Planned Parenthood of Illinois has repeatedly been hearing the same question from transgender patients since Donald Trump won the presidential election.

Patients want to know how many refills they can get of hormone therapy medications, which they often need to maintain their health and certain physical characteristics.

“We’ve definitely had people ask, ‘Can you send me four years of medications?’” said Mallory Klocke, director of the Gender-Affirming Hormone Therapy program at Planned Parenthood of Illinois.

Transgender patients and providers of gender-affirming care in Illinois are preparing for potentially dramatic upheaval once Trump takes office. During the campaign, Trump pledged to strip federal funding from hospitals and other providers that provide certain gender-affirming care to minors. He said he would sign an executive order barring federal agencies from promoting the concept of gender transitions. Trump advertising declared: “Kamala is for they/them. President Trump is for you.”

Gender-affirming care can include a range of services, such as counseling, medications to delay puberty, hormone therapy and/or surgery. Supporters of access to gender-affirming care for minors, including the American Academy of Pediatrics, say it’s important health care with implications for mental health. Trump has called gender-affirming care for minors “child abuse” and “mutilation.” The group Do No Harm says gender-affirming care “can inflict dangerous and irreversible harm on children.”

Many Chicago-area hospital systems and health care organizations provide gender-affirming care, and a number provide such care to patients under age 18. It’s unclear how those hospitals and providers would survive, or whether they would continue to provide that care, if Trump pulled their Medicare or Medicaid dollars — major sources of funding for most hospitals and health care providers.

“Hospitals and clinics will have to basically assess what they can and can’t do in light of an immediate reduction of funds,” said Mony Ruiz-Velasco, deputy director of Equality Illinois, which advocates for equal rights for LGBTQ+ people. “We’re concerned about what that means because most hospitals and clinics can’t operate without federal funding.”

A loss of federal funding would create “a huge hole in our operating budget,” said Tim Wang, director of policy and advocacy for Howard Brown Health, which specializes in caring for patients who are LGBTQ+ and people living with HIV, at centers across Chicago.

“We would not be able to operate in the same way we do now,” Wang said. Howard Brown treats nearly 38,000 patients a year, and about a quarter of its patients are on Medicare or Medicaid.

“Even just the threat of pulling out federal funding would be enough to coerce a lot of health care providers into just ending their gender-affirming services, which would lead to transgender folks having nowhere to go to get the health services they need,” Wang said.

Klocke, with Planned Parenthood of Illinois, said the organization is preparing for all possibilities. It provides gender-affirming hormone therapy to about 4,000 patients a year, Klocke said.

“Transgender people, in general, and the affirming medical care that we get is on the short list of things that people want to take away, and that has people feeling scared,” Klocke said. “But we’re here, we’re providing that care, and we’re going to continue providing that care as long as we’re legally able to.”

Three Chicago-area health systems that provide gender-affirming care — Rush, Advocate Health Care and University of Chicago Medicine — either declined to make representatives available for interviews on the topic or did not respond to requests for comment.

Lurie Children’s Hospital, which has faced criticism in the past for its gender development program, said in a statement that the hospital “is proud to provide gender-diverse youth access to comprehensive, family-centric, and developmentally appropriate healthcare in a safe and inclusive clinical space.”

The American Academy of Pediatrics recommends that youth who identify as transgender or gender-diverse “have access to comprehensive, gender-affirming, and developmentally appropriate health care.” The American Medical Association has urged governors to oppose state legislation that would prohibit “medically necessary gender transition-related care” for minors. In a 2021 letter to the National Governors Association, the CEO of the AMA wrote that “evidence has demonstrated that forgoing gender-affirming care can have tragic consequences.”

Illinois has laws in place meant to protect gender-affirming care. In 2023, Gov. JB Pritzker signed a bill requiring state-regulated health insurance plans to cover hormone therapy medications to treat gender dysphoria, which is when people experience distress when their gender identity differs from their sex at birth or physical characteristics. That law also shields patients and providers of gender-affirming care in Illinois from legal actions from other states.

At least 26 states have laws restricting gender-affirming care for minors, according to KFF, a nonprofit health policy research, polling and news organization. The U.S. Supreme Court has agreed to hear a case in December on the constitutionality of a law banning gender-affirming care for minors in Tennessee.

As with abortion, some patients now travel to Illinois from other states for gender-affirming care, Klocke said.

But it’s unclear how Illinois’ laws would stand up to federal action.

“If Congress were to pass a ban on this care, I think our laws here would be seriously compromised,” said Ruiz-Velasco of Equality Illinois, though some have noted that any type of federal ban would certainly be challenged and could be tied up in court for some time.

Illinois advocates of gender-affirming care aren’t waiting to find out exactly how far the Trump administration will go before they take action.

Wang, with Howard Brown, said advocates are working with state lawmakers to explore whether there might be state funding streams to help provide gender-affirming care if federal funding is lost.

State Rep. Kelly Cassidy, D-Chicago, said Illinois lawmakers years ago began preparing for the possibility of the federal government trying to restrict gender-affirming care. Illinois’ law shielding gender-affirming care from out-of-state legal attacks came out of a House working group established after the U.S. Supreme Court overturned Roe v. Wade.

Cassidy said she’s already working on a bill to enhance protections for people seeking reproductive and gender-affirming care in Illinois, by better protecting certain types of health data.

The American Civil Liberties Union of Illinois is also “constantly looking at the ways we can, through litigation or legislation, combat any of these attacks on access to care,” said Aisha N. Davis, senior policy counsel for the group.

“We know the next four years is going to look a lot different than the last four years, but we also know that whatever is coming we’re going to do our best to be ready and make sure this care is not interrupted or denied,” Davis said.

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