than 500,000 total who compete each year, according to the association. While it’s unclear how many NCAA athletes are trans, the association’s president, Charlie Baker, told a Senate committee in December that he is aware of fewer than 10.
The USCIS policy update may have affected athletes who planned to travel to Los Angeles for the 2028 Summer Olympics; however, the U.S. Olympic and Paralympic Committee barred trans women from competing in female sports last month.
Only a handful of trans athletes have ever competed in the Olympics. Weightlifter Laurel Hubbard became the first out trans athlete to compete in the Olympics in the Tokyo Games in 2021, though she did not medal. American skateboarder Alana Smith and Canadian soccer star Quinn also competed in the Tokyo Games, and Quinn became the first nonbinary and trans athlete to ever medal when their team won gold that year.
Officials in 16 states and Washington, D.C., filed a lawsuit Friday to block the Trump administration’s investigations into hospitals and doctors who provide transition-related care to minors.
The complaint, filed in the U.S. District Court for the District of Massachusetts, argues that the administration, by threatening to prosecute providers, is trying to institute a national ban on puberty blockers, hormone therapy and surgeries for transgender minors even though Congress has enacted no such federal ban.
“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” New York Attorney General Letitia James, who is leading the coalition of states in the suit, said in a statement. “This administration is ruthlessly targeting young people who already face immense barriers just to be seen and heard, and are putting countless lives at risk in the process. In New York and nationwide, we will never stop fighting for the dignity, safety, and basic rights of the transgender community.”
More than half of states have laws that restrict or completely ban transition care for minors. Care is legal in all of the states that joined Friday’s complaint. They are California, Connecticut, Delaware, Hawai’i, Illinois, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New York, New Mexico, Rhode Island, Wisconsin and Pennsylvania, as well as Washington, D.C.
Within days of his inauguration, President Donald Trump signed an executive order seeking to restrict such care nationwide for anyone under 19 years old. Among its provisions, the order sought to bar federal funding from going to medical schools and hospitals that provide such care. As a result of the order, several hospitals announced they were pausing transition care for people under 19. Multiple judges blocked that part of the order, and many hospitals resumed care.
Despite the injunction, Attorney General Pam Bondi issued a memo in April that said the Justice Department would use a variety of existing laws to investigate providers of gender-affirming care for minors. According to Friday’s complaint, the DOJ has issued guidance that “threatens baseless civil and criminal prosecution” of providers, and, just last month, issued more than 20 subpoenas to providers of such care across the country demanding that they give the federal government private patient information.
The lawsuit, which names Trump, Bondi and the DOJ as defendants, challenges Trump’s executive order seeking to restrict access to transition care for minors, Bondi’s April memo and another June memo from Assistant Attorney General Brett Shumate that directed the DOJ’s Civil Division to prioritize investigations into doctors who provide such care.
The complainants, 16 attorneys general and the governor of Pennsylvania, argue that transition care is legally protected in all of their states and that federal attempts to block the care “trammel on State power” in violation of the Tenth Amendment. They also argue that the administration’s actions force providers to make “an impossible choice” of either defying the federal threats or complying and violating their state’s laws against discrimination in medical care.
“These efforts to chill the provision of healthcare for adolescents — even in states where such care is legal and protected — show that the Agency Defendants have adopted and are engaged in a systematic effort to leverage the threat of criminal and civil enforcement to eliminate medically necessary care for transgender adolescents in the United States,” the complaint states.
Taylor Rogers, a White House spokesperson, said in a statement that Americans support Trump’s efforts to stop “the despicable mutilation and chemical castration of children,” using inflammatory language to describe transition care.
“The President has the lawful authority to protect America’s vulnerable children through executive action, and the Administration looks forward to ultimate victory on this issue,” Rogers said.
A DOJ spokesperson, when asked to comment on the lawsuit, said in a statement, “As Attorney General Bondi has made clear, this Department of Justice will use every legal and law enforcement tool available to protect innocent children from being mutilated under the guise of ‘care.’”
As the DOJ has opened investigations into some providers of transition care for minors, a rising number of hospitals — including those in states without laws that restrict trans health care — have announced that they plan to close their youth gender clinics.
The complaint notes that the administration has celebrated these announcements, pointing to a press release from the administration last weektitled, “President Trump Promised to End Child Sexual Mutilation — and He Delivered.”
“These changes have been touted by Defendants as precisely what was intended by their unlawful and disingenuous targeting: the end of healthcare for transgender individuals under 19,” the complaint states.
The plaintiffs ask the court to declare unconstitutional the portion of Trump’s order that would bar federal funding from going to hospitals that provide transition care to people under 19 and prohibit the DOJ from enforcing the memos from Bondi and Shumate.
Some European countries have restricted access to such care, but only the United Kingdom has indefinitely banned new prescriptions of puberty blockers to treat minors for gender dysphoria, the medical term for the distress caused by a misalignment between someone’s birth sex and gender identity.
Nineteen states have laws that prohibit trans people from using the bathrooms that align with their gender identities in K-12 schools.Tilde Oyster / NBC News
Nearly a decade after North Carolina passed its controversial “bathroom ban,” sparking nationwide backlash and corporate boycotts of the state, transgender bathroom restrictions have made a resurgence.
Nineteen states have laws that prohibit trans people from using the bathrooms that align with their gender identities in K-12 schools, and in many of those states the restrictions apply to other government-owned buildings as well. As a result, more than 1 in 4 trans people live in states with policies that restrict their bathroom use, according to the Movement Advancement Project, an LGBTQ think tank.
These measures are similar to North Carolina’s HB 2, a law enacted in 2016 that was widely referred to as the “bathroom bill.” The law sparked nationwide protests and corporate boycotts, most notably from the NCAA, which moved seven championship sporting events out of the state that year. The General Assembly repealed HB 2 with a compromise bill in 2017 that placed a statewide moratorium on municipalities passing nondiscrimination ordinances until 2020, and the state hasn’t passed a similar law since.
Though North Carolina’s law generated widespread protests, the bathroom policies passed over the last few years have received little national or corporate response, despite many of them being far broader than HB 2. That could be due, in part, to the dozens of other bills states have considered and passed targeting trans people.
Logan Casey, director of policy research at the Movement Advancement Project, said part of why there was more backlash to HB 2 was because it was among the first “bathroom bills.” In 2016, the year the bill became law, state lawmakers had introduced about 250 bills targeting LGBTQ rights, and many of those were bathroom restrictions and “religious freedom” bills, which are intended to protect people and businesses who say abiding by state and local nondiscrimination laws would violate their religious beliefs.
This year, Casey said, he’s tracking more than 700 anti-LGBTQ bills, up from nearly 600 last year, and they affect everything from trans people’s access to bathrooms, sports and health care to what LGBTQ materials students can be exposed to in schools.
“Just the sheer volume of attacks made it a lot harder for even just the general public to really track everything that’s been happening,” Casey said. “That’s been a big part of what has allowed so much to happen at once, is that they’re sort of flooding the zone with all these anti-LGBTQ attacks.”
‘I feel singled out’
Of the 19 states that subject trans people to bathroom restrictions, six have bans that apply to all government-owned spaces, including K-12 schools and colleges; eight states restrict bathroom use in K-12 schools and at least some government-owned buildings; and five states restrict bathroom use in K-12 schools only, according to MAP.
Most of those states also have a law or policy that legally defines “sex” in a way that could impact trans people’s access to bathrooms. Four additional states — Indiana, Nebraska, Kansas and Texas — define sex in a way that could affect trans people’s access to restrooms but don’t have official “bathroom bans” on the books.
Proponents of measures that restrict access to bathrooms and other sex-segregated facilities argue that allowing trans women to use women’s bathrooms could threaten women’s safety and privacy. However, a 2018 study from the Williams Institute at UCLA School of Law found that allowing trans people to use facilities that align with their gender identities does not increase safety risks.
Some states have expanded the scope of their bathroom restrictions in recent years. Arkansas, for example, passed a law in 2023 requiring trans people to use the bathroom of their birth sex in K-12 public schools and public charter schools. Earlier this year, the state passed another law expanding that measure to apply to shelters, correctional facilities and all public buildings, which include public colleges and universities.
A trans woman working at a university in Arkansas, who asked to be anonymous because she fears how speaking to the press could affect her current and future employment in the state, said the bathroom restriction, for her, “means segregation.” The day after the expanded law was enacted, the woman said her boss told her she would need to walk across the building to use a single-occupancy bathroom. If that bathroom is occupied, which she said it often is, she has to walk across campus to the only other single-occupancy bathroom.
“I feel singled out for something I don’t have any control over,” she said. “I’m not being treated equally to any of my cisgender colleagues. It makes me feel dehumanized.”
She added that some of her colleagues’ reactions have been upsetting, because “they’ve reacted as if I should be happy, like I have a private bathroom, and I don’t understand how they could come to that conclusion.”
As a direct result of the law, she said, she has accepted another job outside of the public university system that she’ll start next month. In the meantime, she said, more of her colleagues have started to misgender her.
“At this point, I really wish I just hadn’t come out at work,” she said.
Bathroom restrictions, Casey said, can contribute to more hostile workplaces and schools for trans people because they can be interpreted as the government “green-lighting” discrimination.
Many of the bills, like Arkansas’, also use vague language, which Casey said is intentional, because it can “provide cover” for the law to be applied more broadly.
“Because of the confusion and the fear around these bills, as well as the hostile climate that they contribute to, there can often be misperceptions that they also apply to private spaces,” Casey said. “That makes it much harder for trans people to actually know in those states what their rights are and aren’t, and can lead to far more reaching bans than the letter of the law actually calls for.”
Casey noted that there have been an increasing number of cases in which even cisgender women, who are not trans, have been questioned in restrooms. For example, in May, two women filed a discrimination complaint against a Boston hotel where they say a security guard followed them into the bathroom and accused one of them of being a man. Neither Massachusetts nor Boston has measures restricting trans people’s bathroom use.
A different environment now from in 2016
North Carolina’s General Assembly passed HB 2 in response to a 2016 Charlotte ordinance that expanded the city’s existing nondiscrimination protections to include LGBTQ people. The expansion specifically protected trans people’s right to use the bathrooms that aligned with their gender identities.
When HB 2 passed that same year, the backlash was swift and far-reaching. As a direct result of the law, PayPal announced that it would no longer open a new operations center in Charlotte, which would have included investing $3.6 million in the state. The NCAA announced that it would not hold championship events in the state, and prominent musicians including Bruce Springsteen, Ringo Starr, Demi Lovato, Nick Jonas and Maroon 5 all canceled performances, citing the law.
Michael Walden, a retired economics professor at North Carolina State University who gave interviews about the boycotts when they happened, said North Carolina’s status as one of the first states to pass such a law triggered more protest and attention on the issue, and, as a result, businesses had to quickly figure out how to respond.
“When a lot of businesses saw there was a huge backlash, they didn’t want to be associated with that at all, which is understandable,” Walden said.
Recently, however, businesses have likely “assessed that the environment is different,” he said.
“They do observe some protests. They do observe some rallies and marches, etc., but nothing like we saw 10 years ago,” Walden said.
Trans rights have also become increasingly politicized and painted as controversial. Walden noted that in the last few years North Carolina has joined the more than two dozen states that have enacted laws prohibiting certain transition-related medical care for minors and banning trans students from playing on school sports teams that align with their gender identities. Neither of those laws generated national backlash or a response from the business community in the way HB 2 did.
“My analysis would be that the average business doesn’t want to take a position on any of this, either pro or con, unless they think they really have to, to satisfy their customer base or investor base,” Walden said.
The landscape for LGBTQ rights was also much different in 2016, the year after same-sex marriage became legal nationwide, Casey said.
“Opponents of LGBTQ equality were really sort of casting around and looking for some new way to continue to use LGBTQ issues as a wedge issue for a broader radical agenda, and bathroom bans and religious exemptions were really the two things they were focused on at that time, and both of those were relatively unsuccessful,” Casey said.
He pointed both to HB 2 and Indiana’s Religious Freedom Restoration Act, which passed in 2015 and led to criticism from tech giants like Apple and Yelp. As a result of the potential business effects Indiana’s law could have on the state, lawmakers quickly amended the measure to explicitly prohibit it from being used to justify discrimination.
More bathroom bans are likely on the horizon. Fifteen states have considered them so far this year, including three that successfully expanded their existing bans, according to the American Civil Liberties Union. A judge blocked Montana’s law in May while a lawsuit against it proceeds.
A new, broader version of North Carolina’s defunct ban could also be resurrected. Earlier this month, Gov. Josh Stein, a Democrat, vetoed a far-reaching bill that would redefine sex in the state to only recognize birth sex and would prohibit trans North Carolinians from changing the sex on their birth certificates and driver’s licenses. The law explicitly requires sleeping quarters on public school trips to be separated based on birth sex and could affect what bathrooms trans people can use in schools and public buildings. Though Stein vetoed the bill, Republicans in the state’s General Assembly could override his vetoes and plan to try to do so when they reconvene on Tuesday 29.
The Justice Department announced that it had sent more than 20 subpoenas to doctors and clinics involved in “performing transgender medical procedures on children.”
The department’s brief announcement Wednesday did not name any of the 20 doctors or clinics or say where they were. It also did not specify what constituted “transgender medical procedures” but said its investigations “include healthcare fraud, false statements, and more.”
“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,” Attorney General Pam Bondi said in a statement.
Also Wednesday, the Federal Trade Commission hosted an all-day workshop on the “dangers of gender-affirming care.” In his opening remarks, FTC Chairman Andrew Ferguson suggested that such care is deceptive and requires greater scrutiny by the commission.
The workshop and the Justice Department’s announcement are the latest escalation of the Trump administration’s campaign to restrict transgender rights and access to transition-related medical care.
The FTC’s panel Wednesday featured more than a dozen speakers who criticized transgender health care, including people who received such care as minors and now say they regret it; doctors and psychologists who disagree with the current standards for providing such care; and political scientists and lawyers who oppose access to transition care for minors.
Claire Abernathy said she had a double mastectomy by her 15th birthday and detransitioned, or stopped identifying as trans, at 18.
“My doctors didn’t tell me that hormones would cause permanent side effects,” said Abernathy, now 20. “They hid those effects from me. They worked to silence me when I tried to complain about this abuse. We need to make sure no more kids are sold products they can’t return.”
A common refrain from many of the panelists was that it is not possible for someone to be “born in the wrong body” and that there is no evidence to support transition care as a treatment for gender dysphoria, the medical term for the distress that results from the conflict between someone’s gender identity and sex assigned at birth.
Miriam Grossman, a child psychologist who has testified in favor of state legislation to ban access to transgender care for minors, said the idea that someone can know for sure that their gender identity is more authentic to them than their birth sex “is entirely unproven and unprovable.”
“There is no objective evidence of being born in the wrong body, and saying so misleads and takes advantage of consumers, and it impacts their medical decisions,” Grossman said.
Ferguson said the FTC’s statutory mandate is to “protect people from deceptive cures and health claims. He added that the FTC would post a public request for information next week based on what was learned at the workshop.
‘Not the FTC’s lane’
The workshop faced backlash from activists and also from some employees within the FTC, Reuters reported. Nearly 150 FTC employees signed a “statement of concern” dated July 2 about Wednesday’s workshop, writing that it “would chart new territory for the Commission by prying into confidential doctor-patient consultations.”
They added, “Simply put, in our judgment, this is not the FTC’s lane.”
On Thursday, three former FTC employees also opposed the workshop at an event held by Public Knowledge, a nonprofit organization that promotes free expression and an open internet.
Among them was Eileen Harrington, who worked for the FTC for nearly 40 years and was its executive director from 2010 to 2012. She said that, through the workshop, the “FTC engaged in a kind of overreach that we haven’t seen for over 50 years.”
Harrington helped develop the FTC’s workshop process in 1992 when she was director of the division of marketing practices. Before a workshop, she said, the FTC would issue a public statement about the topic and then invite the public to submit comments. It would also invite stakeholders with a variety of views to speak at the workshop.
“Yesterday’s event bears little resemblance to what we intended to create back in 1992 and to what the FTC has done over the years,” Harrington said, noting that the public was barred from attending in person and that the FTC handpicked people who were allowed to speak and who represented only one point of view.
Joe Simonson, a spokesperson for the FTC, criticized the Public Knowledge event in a phone interview.
“I looked up who funds Public Knowledge, and I see it’s all big tech, and so it makes sense to me that a big tech-funded nonprofit, ostensibly devoted to copyright law, would be looking for any excuse to attack the Federal Trade Commission, even if it means standing against young men and women who say they were abused and mutilated by so-called medical professionals,” Simonson said.
He added that the workshop was not open attendance because the panelists received death threats.
Regarding criticism that the workshop included only one viewpoint, Simonson said, “Many of the panelists who appeared say they were victims of mutilation and abuse, and I don’t know who is on the other side of that.”
Asked about the majority of trans people, including youths, who say they do not regret receiving treatment, Simonson said: “We’re not talking about those people. We’re talking about people who were abused and mutilated.”
Kellan Baker, executive director of the Institute for Health Research and Policy at Whitman Walker Health, a medical clinic in Washington, D.C., said he helped create Thursday’s event to provide perspectives that were left out of the FTC’s workshop.
“We wanted to hear from the parents who are in the position of caring for their children and wanting what’s best for their children,” Baker said. “We also wanted to hear from experts in transgender health.”
Some European countries have restricted access to such care, but only one, the United Kingdom, has indefinitely banned new prescriptions of puberty blockers to treat minors for gender dysphoria.
Twenty-five states restrict access to puberty blockers and hormone therapy for trans minors, though courts have permanently blocked restrictions from taking effect in Montana and Arkansas, according to the Movement Advancement Project, an LGBTQ think tank. Arizona and New Hampshire ban operations for minors, which are recommended only in rare cases. Seventeen states and Washington, D.C., have measures that protect access to transgender health care. The care is legal in an seven more states that neither protect nor ban it.
No federal law restricts access to transition-related care. However, the Trump administration has sought to curtail it through a combination of executive orders and actions by federal agencies. In January, President Donald Trump signed a sweeping executive order aiming to prohibit federal funds from going to hospitals or medical schools that provide gender-affirming care to minors, though multiple judges have blocked that part of the order.
Then, in an April memo, Bondi directed U.S. attorneys to use laws against female genital mutilation to investigate doctors who “mutilate” children “under the guise of care” and to prosecute these “offenses to the fullest extent possible.”
Earlier this month, the Defense Department told transgender service members that they had to choose whether they would voluntarily or involuntarily separate from the military.
Four trans service members who are now in the process of separating said nothing about their decisions feels voluntary at all.
“Nobody feels like this is voluntary,” said Emily Shilling, a commander in the Navy and the president of SPARTA, a nonprofit group that advocates for trans service members. “This is coercion. This is under duress.”
President Donald Trump signed an executive order a week into his administration prohibiting trans people from enlisting or serving in the military. Trans service members sued, and a federal judge temporarily blocked the order from taking effect. Then, last month, the Supreme Court allowed the Trump administration to enforce the order. Days later, the Defense Department issued guidance requiring active duty service members to voluntarily self-identify as having been diagnosed with gender dysphoria, which is the distress that results from a misalignment between one’s birth sex and gender identity, by June 6 and reserve service members to self-identify by July 7.
After that, the guidance said, the military will find trans service members who didn’t self-identify through medical readiness programs and begin involuntarily separating them. Affected service members “are eligible for an array of benefits,” the guidance said, including separation pay, “which will be higher for those who self-identify and agree to a voluntary separation.”
However, many details are still unknown, such as what benefits trans service members will be able to access and whether they will all receive honorable discharges. It’s also unclear how many service members will be affected. Just over 4,000 transgender people currently serve in the military, according to Defense Department data, and the department said last month that about 1,000 trans service members have begun the separation process from the military after voluntarily identifying themselves. The department said Tuesday that it does not have an updated number of affected service members.
“Characterization of service will be honorable except where the Service member’s record otherwise warrants a lower characterization,” a U.S. Defense official said in a statement to NBC News. “Military Services will follow normal processes for administrative separation.”
The four trans service members who spoke to NBC News all emphasized that they are speaking in their personal capacity and not on behalf of their respective branches. The biggest question they all face is what comes next.
Bree Fram
On June 30, 2016, the day then-Defense Secretary Ash Carter announced that transgender people could serve openly in the military, Bree Fram, who was then a major in the Air Force, came out to her teammates in an email as a trans woman and then went to burn off her nerves at the gym.
Col. Bree Fram served for 22 years and said she planned to serve “for many years to come” because she loved her job.Courtesy Bree Fram
When she returned to her desk later, she said her colleagues approached her one by one, shook her hand, and told her a version of “It’s an honor to serve with you.”
Fram, who is 46 and now a colonel for the U.S. Space Force at the Pentagon, said that scene repeated earlier this month with leaders from other branches of the military when she told them it would be her last meeting with them. An officer sitting next to her asked where she was going, and she said, “I’m being placed on administrative leave because I don’t meet this administration’s standards for military excellence and readiness.”
Fram said there was a moment of silence before it seemed like her colleagues realized which policy she was referring to — because, she said, trans service members don’t “walk into a room and lead with our identity.”
“I walk into a room and someone sees a colonel, and they see the uniform, and they see all the things that represents about my experience and my expertise,” said Fram, who is one of the highest-ranking out trans officials in the military.
Then, Fram said her colleagues walked over, one by one, and shook her hand and said, again, that it had been an honor to serve with her.
Fram, who served for 22 years until she was placed on administrative leave on June 6, was the director of requirements integration for the Space Force. She helped to identify future technological capabilities the military will need and provided those to developers who built them. She said she planned to serve “for many years to come,” because she loved her job and the team that she worked with.
Fram said she doesn’t know what she’ll do next, but she expects she’ll work in public service.
“I believe in this country, even though it may not believe in me right now,” Fram said. “The oath I swore and the ideals that are embedded in the Constitution still matter to me, and I believe they are worth fighting for.”
Sam Rodriguez
Sam Rodriguez, 38, was recently commissioned as a Medical Service Corps officer in the Navy and was supposed to begin officer training school and then a two-year clinical fellowship in San Diego to become a licensed clinical social worker. However, about a week after the Supreme Court decision allowing the trans military ban to take effect, Rodriguez, who uses they/them pronouns, said the Navy canceled those orders.
Lt. Junior Grade Sam Rodriguez, left, with Lt. Rae Timberlake, center, and Parker Moore, an electronics technician in nuclear power, right. All three of them are trans and nonbinary service members in the Navy.Courtesy Sam Rodriguez
“It was really gut-wrenching to receive that news,” Rodriguez said. They enlisted in 2015 and planned to serve for 15 or 20 years, when they would’ve left the Navy as an experienced licensed social worker. However, now they will leave with their master’s degree in social work, and they will have to look for an employer who is willing to provide supervision for them to receive their clinical license, which will be more difficult.
They submitted their resignation earlier this month and requested a separation date in the fall. They said they don’t think they’ll be able to find an entry-level job as a civilian that’s going to match their current salary, housing allowance, health care benefits and the stipend that they and their wife get to pay for child care for their two children.
They plan to move their family from San Diego to Washington, D.C., so they can become more involved in policy advocacy. Outside of work, they are a board member and membership director for SPARTA.
“People need to realize that this is a national security issue,” Rodriguez said, pointing to research from the Modern Military Association of America, an advocacy group for LGBTQ military members and veterans, which found that 73% of trans service members have between 12 and 21 years of experience.
“We’re not going to be one-for-one swapped tomorrow, and some people it will take two decades to replace,” they said.
Emily Shilling
Shilling, 42, is the highest-ranking out trans person in the Navy after having served for nearly two decades, including in over 60 combat missions in Iraq and Afghanistan. She was also one of the lead plaintiffs in a lawsuit against the administration’s ban.
After Trump was elected, she requested to retire in the fall. Her intention was to rescind that retirement because she expected that the ban on trans troops serving would be blocked, but with the policy taking effect, her last day was June 12, and she will officially retire in September.
Emily Shilling is the highest-ranking out trans person in the Navy.Leah Millis / Reuters
“I am deeply heartbroken that this is how my career has ended, but also deeply proud of what I’ve done,” Shilling said. “I lived my dream. I did everything I ever wanted to in the Navy and I did it honorably, and I stood proud. I might be getting out of the Navy, but it’s not me quitting this fight. I’m just choosing to take on this fight in a different way.”
Shilling said the Navy invested $40 million in training her, and as a result she has many desirable skills and has already accepted an offer to work in defense technologies and advanced development. However, she said her story is rare among trans service members, thousands of whom will be looking for private sector jobs for the first time.
Shilling said the lawsuit against the ban will return to the 9th Circuit Court of Appeals for a hearing in October, but by that time, most trans service members will be out of the military.
“The irreparable harm is done now,” she said.
Alex Shaffer
Alex Shaffer, 48, joined the military as a combat medic in the Oregon Army National Guard in 2007. His mentors in the guard convinced him to go to school to become a physician’s assistant, and he now also works in a private family practice as a PA.
Alex Shaffer, center, with two of the soldiers who are part of the platoon he oversaw.Courtesy Alex Shaffer
“In all of the military, it’s a family,” Shaffer said of what he’s enjoyed about serving in the guard.
Shaffer said he planned to stay in the guard “until I could no longer physically serve or they kicked me out for being too old.” He was in the process of trying to commission as an officer. However, his last drill was June 7, because he began the process to medically separate from the National Guard as a result of the ban. (The National Guard only provides retirement benefits to service members if a medical evaluation board deems them physically unfit for duty.)
“I’m devastated,” Shaffer said. “It’s a loss of identity to me. I’ve been a soldier for so long, and it’s a part of who I am.”
