Photo: Emily Williams stands with other performers from the Colorado Burlesque Festival before the annual Denver Pride parade kicks off on June 25, 2023. Chloe Anderson for Colorado Newsline.
This story by Sara Wilson appeared on Colorado Newsline on December 2, 2024.. Note: This story includes discussions of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org. TransLifeline also provides a hotline for transgender people run by peers at (877) 565-8860.
Colorado LGBTQ+ advocacy groups and health care providers are bracing for what a second administration under President-elect Donald Trump could mean for transgender people, and they are pledging to strengthen existing community support systems.
“We had done scenario planning a few months ahead (of the election) to try and get ahead of it. What would it mean if Republicans won? So we at least have a bit of a starting point,” said Mardi Moore, the executive director of Rocky Mountain Equality.
“I’ve been trying to have the mindset that this isn’t a ‘winner takes all’ situation. There are smaller battles to be won,” she said. “We survived the first round — which felt surprising to a lot of us — and we know we can survive this second round. We’re smarter going into it.”
Still, she said the day after Trump won the presidential election, there was a “continuous stream of people coming in for hugs” at the organization’s Boulder center as the community processed an incoming conservative presidential administration that has vilified large swaths of the LGBTQ+ community.
In campaign policy documents and speeches, Trump promised to roll back transgender rights, restricting their ability to participate in sports teams, join the military, and receive gender-affirming care, among other things.
Gender-affirming care, endorsed by both the American Medical Association and the American Academy of Pediatrics, can range from non-medical interventions like haircuts and name changes to services like hormone therapy and surgery to support the patient’s gender identity.
Specifically, Trump has pledged to end the “left-wing gender insanity” when it comes to transgender youth and cut federal funding, including Medicaid and Medicare, to health providers that offer gender-affirming care. Advocates also fear an attempt to completely ban gender-affirming care at the federal level and weaponization of executive agencies that regulate health systems.
“We should take Donald Trump and the incoming members of his administration seriously when they tell us they want to ban this care,” said Jack Teter, the regional director of government affairs for Planned Parenthood of the Rocky Mountains.
Those policy speculations are coupled with increased transphobic and anti-LGBTQ+ rhetoric from the political right. The Colorado GOP executive committee launched an anti-LGBTQ+ attack during Pride Month this year, including a call to burn Pride flags. In the closing days of the presidential election campaign, advertisements for Trump against gender-affirming care and transgender rights dominated the airwaves. And this month, Republican leaders in Congress moved to ban the first openly transgender lawmaker, Democratic Rep.-elect Sarah McBride of Delaware, from using the women’s bathroom in the U.S. Capitol.
“I think patients and families are terrified right now,” said Dr. Liz Kvach, the medical director for Denver Health’s LGBTQ+ Health Services. “We’ve been flooded with phone calls and messages from patients asking if we’re going to continue to provide care, if they are going to be able to access the hormone therapy — which are medically necessary and life saving treatments for gender diverse people — or if they need to make plans to move out of the country because of hostility and transphobia that they’re experiencing.”
She responds to those anxious patients with the reassurance that as of now, there are strong Colorado laws that protect providers who offer gender-affirming care and that she hopes work will continue in the state even in the event of a restrictive national policy.
Rex Fuller, the CEO of The Center on Colfax, said that some transgender people are scrambling to get certain things done before Trump retakes the White House, such as updating their birth certificate with their correct name and gender and sorting prescriptions with their health care provider.
He also expects the transgender support community at The Center to continue its growth. A few years ago, he said, it had four regularly scheduled peer support groups. Now, it hosts 16 for different sub-demographics, including women, men, non-binary people, significant others and family members. The youth-centric Rainbow Alley program at The Center has also seen an increase in gender-diverse participants, and Fuller worries for them.
“The incoming administration has been especially vocal in its opposition to gender-affirming care for youth. I mean, they’re not friendly to anybody, but youth have been so specifically targeted,” he said. “We have seen real increases in anxiety and depression and all kinds of negative stress for everyone in the trans program, but especially our youth.”
The Trevor Project, a crisis intervention organization for LGBTQ+ youth, saw a 700% volume increase on Nov. 6, the day after the election, than in the weeks prior. Last year, the organization found that 90% of LGBTQ+ youth felt that the current political environment negatively affects their well-being.
Kvach predicted an increase in youth suicide rates if transgender youth are cut off from care during the next presidential administration.
“We know people are being negatively impacted by even just the idea of the next presidential administration. But I think if discriminatory and hateful policies actually start to take place, we’re going to see the impacts of that,” she said.
Since the election, the Trans Continental Pipeline, a group that provides assistance to transgender people hoping to relocate to Colorado out of fear of hostile policies, has received about 550 requests for help.
“It feels like the walls are closing in, and they don’t know what will happen next,” said Keira Richards, TCP’s executive director.
The organization became a nonprofit in April, and Richards said it was not prepared to absorb its current caseload. Ideally, case managers would be able to help people get to Colorado, find housing and work if needed and help them settle into the community. That takes money, partnerships and manpower TCP does not currently have.
“I was not anticipating TCP to be in the position that it is now so quickly, but our two options are crumble or rise to the occasion. So we’re trying to do the latter,” Richards said.
Even if the organization can’t give financial support for everyone looking to relocate, it can provide a comprehensive list of resources and an invitation to join an established community of transgender people and allies. Richards is helping organizers in other states with welcoming policies to create a similar blueprint for new arrivals.
“There’s people coming anyway. Even if you can’t provide the relocation management and the support to get there, at least they can have the resource list once they get into town,” she said.
Over 40% of transgender adults have considered moving because of anti-LGBTQ+ laws in their state, according to a 2023 poll from the left-leaning think tank Data for Progress. Reliable data on that question for families with transgender children is scarce, though Teter said PPRM is already seeing patients uprooting their lives to come to Colorado for consistent care.
Fuller, at The Center, also anticipates a “new class of refugees” coming from states with hostile LGBTQ+ policies, people who would be looking for jobs, housing and health care in an already stressed social support system.
“We’re one of the few areas for about 1,000 miles where there are health care providers addressing gender-affirming care, specifically for youth. So it’s just really causing a real strain on the system already,” he said. “There’s some worry and nervousness about what’s to come.”
In 2023, Colorado enacted a shield law to protect providers and patients seeking gender-affirming care from out-of-state investigations. There are currently 26 states that restrict access to gender-affirming care for minors, and some families travel to states like Colorado for care.
Since Denver Health started offering care to patients in surrounding states in 2023, Kvach said that about 30% of new youth patients for LGBTQ+ services are not from Colorado. The hospital’s CEO is also supporting funding for an expansion at a second site for a multidisciplinary gender clinic.
“We have support at the highest level to expand our capacity for this care,” she said. “We’re preparing for a potential increase in volume.”
Colorado also requires private insurance to cover gender-affirming care. Additionally, it includes sexual identity and gender expression in its anti-discrimination law. Last year, lawmakers approved a bill that requires school staff to use a student’s preferred name, even if it is not their legal name.
“We are so lucky to live in Colorado, because there are protections. We have court systems that work. Even though there’s great disappointment and there’s backward tracking, we’re OK. At the same time, there are so many unknowns right now,” Moore said.
Those laws create a strong foundation for Colorado to continue its ascendance as a sanctuary state for transgender people seeking care, and there could be more changes coming during next year’s legislative session.
That could mean more protections for health insurance coverage and making it statutorily required, Teter, with PPRM, said.
Other legislative efforts could focus on the state’s prescription drug monitoring program (PDMP), an electronic database that tracks interstate-controlled substance prescriptions. It is helpful for providers to identify patients who might abuse prescription medication such as opioids by getting prescriptions in multiple states.
The worry is, however, that the system could be weaponized against people who cross state lines to take testosterone for gender-affirming care, since the drug is a controlled substance and subject to PDMP disclosure. Teter said a draft bill could prevent Colorado from sharing information about legally protected care on the PDMP.
“In talking with folks in other safe haven states about this over the past several months, I think there’s a growing consensus that this is something that should be adopted into the gold standard of the shield protections,” Teter said.
Despite the post-election gloom, he thinks Colorado will emerge as a leader for transgender care and protection.
“Colorado has an incredible health care infrastructure. We have incredible health care providers,” he said. “I think that our infrastructure will grow where needed and adapt where needed to be able to serve the number of patients who are coming in.”