Health Implications of Recent Policy Changes Affecting LGBTQ+ Populations

There is abundant evidence that sexual minority groups have worse health indicators than sexual majority groups.For example, adults and adolescents who identify as lesbian, gay, bisexual, transgender, queer, or other sexual orientation (LGBTQ+) consistently report higher prevalence of depression and generalized anxiety than their heterosexual peers. 1 LGBTQ+ youth are also much more likely to attempt suicide than heterosexual youth. 2 LGBTQ+ populations are exposed to higher rates of violence 3 and have delayed screening for cancer and chronic disease. 4They have higher rates of infectious diseases, such as HIV, 5 and substance use, 6 including alcohol, smoking, and illicit drugs.Despite these health challenges, substantial progress has been made in the US toward improving the health of LGBTQ+ populations.In 2004, Massachusetts became the first US state to adopt marriage equality, and in 2015, the US Supreme Court ruled that the 14th Amendment of the Constitution requires all states to license and recognize same-sex marriage.This paved the way for better access to health insurance and health care services for persons who are LGBTQ+. 7In addition, a range of states have passed laws that prohibit discrimination based on sexual orientation and gender identity in housing, employment, and insurance; these laws have been shown to be associated with better mental and physical health among LGBTQ+ populations. 8Medicaid policies have been tailored to better meet the needs ofLGBTQ+ populations, improving both access and quality of care. 9National efforts to protect and affirm transgender and gender-diverse youth have been associated with improved mental health outcomes. 10More specific efforts to provide comprehensive LGBTQ+ health throughout the system, including through the Veterans Health Administration, have been associated with better health. 11These gains, hard fought by advocates over decades, have been shaken in the past year by a number of actions taken by the second Trump administration through executive orders.Executive Order 14168 rescinded protections for LGBTQ+ persons, made it "the policy of the United States to recognize two sexes, male and female," 12 and removed nondiscrimination protections, including those under Section 1557 of the Affordable Care Act.Consequently, a number of federal programs and policies were stripped of provisions recognizing LGBTQ+ individuals.Executive Order 14187 directed the federal government to withhold funding for gender-affirming surgical procedures resulting in several hospitals across the country pausing this type of care.In June 2025, the Trump administration terminated funding for the LGBTQ+-specific "press 3" option of the 988 Suicide Crisis Lifeline-effectively removing a resource dedicated to LGBTQ+ care-and canceled tens of millions of dollars in grants from the US National Institutes of Health concerning the health of LGBTQ+ persons.While the foundational gains in LGBTQ+ equality, including same-sex marriage, have not yet been threatened, the raft of efforts to claw back gains to equal treatment of LGBTQ+ populations is understandably enough cause for concern that some of these gains will be challenged in coming years.The challenges to LGBTQ+ health in the past year are inimical to the goals of health for a range of reasons, but perhaps it is worth summarizing the core reasons why those of us who are in the business of promoting health should find these moves alarming.First, a number of the new efforts pertaining to LGBTQ+ health will lead directly to more limited access to health care services forLGBTQ+ populations.This includes limited access to gender-affirming care, but also to mental health services, and through the rollback on nondiscrimination standards embedded in health care programs, creates opportunities for heterogeneous implementation and more limited access to care +