Trump's anti-trans order clashes with New York law
'None of us asked to be born a certain way,' Kelly Metzgar, a transgender woman and executive director of the Adirondack North Country Gender Alliance in Saranac Lake, told New York Focus. 'Tall, short, red hair, blond hair — this is how we were created.'
Metzgar's brain and body used to feel unbalanced, driving her to the point of contemplating suicide. She says gender-affirming care saved her life. 'It made such a difference,' she said, providing her 'with a sense of wholeness.'
Gender-affirming care helps align a person's body with their gender identity. Treatment differs from person to person but can include medical, psychological, social, and legal support. Both cisgender people — those whose gender identity corresponds with their sex assigned at birth — and transgender people receive and benefit from gender-affirming care.
If they can access it.
GENDER-AFFIRMING CARE
Immediately upon retaking the Oval Office, President Donald Trump issued an executive order directing federal agencies to withhold funding from health care entities that provide gender-affirming medical care to people under 19. In the order, Trump described the care Metzgar credits with saving her life as 'mutilation' and a 'horrifying tragedy.'
Trump's order sent shockwaves through the LGBTQ+ community. Some healthcare providers — scared of losing their funding and confused about their legal obligations — stopped treating transgender youth.
Hayley Gorenberg, a civil rights lawyer and co-chair of the New York City Bar Association's LGBTQ+ Rights Committee, told New York Focus that Trump's order has 'no mooring in medical reality.'
Private plaintiffs, public interest groups, and state attorneys general quickly filed lawsuits to invalidate Trump's order. Federal judges have blocked the Trump administration from freezing any funding while the lawsuits play out.
Letitia James, New York's attorney general, has a long history of battling Trump. Now, she's committed to fighting his anti-trans agenda.
James warned hospitals that denying gender-affirming care to transgender people is against New York law, regardless of the availability of federal funding. The state's Human Rights Law — amended during the first Trump administration after years of advocacy by LGBTQ+ New Yorkers — expressly prohibits discrimination on the basis of gender identity or sexual orientation in places of 'public accommodation.'
SANCTUARY STATE
Legal experts told New York Focus that even if the federal courts ultimately uphold Trump's order, the Human Rights Law still requires that health care providers supply the same treatment to transgender people as they do cisgender people — including gender-affirming care. But while New York's law is clear, advocates say, litigation is not a cure-all.
Metzgar said she's optimistic that New York will remain a 'sanctuary state' for transgender people.
'Letitia James will fight back,' said Metzgar. 'That's what we're hanging our hats on.'
Hilary Avallone is the LGBTQ+ program manager for acr Health's Q Center, which supports LGBTQ+ youth and their families across nine counties in Central New York, the North Country, and the Mohawk Valley. She told New York Focus that Trump's order had an immediate effect, making already hard-to-get care even tougher to access.
'You know there's only so many pediatric providers for hormone replacement therapy,' Avallone said. She said some providers asked the Q Center to remove its resource guide listing recommended gender-affirming care providers from its website. Some providers put holds on appointments, and some stopped taking new patients, she heard.
Since James's warning, Avallone said, the trans youth she works with have continued to receive the care they need. Metzgar said she hasn't heard of any providers in her area denying gender-affirming care, for which she also credits James.
Not all providers have been so compliant.
NYU LANGONE
The NYU Langone health system stopped providing gender-affirming care to transgender youth after Trump's order. On March 13, Assemblymember Harvey Epstein, state Senator Kristen Gonzalez, and the 1199SEIU health care workers union sent a letter reminding NYU of James's warning and demanding the hospital resume its full suite of services for trans youth. They never got a response, Epstein told New York Focus.
On Monday, hundreds of protestors marched on NYU Langone. The protestors carried some 10,000 letters demanding that the hospital resume its gender-affirming services, which Gonzalez says the hospital refused to accept.
'NYU must affirm their commitment to providing gender-affirming care to all patients who seek it, whether they be youth or adults, whether existing or new — in compliance with state law,' Gonzalez said in a statement. 'If we're going to beat fascism, we have to stand together.'
NYU Langone declined to comment for this article.
VARIETY OF TREATMENTS
Gender-affirming care encompasses a variety of types of support — name and clothing changes, updating official documents, speech therapy, counseling, puberty blockers, and more. Medical interventions for transgender youth typically require the child's assent, parental consent, and approval by a mental health professional. Surgery is vanishingly rare for transgender youth. A Harvard study found that fewer than 0.01 percent of transgender and gender-divergent youth undergo gender-affirming surgery.
Delaying or denying gender-affirming care can cause real harm to young people. Hormone therapy, for example, helps prevent permanent and distressing body changes. One study found that transgender and nonbinary youth who receive gender-affirming care are 73 percent less likely to have suicidal thoughts.
Cisgender people benefit from hormone therapy and puberty blockers, too — to manage menopause symptoms, for example, or to treat early puberty.
Denying care to transgender people while making it available to cisgender people is discrimination, Gorneberg said. 'And as the attorney general points out, that's illegal.'
HUMAN RIGHTS LAW
Enacted in 1945, New York's Human Rights Law guarantees everyone in the state 'equal opportunity to enjoy a full and productive life.' The law prohibits discrimination in employment, housing, education, and places of 'public accommodation' — including hospitals and clinics. The state attorney general can investigate discrimination complaints and enforce the law. People experiencing discrimination can also sue on their own behalf or file a complaint with the state's Division of Human Rights.
'Being able to access the Division of Human Rights is really important,' said Susan Hazeldean, an associate dean at Brooklyn Law School — especially for people who don't have a lawyer.
The Human Rights Law has long forbidden discrimination based on race, sex, religion, and national origin. In 2002, the state legislature expanded the law to cover sexual orientation — and in 2019, after a decades-long push by LGBTQ+ activists, to explicitly prohibit discrimination based on gender identity.
Despite Trump's executive order, that protection still applies to New York-based providers of gender-affirming care.
Katie Eyer, an anti-discrimination law scholar and professor at Rutgers Law School, noted that New York has some of the strongest protections in the country for transgender people — and that Trump can't unilaterally override them. 'It's right there,' she said. 'There's no debate.'
But even when the law is clear, legal advocacy has its limits.
A VERY GRAVE THREAT
Litigating even straightforward discrimination cases takes resources and forces victims to wait for relief. and despite New York law, Trump's executive order may still have severe financial ramifications. Advocates are unsure how health care providers that comply with New York's Human Rights Law would make up for lost federal funding.
'It is a very grave threat,' said Hazeldean. 'Federal support for the provision of health care is vital.'
Eyer said it's also unclear if insurance will continue to cover gender-affirming care for transgender people. Not all plans have to comply with New York's anti-discrimination laws. Assemblymember Linda Rosenthal introduced a bill that would require Medicaid to cover the costs of gender-affirming care, even if Trump succeeds in cutting off federal funding.
Federal judges have blocked Trump from withholding funding from health care providers while lawsuits against the order proceed, indicating they believe the lawsuits will likely be successful. One judge wrote that Trump's order 'facially discriminates on the basis of transgender status' and 'does not survive constitutional scrutiny.'
Ultimately, Trump's order could reach the United States Supreme Court. It's unclear how they would rule: Conservative justices hold a 6-3 majority on the court, but two of them have joined with liberal justices to hold that anti-trans discrimination is illegal, at least in the context of employment law.
'MY DEATH IS NOT A SURRENDER'
Trump and his allies have threatened federal judges with impeachment if they rule against the president and stoked fears that the administration may openly defy court decisions.
New York's protections have led many to view it as a 'safe haven' and 'sanctuary state' for transgender people. 'We've had a lot of folks coming from other states wanting to access care,' said Avallone. More may make the trip in the wake of Trump's order.
But even a 'safe haven' can be a dark place.
This February, Sam Nordquist, a 24-year-old Black transgender man from Minnesota, was found dead in a field in Canandaigua, a small city in New York's Ontario County. Nordquist was an animal lover who worked alongside his mother in a group home for people with disabilities. Before his death, police said, Nordquist was sexually assaulted and tortured for over a month. Seven people have been charged with his murder. Authorities have declined to charge the killing as a hate crime.
In January, Elisa Rae Shupe, a transgender activist and retired army sergeant first class, hanged herself from the top of the Syracuse VA Medical Center parking garage, her body wrapped in a transgender pride flag. The VA's inpatient psychiatry unit had discharged Shupe the day after Trump's inauguration. (The Syracuse VA declined to comment for this story.) Shupe reportedly aimed her last words at the Trump administration and the United States writ large.
'My death is not a surrender,' reads a note attributed to Shupe. 'You cannot erase non-binary and transgender people because you give birth to more of us each day.'
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