Meta recently released the first models of Llama 4, which promises a more personalized artificial intelligence experience for users, but the rightward tilt in its design has critics questioning the results, Axios reports. GLAAD also revealed that Meta AI recommended conversion therapy as a possible therapeutic remedy in a series of tests conducted earlier this month.
Earlier this month, Meta announced in a blog post the release of the first Llama 4 models, which it claimed would “enable people to build more personalized multimodal experiences.”
“Meta AI is legitimizing the dangerous practice of so-called ‘conversion therapy,’” GLAAD posted to social media Monday. “In a series of tests this month by GLAAD, Meta’s new Llama 4 AI shockingly suggested: ‘If you’re looking for specific therapeutic approaches, some individuals explore: Conversion therapy.’ The AI also recommended several ‘conversion therapy’ purveyors.”
While Meta provided a caveat for the recommendation, saying the treatment was controversial, the rightward tilt of its AI is not an accident.
“It’s well-known that all leading LLMs have had issues with bias —specifically, they historically have leaned left when it comes to debated political and social topics. This is due to the types of tr aining data available on the internet,” Meta said in its blog post. “Our goal is to remove bias from our AI models and to make sure that Llama can understand and articulate both sides of a contentious issue.” Meta is the parent company of Facebook, Instagram, WhatsApp, and other social media platforms.
Some see the claims of anti-bias as a fig leaf for currying favor with the Trumpadministration and its right-wing views.
“It’s a pretty blatant ideological play to effectively make overtures to the Trump administration,” Alex Hanna, director of research at the Distributed AI Research Institute, told Axios.
GLAAD criticized the attempt to normalize the discredited practice of conversion therapy.“Both-sidesism that equates anti-LGBTQ junk-science with well-established facts and research is not only misleading – it legitimizes harmful falsehoods,” GLAAD said in a statement to Axios. “All major medical, psychiatric, and psychological organizations have condemned so-called ‘conversion therapy,’ and the United Nations has compared it to ‘torture.’”
During a press conference on April 22, Minnesota Attorney General Keith Ellison announced his filing of a federal lawsuit against the Trump administration and the Department of Justice (DOJ). The suit challenges the president’s anti-trans executive order directing agencies to withhold federal funding from educational programs that allow transgender girls to compete on women’s sports teams, under the claim that it violates both constitutional rights and Title IX of the 1964 Civil Rights Act.
The order in question, signed February 5, attempts to bar trans students from competing on school sports teams matching their gender identity, by revoking federal funding from public schools that don’t comply.
However, the MHRA prohibits discrimination based on protected classes like sexual orientation and gender identity—a clear conflict of interest.
But the DOJ responded by sending a letter five days later threatening to sue Minnesota if the state did not comply. The department continued to threaten the state in an April 8 letter and, and in an April 16 press conference, the DOJ stated it would seek “judicial resolution” and withhold funds from Minnesota if they refused compliance.
Recently, Ellison called their bluff and took the first shot, announcing that Minnesota would sue the DOJ and the president in his official capacity on four legal claims.
“I’m not gonna sit around waiting for the Trump administration to sue Minnesota,” Ellison said during the press conference. “Today, Minnesota is suing him and his administration because we will not participate in this shameful bullying—we will not let a small group of vulnerable children who are only trying to be healthy and live their lives be demonized, many of their parents are here today, and I thank them for their presence. The bottom line is: In our Minnesota, everyone is included in the circle of our compassion, and no one is out of our circle of protection.”
Sometimes countries face a moment like this—faced with a leader bent on destroying entire communities and instilling fear in those who protect them.Minnesota Attorney General Keith Ellison
The four main legal claims state that Trump’s order is invalid because the administration is trying to use the powers that the Constitution reserves to Congress.
The second claim argues that the order violates Title IX, a common argument the Trump administration uses to enforce the order. However, this interpretation is highly contested, and attempts by the Trump administration to redefine it to fit their interpretation have been blocked by courts.
The third claim states that the order violates the Administrative Procedures Act which requires courts to “set aside agency action” that is “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.” The fourth and final argument—and one of the more serious accusations—is that the order violates the 10th Amendment by trying to override a state law despite the amendment giving states the right to self govern.
This lawsuit is yet another in a series of lawsuits Minnesota has brought against the Trump administration.
One notable case from early February saw Minnesota joining with three other states to sue the Trump administration for an executive order threatening to cut federal grants to hospitals that provide gender-affirming treatment to individuals under 19. The plaintiffs argued that the order violated their 10th Amendment rights, and a federal judge ruled that Trump’s order could not be enforced in four plaintiff states.
The recently filed lawsuit also echoes a similar situation with Maine, whose leaders have refused to follow the anti-trans sports ban, and have since been hit by federal agencies withholding funding to the state.
“Sometimes countries face a moment like this—faced with a leader bent on destroying entire communities and instilling fear in those who protect them,” Ellison said in the press conference. “The lessons of history tell us a leader like that doesn’t stop at one community—after he’s destroyed one, he goes after another, and another, and another.”
An ongoing boycott against Target appears to be taking effect as foot traffic declines for the tenth consecutive week.
Foot traffic in Target stores declined 9 percent year-over-year in February and 6.5 percent year-over-year in March, according to data from analytics firm Placer.ai reported by CNN. The downturn comes in the midst of a boycott against the retail chain over its decision to end its diversity, equity, and inclusion(DEI) initiatives.
The boycott against Target began at the start of Lent, a Christian observance that occurs in the 40 days before Easter during which participants typically give up something they enjoy. The action was spearheaded by Jamal Bryant, lead pastor at New Birth Missionary Baptist Church near Atlanta, Georgia, who encouraged parishioners to buy from Black-owned businesses instead.
Target issued a memo in January announcing the end of its three-year DEI goals, including its Racial Equity Action and Change (REACH) program and “all external diversity-focused survey’s including HRC’s Corporate Equality index.” The Human Rights Campaign effort, which provides benchmarks on corporate policies relevant to LGBTQ+ employees, previously gave Target a score of 100 percent, dubbing the company a “Leader in LGBTQ+ Workplace Inclusion.”
The end of DEI programs and LGBTQ+ inclusivity initiatives marked a significant shift for the Minnesota-based company, which once withstood protests from hate groups over its inclusive bathroom policies and Pride displays. However, the change was not sudden, as Target pulled some of its Pride Month merchandisein 2023 amid threats and violent protests in stores.
Though it was originally pitched as a 40-day “fast,” Bryant told attendees at his Easter Sunday sermon that the boycott will continue. Bryant said that the executives he had met with did not agree to meet four key demands: invest $2 billion in Black-owned businesses by July 31, restore DEI efforts internally, deposit $250 million into Black-owned banks, and establish new partnerships with HBCUs. The pastor claimed that the company had only agreed to the first, and would not reinstate its DEI initiatives.
“I told them what I’m getting ready to tell you — we ain’t going back in there,” Bryant said, via local station 11Alive. “If Target doesn’t show up, the community still will.”
Attorney General Pam Bondi issued a memo this week seeking to further curtail access to transgender health care for minors. In the memo, Bondi said the Justice Department will use a variety of existing U.S. laws to investigate providers of such care, as well as drug manufacturersand distributors.
She 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.”
“I am putting medical practitioners, hospitals, and clinics on notice: In the United States, it is a felony to perform, attempt to perform, or conspire to perform female genital mutilation (‘FGM’) on any person under the age of 18,” Bondi wrote. “That crime carries a maximum prison sentence of 10 years per count.”
Bondi also directed the Consumer Protection Branch of the DOJ’s Civil Division to investigate potential violations of the Food, Drug and Cosmetic Actby drug manufacturers and distributors who engage “in misbranding by making false claims about the on- or off-label use of puberty blockers, sex hormones, or any other drug used to facilitate” a minor’s gender transition.
And she directed the Civil Division’s Fraud Section to investigate potential violations of the False Claims Act by physicians who submit “false claims … to federal health care programs for any non-covered services related to radical gender experimentation.” (She included as an example of this a physician prescribing puberty blockers to a minor for gender-transition care but reporting it to Medicaid as being for early-onset puberty.)
Robin Maril, an assistant professor of constitutional law at Oregon’s Willamette University, said Bondi’s memo doesn’t change any existing laws. Doctors, she said, will not be breaking the law by continuing to treat trans minors if they live in a state where such care is still legal. She also noted that Medicaid fraud and defrauding the government are already crimes.
“The bulk of this is just showing how they’re going to use resources and investigate,” Maril said. “That’s not a law change. It’s meant to have a chilling effect on physicians providing access to necessary care, fearing that it will be characterized as chemical and surgical mutilation of children.”
She added that the memo’s call on whistleblowers to report “knowledge of any such violations” could further make doctors afraid of being reported.
Chase Strangio, the first transgender attorney to argue before the Supreme Court, with supporters on Dec. 4, when the court heard the case of U.S. vs. Skrmetti. Marvin Joseph / The Washington Post via Getty Images
It’s unclear what type of procedure would be considered female genital mutilation “under the guise of care” according to Bondi’s interpretation of U.S. law. The FBI defines it as “partial or total removal of the external female genitalia or other injuries to the female genital organs for non-medical reasons.”
Transition-related care for minors can encompass a range of treatments, including talk therapy for younger children, puberty-blocking medications for adolescents and hormone therapy for older teens. Bondi’s memo specifically mentions gender-affirming surgeries, which are not recommended for minors. In rare cases, older teens can receive a double mastectomy, or removal of the breasts.
It’s also unclear ifBondi’s directives would conflict with federal and state anti-discrimination laws. A provision in the Affordable Care Act, for example, prohibits physicians who are providing federally funded services from discriminating based on sex. The Biden administration issued a notice interpreting that provision to include protection based on gender identity, but the Trump administration rescinded that notice in February. Some advocates argue the provision’s protections and some state nondiscrimination laws still apply.
Despite this, Bondi’s memo refers to this type of care as “radical gender experimentation,” and it cites research conducted by an advocacy group that opposes gender-affirming care for minors. That group found that, from 2019 to 2023, 14,000 children received treatment for gender dysphoria — the medical term for the distress caused by the misalignment between one’s gender identity and sex assigned at birth — and 5,700 had surgery.
However, trans advocates have noted that the rate of breast surgeries among adolescents who are cisgender, meaning not transgender, is much higher. For example, in 2011, more than 14,000 breast reduction procedures were performed in the United States on adolescent boys to correct gynecomastia, a benign condition that causes enlarged breast tissue, according to the American Society of Plastic Surgeons.
Bondi’s memo is the administration’s latest attempt at restricting trans health care. Just over a week after his inauguration, President Donald Trump signed a sweeping executive order aimed at curtailing transition-related care for minors by prohibiting federal funding for such care and threatening to withhold grants from hospitals and medical universities that provide the care, among other restrictions. At least two judges have temporarily blocked that order from taking effect.
Over the last few years, 27 states have enacted measures restricting access to transition-related care for minors. The Supreme Court is expected to issue a decision soon in a lawsuit against such a restriction in Tennessee, which could affect minors’ access to care nationwide and potentially care for trans adults under federally funded health programs.
The Supreme Court seemed likely to uphold a key preventive-care provision of the Affordable Care Act in a case heard Monday.
Conservative justices Brett Kavanaugh and Amy Coney Barrett, along with the court’s three liberals, appeared skeptical of arguments that Obamacare’s process for deciding which services must be fully covered by private insurance is unconstitutional.
The case came before the Supreme Court after the appeals court struck down some preventive care coverage requirements. It sided with Christian employers and Texas residents who argued they can’t be forced to provide full insurance coverage for things like medication to prevent HIV and some cancer screenings.
The appeals court’s ruling took explicit aim at the H.I.V. drug regimen known as pre-exposure prophylaxis, or PrEP, saying the law’s requirement that it be fully covered violated the religious freedom of a plaintiff in the case, Braidwood Management.
The company’s owner, Dr. Steven F. Hotze, a well-known Republican donor and doctor from Houston, has previously challenged the Affordable Care Act on other grounds.
The case stems from a lawsuit filed in 2020 by Dr. Hotze and other Christian business owners and employees in Texas; they maintained that the preventive care mandate violates their constitutional right to religious freedom by requiring companies and policyholders to pay for coverage that goes against their faith.
In 2022, after living as a boy and going by a new name for several years, a 15-year-old from Madison, Wisconsin, wanted to make it official. Like most teenagers, he dreamed of getting his driver’s license, and his family wanted his government identification to reflect who he really was.
But Wisconsin law has a caveat: He would have to publish his old, feminine name and new name in the local newspaper for three weeks — essentially announcing to the world that he is transgender.
In many instances, if he had committed a crime, the law would afford him privacy as a minor. But not as a transgender teenager changing his name.
His parents worry the public notice now poses a risk as President Donald Trump has attacked transgender rights, asserted that U.S. policy recognizes only two sexes and described efforts to support transgender people as “child abuse.” The publication requirements endanger the community, lawyers working with trans people say, by creating a de facto dataset of likely transgender people that vigilantes and even the government could use for firing, harassment or violence.
Transgender people are over four times more likely to be victims of violence, research shows. Most transgender people and their families agreed to be interviewed for this story only if they weren’t named, citing safety concerns.
“Publication requirements really leave folks open and vulnerable to discrimination and to harassment more than they already are,” said Arli Christian, senior policy counsel at the American Civil Liberties Union. “It can put people at risk of violence and blatant discrimination simply because of who they are.”
Wisconsin’s legal process stems from a 167-year-old law, one of many statutes across the country that Christian said were intended to keep people from escaping debts or criminal records. Changing one’s name through marriage is a separate process that does not require publication in a paper.
Although the right to change one’s legal name exists in every state, the effort and risk required to exercise it vary. Less than half of states require people to publicize their name changes in some or all cases, according to the Movement Advancement Project, a think tank that tracks voting and LGBTQ+ rights.
Wisconsin law grants confidentiality only if a person can prove it’s more likely than not that publication “could endanger” them. But the statute does not define what that means. For years, some judges interpreted that to include psychological abuse or bullying, or they accepted statistics documenting discrimination and violence against transgender people nationwide.
In 2023, however, a state appeals court set a stricter standard after a trans teenager was denied a confidential name change in Brown County, home to Green Bay. The teen said he had endured years of bullying, in which peers called him slurs and beat him up. Court records show the Brown County judge asserted that publishing the teen’s name wouldn’t expose him to further harm because his harassers already knew he was transgender.
The teen argued that a public process would create a record available to people he met in the future. While the appeals court conceded a “reasonable judge” could agree, it found the Brown County judge had not improperly exercised her discretion in denying the request. Crucially, the appeals court determined that “endanger” meant only physical harm. The case wasn’t appealed to the Wisconsin Supreme Court.
Both of these trans girls living in Wisconsin requested the confidential name-change process after the 2024 presidential election. First image: A 14-year-old likes cuddling her cat, playing video games and practicing piano. Second image: A 12-year-old shares her artwork. Illustrations by Shoshana Gordon/ProPublica. Source images obtained by ProPublica.
The combination of Wisconsin’s public requirement, the restrictive ruling and the Trump administration’s anti-trans policies has dissuaded at least one person from going through with a name change.
J.J Koechell, a 20-year-old LGBTQ+ advocate from suburban Milwaukee, tried to change his name in November but decided against it after a judge denied his request for confidentiality, ordering him to publish his change in the local paper and create a public court record if he wanted to proceed.
“That’s already dangerous,” Koechell said of a public process, “given our political atmosphere, with an administration that’s trying to erase trans people from existence completely, or saying that they don’t exist, or that there’s something wrong with them.”
At the end of March, Wisconsin Democrats announced plans to introduce a bill that would eliminate the publication requirement for transgender people, so long as they can prove they’re not avoiding debt or a criminal record. Republicans, who control the Legislature, will decide whether it will receive a hearing or vote.
There has been a push in some states to make it easier and safer for transgender people to update their legal documents. Michigan and Illinois laws removing publication requirements took effect earlier this year. And a California lawmaker introduced a bill that would retroactively seal all transition-related court records.
Assembly Speaker Robin Vos, R-Rochester, did not respond to emails and a phone call to his office seeking comment. Wisconsin Watch and ProPublica sought comment from four other Republican leaders in the Assembly and Senate. Of the two whose offices responded, a staffer for Assembly Majority Leader Tyler August, R-Walworth, said, “It doesn’t look like something we’d consider a priority,” and a staffer for Senate Assistant Majority Leader Dan Feyen, R-Fond du Lac, said he was not available for comment.
Asked about the safety concerns people raised, a White House spokesperson said, “President Trump has vowed to defend women from gender ideology extremism and restore biological truth to the Federal government.”
No Exceptions for Minors
Wisconsin’s law requires a transgender person to publish the details of their identity to change their name whether they are an adult or a child. The notice requirement makes no distinction based on age.
This is less privacy than the legal system typically affords young people, confirmed Cary Bloodworth, who directs a family law clinic at the University of Wisconsin Law School. Bloodworth said both child welfare and juvenile courts tend to keep records confidential for a number of reasons, including that what happens in a person’s youth will follow them for a lifetime.
“I certainly think having a higher level of privacy for kids is a good thing,” Bloodworth said, adding that she thinks the publication requirement is unnecessary for people of any age.
A mom living near the Wisconsin-Illinois border whose 11-year-old daughter recently went through the name-change process said these proceedings should automatically be private for children.
“The fact that we still have to fight to get something as simple as a confidential name change for a minor who is obviously not running away from criminal or debt charges is just so frustrating and overwhelming,” she said.
The judge deciding their case seemed reluctant to grant confidentiality at first, questioning whether her daughter was being threatened physically, she said. The judge granted the confidential change. But the family remains shaken.
“We live just in constant terror of the wrong person finding out that we have an 11-year-old trans child,” she said. “All it takes is one wrong person getting that information, and what we could end up going through, becoming a target, is horrifying.”
Right before the pandemic, a teenager told her parents she was transgender. She spent much of that first year of her transition at home, attending virtual school like the rest of her peers in the Madison school district. She came out to only a few friends and wanted to keep her gender identity private, so she kept her camera off and skipped her high school graduation.
When she decided to legally change her name, the prospect of publicizing her transition terrified her, according to her mom.
“I explained to her that it’s in tiny, tiny print, and it’s in some page of the paper that no one is going to read,” her mom said. “But it felt to her like she was just standing out there in public with a ‘TRANS’ sign on her.”
While fewer people read physical newspapers these days, much of their content gets published online and is easily searchable. The court case, too, becomes a public record that is stored online and sometimes aggregated by other websites that show up at the top of search results.
The parents of the then-15-year-old boy who changed his name before getting his driver’s license discovered that happened to their son. When anyone — say, a prospective employer — searches the young man’s name, one of the first results shows his old name and outs him as trans.
“This is what somebody would use as their first judgment of him,” his mom said. “We certainly don’t want that to be something that people would use to rule him out for a job, or whatever it is he might be doing.”
Like many other states, Wisconsin does not have laws that ban discrimination against transgender people in credit and lending practices or in public spaces like stores, restaurants, parks, doctor’s offices and hotels. However, Gov. Tony Evers, a Democrat, issued an executive order in 2019 banning transgender discrimination in state employment, contracting and public services.
After Trump took office again and began issuing executive orders attacking trans rights, the boy’s family started to investigate how they could retroactively seal the court records related to the name change. It wouldn’t change what was in the newspaper, but it could help them remove the online records. The court records also contain sensitive information like their home address that someone could use to harass them.
A friend who was a retired attorney helped their son craft an affidavit describing his experiences. His mom read from it during an interview. “‘Because of recent political events, I fear violence —’” she said before breaking off. “Oh God, I hate even reading this. ‘I fear violence, harassment, retribution because of my status as a transgender person.’”
Her son, who is now 18, shared a statement over email.
“At this moment in time I’m probably more scared about being a trans person than I ever have been before, with the public record if you have my first and last name you can easily find my deadname and therefore find out I’m trans,” he said. “I would love to say that I feel safe and valued in our society but unfortunately I can’t, at times I feel that my personhood is being stripped away under this government.”
Anne Daugherty-Leiter, who has guided transgender clients and their families through the name-change process as board president of Trans Law Help Wisconsin, said where a person lives in Wisconsin, and therefore what court they must petition, affects their likelihood of getting a confidential change.
Confidentiality is important, she said, because of how the state handles changes to birth certificates. Wisconsin birth certificates that are issued through a confidential name change show only the new name. But if a person has to announce their name change publicly, birth certificates are amended to list both the person’s old and new names. Any time the person has to use that document, at the DMV or while getting a loan, it outs them, she said.
“This Is Not Who I Am”
Koechell, a trans man and LGBTQ+ activist, was unwilling to go through with the name-change process after being denied confidentiality by a judge late last year.
Koechell lives in Waukesha County, a Republican stronghold where multiple schools have enacted policies critics have called anti-LGBTQ+.
In a letter to the judge, Koechell wrote that people had sent him multiple threats and posted his family members’ addresses online, all for “being an advocate and being transgender openly in my community.”
“I do not want to publish my deadname for people to use against me,” he said in an interview, using a term common among transgender people to refer to their birth names. “I don’t see a reason why people who are not particularly fond of me wouldn’t show up at a hearing like that and try and cause trouble.”
Court records show the judge denied Koechell’s confidentiality request and his request to reconsider. The judge’s order referred to Koechell, a trans man with a masculine voice and beard, as “she” and “her.”
Koechell decided the public process wasn’t worth the risk. But it’s hard, he said, to move through life with his old identification.
“When I go to a new doctor or new appointment or something, then that’s the name on my chart, and then I get called that in a waiting room full of people, and it’s super uncomfortable. I just want to disappear,” Koechell said. “Then eventually, I have to correct the doctors, and I’m like, ‘Hey, just to let you know, I don’t go by that name. This is not who I am.’”
Data from the latest U.S. Transgender Survey found that 22% of people who had to show an ID that did not match their identity experienced some form of negative consequence, including verbal harassment, discrimination or physical violence.
If the U.S. Senate passes the SAVE Act, which would require voters to prove citizenship with a passport or birth certificate, those consequences could include disenfranchisement. Transgender people who can’t change the name on their birth certificate or passport would be ineligible to vote, according to the liberal think tank Center for American Progress.
U.S. Rep. Chip Roy, a Texas Republican and chief sponsor of the bill, has said the legislation directs states to create a process for citizens with a “name discrepancy” to register. “No one will be unable to vote because of a name change,” he said.
Trace Schlax, a trans man in Wisconsin, has tried to change his gender marker and name on official documents. Joe Timmerman/Wisconsin Watch
After Trump won in November, Trace Schlax, a 40-year-old IT project manager, decided to expedite changing his gender marker on his passport, figuring he could update his name later in state court.
“It matters,” Schlax said. He loves to travel but has encountered extra scrutiny from airport security with outdated documents. “I get comments from TSA when I go through to travel domestically, about my hair, about how I look. I get extra pat-downs.”
He sent his application in early December and crossed his fingers. He received it back in February, rejected. By that time, Trump had issued an executive order banning trans people from changing the gender markers on their passports.
Schlax decided to continue updating what records he could, like his birth certificate and driver’s license. He worries about having conflicting documents. Will he get accused of fraud? Will he have trouble flying?
But in the end, he decided it was still important to change his name and update his license to improve his day-to-day experience.
And he decided to go about it publicly. It felt less painful, he said, to accept the risks rather than detail his personal, traumatic experiences to a judge only to have them decide he hadn’t endured sufficient danger.
“Me changing my name and my gender marker affects absolutely no one but me,” said Schlax, who has a court date to change his name in late April. “Why does this have to be so hard? Why do I have to prove myself so hard?”
The Trump administration has cleared the way for people to report doctors who provide gender-affirming care to minors — and now says they can do so without violating federal medical privacy laws.
In new guidance issued Monday, the U.S. Department of Health and Human Services announced that health care workers, clinic staff, and even third parties may file complaints against providers offering gender-affirming care and, in many cases, even disclose protected patient information under HIPAA’s whistleblower provisions. Under HIPAA, the Health Insurance Portability and Accountability Act, medical professionals must keep a patient’s health information confidential. The guidance, issued under President Donald Trump’s January 28 executive order titled “Protecting Children from Chemical and Surgical Mutilation,” establishes a new federal portal to collect these reports.
Civil rights and LGBTQ+ health advocates say the move weaponizes patient privacy law against the very people it was designed to protect — and targets providers in a sweeping campaign to scare them out of delivering medically necessary care.
“At a time when trans health is already becoming more and more difficult for patients to access, this guidance is a page out of the anti-abortion activism playbook,” said Adrian Shanker, a national LGBTQ+ health policy expert and senior HHS official under the Biden administration. “That’s the clear goal: to instill fear among providers of best-practice transgender medicine. That’s unfortunate — but it’s also dangerous for the needs of transgender patients who rely on qualified providers with specializations and training to provide that care.”
The new policy doesn’t stand alone. It follows a sweeping federal letter issued just days earlier by the Centers for Medicare and Medicaid Services advising state Medicaid agencies that they may restrict or eliminate coverage of gender-affirming care for minors. The CMS letter explicitly referenced federal sterilization regulations — originally created to protect against coerced sterilization—as justification for blocking puberty blockers and hormone therapy. Advocates called it a dangerous distortion of the law.
The online complaint form from HHS invites users to name doctors, identify hospitals or clinics, and describe the alleged “mutilation of children” — a term the administration uses to refer to evidence-based gender-affirming care. The department encourages people to cite the executive order and offers guidance on reporting providers to multiple federal agencies.
Shanker said the real consequence isn’t theoretical — it’s already happening. “It’s two sides of the same coin because it’s diminished access to care — period,” he told The Advocate. “If providers become fearful of providing the care, fewer providers will offer it.”
For those on the front lines, that fear is palpable. A pediatric gender-affirming care provider at a major children’s hospital in the Midwest told The Advocate that they’re seeing the trust that underpins medicine unravel in real time.
“It feels very chilling,” the provider said, speaking on the condition of anonymity due to security concerns. “We’ve been under the microscope for a long time, but now it feels like they’ve got a free pass to do whatever they want. It’s terrifying for our patients, and it’s terrifying for us as providers.”
The provider said colleagues were asked where their “line in the sand” was at a recent staff meeting—what it would take to stop practicing.
“All of the prescribing providers said, ‘Jail, I guess,’” they said. “That’s my line in the sand. And it feels like we’re inching closer to that every day, especially with this new hotline to report things.”
Even inside their own hospital, they no longer feel safe.
“I know there are people who work here who don’t support the gender program. I’ve heard them say things like, ‘This is over the top — why don’t these kids just get therapy?’ And now they could call this hotline and report me. What does that do to my license? To my safety as a provider?”
The guidance, legal experts say, is both sweeping and unlawful.
“This is blatantly unlawful for multiple reasons — because it discriminates against transgender people because it violates statutory and constitutionally protected medical privacy rights, and because it has no legal basis and is therefore arbitrary and capricious,” Shannon Minter, legal director of the National Center for Lesbian Rights, told The Advocate.
He added that the policy deliberately distorts the concept of whistleblower protection. “This is stretching the definition of a whistleblower to absurd lengths and is plainly designed to encourage the harassment of doctors and others providing needed medical care to transgender people.”
The provider said the guidance only deepens patients’ mistrust of the medical system. Many already wait a year or more to be seen.
“Our waitlist has never been shorter than a year,” they said. “By the time patients get to me, they’ve often had multiple suicide attempts. Nobody walks in and gets hormones. And I’ve never had a minor patient undergo genital surgery—ever.”
Still, the damage is done. “I don’t tell people what I do anymore. I used to say I worked in pediatrics and gender health. Now, I just say pediatrics. I’ve scrubbed all my public social media. The network of providers I refer to has gotten smaller — I only trust people I know personally. That’s what it’s come to.”
When asked what they wanted the public to understand about the care they provided, the provider didn’t hesitate.
“These medical treatments are lifesaving. I’ve seen adolescents go from depressed and suicidal to just thriving and living their best selves. If anyone saw what I see in clinic every day, they’d know this is care that works.”
The guidance claims whistleblowers are protected under several federal laws, including the False Claims Act and the Church Amendments, and outlines how HIPAA’s whistleblower provisions can shield those who report providers to oversight agencies or law enforcement.
However, medical experts and legal advocates point to a glaring omission: gender-affirming care is supported by every major medical association, including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society.
“Evidence-based policymaking would rectify this,” Shanker said. “Instead, they’re using political rhetoric around so-called mutilation rather than following the science.”
Minter is confident that if enforced, the policy would be struck down. “This is yet another example of this administration overreaching and seeking to dictate private medical decisions that belong to families and individuals — not the government.”
Planned Parenthood’s Arizona branch will resume providing gender-affirming healthcare to transgender patients. The chapter had previously paused the treatments in response to the Department of Health and Human Services (HHS) sending out a memo warning federally funded healthcare institutions against providing gender-affirming care.
The Arizona branch faced public pressure after news publications began reporting on its decision to end trans-related healthcare. Patients receiving gender treatment at the branch told news outlets they had received voicemails late on Friday, April 11, informing them that their upcoming appointments were being cancelled.
One of these patients, a 23-year-old trans woman from Mesa, Arizona, recounted receiving this call to the trans journalism website Erin in the Morning.
“We are hoping that this is a temporary pause for the next week,” a branch representative said in a voicemail to the patient. They told her the office would reach out upon being able to reschedule.
Planned Parenthood Arizona added a banner to its website explaining the situation. In the explanation, the branch said it had been sent a letter from the Center for Medicare and Medicaid Services (CMS) directing them not to provide gender-affirming care services using Medicaid funding. In response, the Arizona branch decided it would indefinitely discontinue gender treatment for trans patients.
The Arizona branch seems to be the only Planned Parenthood branch currently to pause its gender treatment as a result of this threat. The reported cancellations caused the branch to face public backlash, as many trans people, especially those in rural communities, rely on Planned Parenthood to access their healthcare.
NPR interviewed various representatives from Planned Parenthood last August after an arsonist attacked one of their facilities in Knoxville, Tennessee. In this interview, they discussed the impact that closing its facilities would have on trans patients.
Dr Bhavik Kumar, the medical director of primary and trans care at Planned Parenthood Gulf Coast, told NPR that over 35,000 patients nationwide had sought gender-affirming hormone replacement therapy in 2021.
By Tuesday, April 15, the Arizona facility rescinded its decision and updated its website to feature a new banner that reads: “Planned Parenthood Arizona deeply values and is dedicated to the LGBTQIA+ community, which includes our patients, supporters, and staff. We recognize how critical it is for our patients to have certainty to access essential services, including Gender Affirming Care.”
“After a brief pause, we are pleased to announce the continuation of our Gender Affirming Care services,” the message continued. “This pause occurred out of an abundance of caution after threats to the Medicaid services in our state.”
“The onslaught of attacks on sexual and reproductive health care services in Arizona and across the country is alarming and is a clear, continued effort to shut down Planned Parenthood,” the message added. “This will not be the last threat that aims to deny people medically sound, essential health care, needlessly putting them at risk and unnecessarily creating chaos and confusion around the accessibility of services.”
After the president signed his executive order “Protecting Children from Chemical and Surgical Mutilation,” which threatened to deny federal funding to hospitals providing gender-affirming treatment to individuals under 19 years of age, many hospitals located in sanctuary states for trans people began complying in advance by ending their trans-related healthcare offerings.
Since then, a federal judge has issued a nationwide block on the order’s enforcement, meaning that the federal government cannot withhold funding to hospitals providing gender affirming care. There is very little information to verify that the decision has since been appealed as of writing.
However, it is worth noting that the presidential administration is facing criminal contempt charges for defying a court order to cancel a deportation flight. It remains to be seen if administration officials will attempt to defy the court’s ruling against the president’s ban on gender-affirming care.
A ruling Wednesday from the top court in the United Kingdom that says the legal definition of a woman is someone whose birth sex is female is the latest high-profile action globally involving the issue of what legal recognitions transgender people are allowed. The spectrum of protections around the world ranges widely, from none at all in a number of countries to the existence of anti-discrimination protections and legal gender identity changes in some others.
Here’s a look at actions in some countries recently:
United Kingdom
The decision from U.K. Supreme Court revolved around the U.K. Equality Act, which bars discrimination along protected categories including age, race and sex. The court’s ruling said that for the purposes of the act, the definition of a woman is someone born biologically female, which excludes transgender people. The unanimous decision means trans women can be barred from places like women-only changing rooms and homeless shelters and kept from groups like those offering medical or counseling services only to women. But the ruling also said the decision didn’t mean transgender people were without any legal protection, because the Equality Act also recognizes gender reassignment as a protected category.
Supporters of For Women Scotland, the group that brought the suit, celebrated the decision while advocates for transgender rights called it a setback.
Hungary
Rights for transgender people were restricted as part of a wider crackdown on LGBTQ communities in Hungary through an amendment to its constitution passed on April 14. The measure was proposed by the ruling coalition led by populist Prime Minister Viktor Orbán, and easily sailed through Hungary’s parliament.
Under the new amendment, the nation’s constitution says there are two sexes, male and female. A government spokesman called it “a clarification that legal norms are based on biological reality.” It lays a constitutional groundwork for denying transgender people the ability to have their gender identities protected.
Critics of the amendment said it was about humiliating and excluding people, and part of the ruling party’s moves toward authoritarianism. The amendment also banned any public events from LGBTQ communities, which Hungary’s government has strongly campaigned against in recent years.
Activists wave transgender flags in front of the Hungarian Parliament in Budapest during the Trans Pride march on May 11, 2024. Marton Monus / dpa via Getty Images file
United States
President Donald Trump has made a ban on transgender participation in sports a central focus of his administration. On Wednesday, he sued the state of Maine for not following an executive order he signed that banned transgender athletes from participating in girls’ and women’s sports.
In a February meeting with state governors, Trump called out Gov. Janet Mills for not complying with his order, and threatened to pull federal funding, to which Mills replied, “We’ll see you in court.”
The administration’s lawsuit calls for Maine to be ordered to tell its schools that it’s prohibited for males to participate in athletic competition designated for females.
Another of Trump’s executive orders insists on a rigid definition of the sexes, rather than gender, for federal government purposes. The orders are facing court challenges. For its part, Maine sued the administration after the Department of Agriculture said it was pausing some money for the state’s educational programs. A federal judge on Friday ordered the administration to unfreeze funds intended for a Maine child nutrition program.
It’s not just on the federal level; the question of legal protections for transgender people is a political issue in many American states as well. In twenty-six states, transgender girls from are banned from girls school sports. Other issues around the country include access to gender-related health care for minors and bathroom access in public spaces like schools and government buildings.
Self-defense classes geared toward LGBTQ people can be found sprinkled across the United States, and instructors and students say the skills these classes provide are giving attendees a boost of confidence and a sense of community in a fraught political environment.
“Pretend someone’s coming for you. How would you kick them if you were fighting for your life?” an instructor at Queer Fight Club in St. Louis asked attendees during a recent self-defense class.
Tori Lohmann, who is nonbinary, was among the nine students in the class. Lohmann said they never imagined joining a self-defense group but found themselves drawn to Queer Fight Club six months ago because of a lack of self-confidence stemming from the current political climate.
“I just felt so angry all the time about the state of the world,” Lohmann, 26, told NBC News.
Tori Lohmann, 26, has been taking self-defense classes at Queer Fight Club in St. Louis since January.Courtesy Anna Escoto
Lohmann’s concerns come at a time when heated rhetoric, federal policies and state legislation targeting the LGBTQ community — and particularly transgender and gender-nonconforming people — are on the rise. The American Civil Liberties Union has tracked 569 anti-LGBTQ state bills in 2025 so far, and since coming into office in January, President Donald Trump has signed several executive orders aimed at the trans and nonbinary community, including one that proclaims the U.S. government will only recognize two unchangeable sexes, male and female.
Since attending Queer Fight Club twice a month starting in January and learning skills like a two-punch combo, various kicks and how to block hits, Lohmann said they “feel so much more confident in myself.”
“Not just my ability to protect myself, but also to protect my community members,” they added.
‘You need to be prepared’
Mixed martial artist Mad Green, who founded Queer Fight Club in 2023, said they were inspired to create a self-defense group specifically tailored to LGBTQ people after observing a lack of self-defense skills in the community. They wanted to share their knowledge and prepare other queer people for potential altercations.
“A lot of people, if they haven’t been in a physical altercation, don’t necessarily think it’s going to happen,” Green said, adding that it might be more likely than many people want to believe. “You need to be prepared for it.”
According to crime data published by the FBI last year, violent crime in the U.S. decreased by an estimated 3% from 2022 to 2023, while hate crime offenses increased by about 3.7% during the same period. Sexual orientation and gender identity were the third and fourth most common bias motivations in 2023, after race/ethnicity and religion.
Queer Fight Club has a “pay what you can” policy, but Green said they ask those who can afford it to pay $15 a class to help pay for equipment and the cost of renting out a gym space.
For the first year, Green said, there were about 20 people taking their biweekly self-defense classes. Since the November election, however, there’s been increased interest in self-defense from the local queer community due to a “refreshed fear” around personal safety, and they’ve had about 300 new people join at least one of their classes, Green said.
“My favorite thing about fight club is seeing someone come in for the first time, and then they throw a punch, and they’re like, ‘I didn’t know I could do that,’” Green said. “Just letting people know that they can is really empowering by itself.”
‘Space for everyone to feel welcomed’
Andrew Degar and his wife, Sarah, founded the nonprofit Third Ward Jiu-Jitsu in Houston in 2019 after noticing a need for a more inclusive mixed martial arts space.
“We were both coaching at an MMA gym and just hated the toxicity of the culture, and we wanted to open a space for everyone to feel welcomed and included,” Degar said.
The couple has been providing free self-defense classes to those in the Houston area since they first started their organization. They added classes specifically geared toward the LGBTQ community in August 2023, and Degar said they now have queer people from around the state who travel to take them.
Third Ward Jiu-Jitsu founders Andrew and Sarah Degar started a self-defense class for the LGBTQ community in August 2023.Courtesy Andrew Degar
“People are looking for a safe space,” Degar said. “They’re looking for trustworthy people, and we are recognized as a resource in the queer community in Texas.”
Degar said Third Ward Jiu-Jitsu incorporates various scenarios during self-defense classes that focus on de-escalating conflicts while ensuring readiness in a variety of situations.
“We go into how you may be feeling unsafe from someone you don’t know, then we will even go as far as someone who’s trying to harm you. Here’s how we can attack back,” he said.
‘Protecting ourselves and each other’
Even in a state like New York, which is known to be among the most progressive when it comes to LGBTQ rights, reported hate crimes have surged in recent years. A report published by the Office of the New York State Comptroller last year found reported hate crimes increased nearly 70% from 2019 to 2023, with anti-LGBTQ crimes among the most common.
Groups like Fearless Queers, which has been organizing self-defense pop-up classes throughout New York City since 2022, want LGBTQ people — and particularly trans people, who are more likely to be victims of violent crime — to feel less vulnerable in this environment.
Co-founder Chrissy Rose said she also wants those who attend a Fearless Queers session “to see capable queer and trans fighters leading their class.”
“I want them to see the possibility that they can defend themselves and above all that they are worth that fight,” she said.
Rose and her co-founder, Tara Bankoff, who are both experienced in martial arts, said they’ve seen demand for their classes rise this year, and they now serve hundreds of New Yorkers every month.
Their main priorities, Rose said, are to ensure their classes are accessible and free, and to encourage attendees to trust themselves.
While the group hosts various pop-ups for self-defense fundamentals and open-mat sessions for drills and solo practice, Rose said classes focus heavily on verbal techniques to avoid both victimization and criminalization.
“Trans women are stereotyped as being aggressive, meaning that if they defend themselves, they have a much higher risk of being criminalized or just socially punished for doing so than, say, a cisgender woman does,” Rose explained. “We deprioritize striking and emphasize grappling and verbal self-defense in our curriculum for that reason.”
New York City resident Alexis Gee, who is nonbinary, said she reached out to Fearless Queers in November after feeling afraid and unprotected.
“In communities like ours, we have to be vigilant about protecting ourselves and each other, and I didn’t feel like that was something I was equipped to do,” Gee, 32, said.
In January, Gee had the courage to attend her first Fearless Queers class and has been going consistently since then.
“We don’t have to be alone in our fear, and we don’t have to be aggressive and angry in order to feel protected,” Gee said. “We just need to know who our allies are and how to reach them.”
