The Role of Medical Training in Ensuring Gender-Affirming Care Access in 2025 and Beyond

Abstract

The evolving landscape of transgender healthcare in the United States has become more fraught with challenges following the 2024 presidential election and associated policy shifts, especially with the implementation of Executive Order 14168 (EO 14168). EO 14168 mandates a binary understanding of gender based on biological sex assigned at birth and imposes constraints on federal funding, academic freedom, and access to medical training related to gender-affirming care. Although the order is currently under legal challenge and its implementation remains uneven, it has already caused tangible disruptions in academic medical settings, with transgender clinics reporting increased patient anxiety, reduced visibility of LGBTQ +  content in federal resources, and institutional self-censorship of curricular content, even moreso in areas struggling with LGBTQ +  inclusion prior to EO 14168. Medical education, which has historically lacked comprehensive training on transgender health, is now at heightened risk of inadequate preparation for future physicians. Many medical schools continue to struggle with core curricula on gender-affirming care, leaving providers unprepared to meet the unique needs of transgender patients. This paper provides concrete examples of how EO 14168 has affected medical education and offers 5 evidence-based strategies, including as faculty development programs, protected simulation-based curricula, and institutional policy adaptations, to resist censorship and preserve high-quality, inclusive care training.

Introduction

The 2024 US presidential election has ushered in significant policy shifts concerning transgender healthcare, particularly in the realm of gender-affirming care. On his first day in office of his second term, President Donald Trump signed Executive Order 14168 (EO 14168), defining gender strictly based on biological sex assigned at birth, a move anticipated to create substantial administrative and educational challenges across federal agencies and potentially limit access to gender-affirming services.^1,2

The order mandates that federal departments recognize only 2 immutable sexes, male and female, based on reproductive function at conception, prohibits gender self-identification on federal documents like passports, and revokes federal funding for institutions offering gender-affirming care to individuals under 19. ² It also prohibits transgender people from using single-sex federally funded facilities that align with their gender identity. Further, the order instructs the Attorney General to reinterpret the Supreme Court's Bostock v. Clayton County (2020) ruling to remove gender identity protections from federal agency activities.

EO 14168 has shed new light on transgender health concerns, however it is important to recognize that the disparities facing transgender individuals long predate this order. Over the past decade, federal and state reforms have alternated between expansion and retrenchment of transgender rights. In 2016, federal guidance extended Title IX protections to gender identity, and the 2020 Bostock v. Clayton County ruling affirmed employment protections under Title VII. Subsequent years saw the reinstatement of open military service (2021), and expansion of Medicaid coverage for gender-affirming care in multiple states, alongside growing state-level recognition of gender identity in birth certificates and anti-discrimination statute.^3–5 The first-ever US passport with the “X” gender marker was issued in October 2021, and recognition of the nonbinary gender marker was not approved federally until April 2022. ⁶ This historical context underscores that EO 14168 represents not a new problem but an intensification of long-standing inequities.

Though gender-diverse protections existed marginally on the federal level after considerable progress over the last decade, this has not translated into inclusive medical care. The 2022 U.S Transgender Survey found that 24% of respondents reported that they avoided seeking healthcare due to fear of being mistreated, and 47% of respondents experienced at least one negative interaction with a healthcare provider. ⁷ This effect worsens when we look at transgender men and non-binary individuals assigned female at birth, who experience greater proportion of negative experiences, 55% and 53% respectively. Even when providers are well-intended, they are not necessarily equipped with the training to provide affirming care, as 18% of folks seeking gender affirming care reported that they had to teach their provider how to do it. ⁷

While the implementation of EO 14168 remains uneven due to active legal challenges, the fear of federal repercussions and losing federal funding has already shaped institutional behavior and prompted widespread concern about threats on academic freedom and censorship in medical education. In one example, a family medicine program in a public academic medical center reported that its long-established transgender clinic has remained operational but now faces a rise in patient concerns regarding safety when traveling across state lines due to changes to passport gender marker policies and increasing legal uncertainty for families of transgender youth due to bans on gender-affirming care.^8,9 We have already seen reports of the largest gender-affirming care center at Children's Hospital of Los Angeles closing soon, and other leading LGBTQ +  health institutions such as Rush University Medical Center and Yale New Haven Health also halting non-surgical gender affirming care for patients below age 19.^5–7

The evolving reversals of gender-affirming care provisions have translated into growing clinical and teaching hesitancy and fear. Some institutions have reported delays in implementing new transgender-inclusive curricula or have quietly removed lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) training modules from clerkships, particularly in pediatrics and family medicine, for fear of federal noncompliance. ⁸ Preliminary judicial restraining orders have been issued to temporarily halt the enforcement of specific provisions of the policy, including efforts to defund programs supporting gender identity initiatives, mandate the involuntary transfer of transgender inmates, and remove LGBTQ + -related resources from federal websites, however the effectiveness of these measures is uncertain.

Historically, medical curriculum has been criticized for inadequate coverage of transgender health issues. Most medical students receive limited training on transgender medicine, often lacking comprehensive content on gender-affirming care. ⁹ The recent political developments and fear of legal repercussions potentially exacerbate these educational gaps, posing challenges for medical students and residents committed to providing competent care to transgender patients.

Additionally, while this perspective draws upon current legal and educational events, the authors’ viewpoint reflects experiences as medical trainees, community leaders, educators, and advocates for medical curriculum reform. Our recommendations are informed by published and practiced curricula, teaching tools, trauma-informed care models, and ongoing dialogue with LGBTQ +  health educators and clinical faculty to improve inclusivity and accessibility of medical education. Clarifying this perspective helps contextualize the recommendations we present for medical education stakeholders and inform medical education practices considering changing legislation and policy.

This paper focuses on how medical education institutions can respond to these challenges by safeguarding and strengthening gender-affirming care training. As the legal and political context continues to evolve, ensuring that medical education remains inclusive, evidence-based, and responsive to all patients regardless of gender identity remains a critical component of professional preparation of future physicians.

Legislative Actions to Date

In 2025, the policy landscape around transgender healthcare in the United States has become increasingly complex.

Federal Actions

On January 20, 2025, President Donald Trump signed EO 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” ² The order mandates that federal agencies recognize gender strictly as male or female, determined by biological sex assigned at conception. It directs the replacement of the term “gender” with “sex” in official materials, ceases federal funding for gender-affirming care, and prohibits the use of federal funds to promote “gender ideology.” Additionally, it requires that federal identification documents reflect this binary definition, eliminating recognition for nonbinary or intersex individuals.

While sweeping in scope, EO 14168's legal authority is subject to judicial review, and implementation may vary across agencies and regions depending on ongoing legal challenges. Implementation remains uneven, with preliminary injunctions issued in some jurisdictions and lawsuits underway challenging the order on constitutional, procedural, and human rights grounds. ¹⁰ Despite these legal challenges, the order has already had effects on federal agencies and the institutions they influence, including medical schools. ¹¹

For example, in compliance with the executive order, the Centers for Disease Control and Prevention (CDC) removed large amounts of online public health information related to human immunodeficiency virus (HIV), LGBTQ +  health, and transgender healthcare from its website. The CDC's data directory, which contained vital resources on health disparities and risk factors affecting LGBTQ +  populations, was taken offline, sparking widespread concern among public health professionals and researchers. ¹² This action, coupled with reports of federally funded research projects being withdrawn or delayed, illustrates the tangible effects of censorship on public health and education. These developments raise serious First Amendment and academic freedom concerns and may restrict evidence-based training in gender-affirming care.^13,14 When federal directives compel the exclusion of medically relevant topics such as gender identity from educational settings, they risk crossing the line from regulation into unconstitutional viewpoint discrimination. By limiting discourse around transgender health in scientific and medical settings, such measures may constitute government overreach and suppression of free speech. They also reflect growing constraints that may discourage educators from incorporating transgender health into curricula, for fear of violating ambiguous federal mandates.

It is also worth noting that several states have passed or are enforcing laws that further restrict gender-affirming care, creating a fragmented legal landscape that complicates curricular planning in affected regions. As medical schools operate within this shifting federal and state policy environment, educators face increasing pressure to adapt while defending academic autonomy and the integrity of medical training.

Impact on Medical Education and Training

Curriculum Challenges

Medical schools have historically struggled to incorporate comprehensive training on LGBTQ +  healthcare, particularly transgender-specific topics. In 2014, the Association of American Medical Colleges (AAMC), released a call for the 158 US and Canadian medical schools to provide comprehensive training in caring for LGBTQ +  people and those born with sex-development differences. ¹⁵

Since then, there has been measurable but inconsistent progress in transgender medical education. A comparison of survey data from Streed et al in 2011 and 2022 revealed an underwhelming increase in LGBTQ +  health coverage. ¹⁶ In 2011, 132 schools reported a median of 5 h dedicated to LGBTQ +  health, while in 2022, 85 schools reported a median of 11 h. Yet, 6.8% of schools still reported no LGBTQ +  content in preclinical years, and 33.3% reported none during clinical years. Although 97% of schools taught students to inquire about sexual history (eg, “Have you had sex with men, women, or both?”), LGBTQ + -specific topics continued to be less frequently covered throughout the curriculum. ¹⁶

Long-standing educational gaps leave students unprepared to provide competent care for individuals or patients who are transgender, which are gaps that EO 14168 threatens to widen. For example, an internal survey conducted at a southeastern US medical school found that faculty in family medicine and psychiatry declined to participate in a transgender healthcare panel after the release of EO 14168, citing fears of federal funding repercussions. ¹⁷ Several academic institutions have also reported postponing revisions to LGBTQ + -inclusive curricular content, particularly related to pediatric endocrinology and hormone replacement therapy, due to ambiguous language in the EO regarding “promotion of gender ideology.” ¹⁷

This chilling effect has been documented in early commentaries and legal analyses. Recent peer-reviewed research has documented that medical schools and clinical training programs, especially in states with restrictive policies, have delayed or reconsidered LGBTQ + -specific curriculum content due to legal uncertainty and political pressure. For example, Gupta et al found that pediatric endocrine providers reported pausing or modifying gender-affirming care training to mitigate perceived legal risk, while McNamara et al described how adolescent medicine providers face dilemmas balancing care delivery with restrictive new laws.^8,17 Similarly, Streed et al reported that faculty in some regions feel unprepared or discouraged from discussing gender identity in clinical education, often citing unclear institutional policies and fear of noncompliance. ¹⁶ These trends illustrate how policy shifts can create a censoring effect on evidence-based transgender healthcare education. ¹⁸ This further marginalizes already-overlooked transgender healthcare content, at a time when understanding of transgender health issues are increasingly relevant.

One key issue is the lack of structured, longitudinal transgender health curriculum. Many educators and clinicians have advocated for more specific training in gender-inclusive care, beginning with pronoun terminology and extending to clinical issues that disproportionately affect the LGBTQ +  community such as mental health disorders, sexually transmitted infections, and hormone replacement therapy. ¹⁹

However, many medical faculty are often underprepared to lead these discussions effectively. Over 80% of medical students report feeling “not competent” or “somewhat not competent” with providing LGBTQ +  care with the education they received. ²⁰ Furthermore, as most data on clinical preparedness focuses on the collective LGBTQ +  experience, specific considerations for transgender patients are routinely excluded, and data may overrepresent competency in caring for gender-diverse patients. As a result, future physicians may graduate, and eventually practice, without foundational knowledge and confidence required to provide affirming health care.

Training Opportunities

A 2022 systematic review of all published interventions on transgender health curriculum in medical schools found that most transgender-health trainings are single-session and inconsistently implemented, with persistent barriers, such as limited faculty expertise and resources. ²¹ To address these gaps, medical schools should consider developing sustainable training strategies that can remain viable amid legal and political shifts. This includes embedding transgender care topics not only in LGBTQ + -specific modules but also in core rotations such as primary care, psychiatry, and reproductive health. Doing so normalizes affirming care, brings awareness to transgender health concerns, and reduces perceived political risk. Furthermore, trans-inclusive curricula benefit from skills-based learning, engagement of transgender educators, and critical approaches to binary sex and gender concepts. ²¹

Programs such as those at the University of California San Francisco (UCSF), which incorporate simulation-based training and standardized patient encounters focused on gender-affirming care scenarios, offer structured and reproducible approaches.^21,22 The University of Louisville School of Medicine also developed and integrated a comprehensive, longitudinal transgender health curriculum across all 4 years of medical school, combining didactic sessions, standardized patient encounters, and faculty training to improve students’ competence and confidence in providing gender-affirming care. ²³ Further work has been done in the medical education literature, including case-based workshops for LGBTQ +  youth care, faculty development on navigating gender and sex curricula, and standardized patient cases for gender-affirming care, all providing ready-to-implement materials across preclinical and clinical phases for medical students.^24–26

These examples underscore the value of protected educational infrastructure that combines didactic, case-based, and experiential learning. As the AAMC develops materials for their new foundational competencies, it is essential that transgender health content, particularly content informed by proven models like UCSF and University of Louisville, be institutionally embedded and insulated from political shifts.

In contexts where direct patient contact is limited by safety, stigma, or legal uncertainty, simulation-based training and trauma-informed standardized patient encounters present practical alternatives for training future practitioners. Such methods reduce reliance on overburdened communities of individuals who are transgender while still centering affirming care in medical training.

Additionally, Continuing Medical Education (CME) courses, along with resources and certification programs from organizations like World Professional Association for Transgender Health (WPATH) also provide essential support for practicing physicians, especially in states where curricular mandates are restricted. Partnering with LGBTQ +  health advocacy organizations remains critical, but these partnerships must be designed with sensitivity to the safety, bandwidth, and compensation of collaborators who are transgender. Moreover, institutions should consider protective administrative policies that explicitly affirm academic freedom in teaching medically relevant content related to gender identity. For example, some institutions have passed resolutions asserting faculty rights to teach evidence-based transgender care under the guidance of the AAMC and AMA, regardless of federal reinterpretation of Bostock v. Clayton County. ¹⁸ As EO 14168 continues to reshape institutional behavior, emphasizing sustainability, equity in collaboration, and alignment with community needs remains essential.

Healthcare Considerations

Medical training must extend beyond clinical skills to emphasize all aspects of care for patients who are transgender, especially in considering the unique mental health challenges and social determinants of health that significantly impact their overall well-being. ²⁷ Individuals who are transgender experience elevated rates of mental health issues compared to the general population, with studies showing that nearly 46% of transgender and nonbinary youth have seriously considered suicide in the past year, underlining the importance of mental health support. ²⁴ Nearly half of transgender and nonbinary young people report unmet mental health needs, and around 55% of transgender adults reported suicidal ideation, with 29% reporting a previous suicide attempt. ²⁵

Additionally, individuals who are transgender often face greater discrimination, violence, and stigma, which can lead to chronic stress and reduce access to quality healthcare. Medical curricula must therefore include content that prepares students to understand the psychosocial drivers of health, such as chronic stress, violence, and marginalization. These topics represent core components of culturally responsive and comprehensive care. Yet, under EO 14168, institutional pressure to avoid discussing gender identity or systemic oppression may further marginalize this critical training. In a recent cross-institutional survey, over 40% of medical educators expressed uncertainty about the legality of including transgender mental health topics in federally supported academic settings. ²⁶ To mitigate this, schools can frame transgender mental health not as a political issue, but as a public health and clinical competency imperative. Embedding these topics in courses on psychiatry, primary care, and social medicine, rather than isolating them, can reduce perceived political risk while preserving essential knowledge.

Equipping students to recognize and navigate these disparities is a necessary step in fostering affirming, trauma-informed, and culturally responsive care. Developing such skills through consistent and well-integrated curricular methods will support student preparation in an evolving policy environment.

Why Medical Education Must Respond

The effects of EO 14168 on healthcare institutions threaten to widen already stark disparities in transgender health outcomes. While many of these outcomes, such as elevated suicide risk, increased healthcare avoidance, and reduced access to gender-affirming care, are well-documented, they also reflect a failure of educational preparation.^3,8,28

Medical schools must now navigate teaching about a population whose care is increasingly politicized, stigmatized, and criminalized in some jurisdictions.^29,30 In states enforcing or aligning with EO 14168, students may graduate with little or no training on how to serve transgender patients—despite evidence showing that competent, affirming care reduces suicidal ideation, substance use, and long-term health disparities.^31,32

When medical education excludes transgender health, the downstream public health costs are not just theoretical. Biases among healthcare professionals have been shown to directly exacerbate health disparities, resulting in quantifiable consequences for population health.^33–35 Recent reports from institutions in EO-compliant states (eg, Texas, Florida) have shown rising rates of medical students reporting that they feel “unprepared” or “discouraged” from discussing gender identity in clinical spaces due to unclear institutional policies and faculty avoidance. ¹⁶ Roughly 30% of transgender people avoid care due to anticipated discrimination, and many report needing to educate their providers.^17,36,37 Consequently, only 66% report their health as “excellent,” “very good,” or “good,” compared to 81% of the general US population; and over 80% experience frequent depressive symptoms, far exceeding the national average of 57%. ⁷ These realities underscore that preparing future physicians to deliver gender-affirming care is not only clinically relevant, but also a necessary step toward health inequity and upholding ethical practices in medicine.

Focused Recommendations for Medical Education

Recommendations for Medical Education Stakeholders

Considering the historical neglect and the heightened legislative impact of EO 14168, our recommendations prioritize strategies that are practical, context-aware, and grounded in educational priorities. These recommendations are tailored to all medical educators, from those active in national organizations to those advocating for reform at their own medical school.

Increasing gender affirmative care in medical education should follow a multiple pronged approach as outlined in Figure 1.

1. Standardizing and Improving Curricular Integration: Medical schools should integrate stimulation-based training that equips students with practical, affirming communication skills without relying on vulnerable patient populations. This can be achieved by working with standardized patients and adopting patient-centered models into the curriculum. Patient-centered models should emphasize creating individualized treatment plans that reflect each person's identity and goals. When care is approached from a “patient-first” model, shared decision making can be employed to ensure care provided aligns with care that is affirming to each patients’ identity, whether they identify as LGBTQ + or not. Clinicians must actively listen to patients’ concerns, provide affirming mental health services, and engage in community outreach to evaluate how care is received and where it can improve. By maintaining open channels for patient feedback and integrating that input into care models, providers can ensure their approach is responsive, respectful, and effective in addressing the needs of gender-diverse populations.

2. Focusing on Faculty Development: Currently, faculty members themselves may not know how to provide gender-affirming care or teach about it. Therefore, it is crucial for institutions to train faculty members on inclusive teaching, so they are prepared to impart this knowledge onto students in an effective manner. Schools must also address any implicit biases that may exist by adding bias awareness workshops to faculty development material to ensure faculty members know how to identify and mitigate any biases they may have. Lastly, it is important for faculty members to make a conscious effort to continue educating themselves on local LGBTQ + issues that may be affecting their community members and potential patient populations. Faculty development programs must focus on helping instructors build both confidence and competence in teaching transgender health.

3. Expanding Research and Scholarship: The field of gender-affirming care is a new and growing one. Accordingly, it is vital to continue to explore and advance the field through gender-affirming care research efforts. Members of the LGBTQ + community face unique mental, physical, and emotional health challenges that have not been delved into nearly enough, that is why it is important to continue research efforts into such topics so we are able to provide care that is relevant and personalized to these populations. Part of the research efforts should include creating new and evolving gender-affirming care curricula that match any new findings. It is also important to perform community outreach studies and surveys to confirm that the current curricula is adequately addressing LGBTQ + concerns and in the correct manner that does not further marginalize the community.

4. Standardizing and Improving Clinical Training: Medical schools should adapt more inclusive history taking skills when training their students on clinical skills. Institutions should be encouraged to engage in community outreach and adapt their history-taking and clinical practices to better reflect the lived experiences of transgender and non-binary individuals. Faculty and staff must also be protected through clear institutional policies that affirm their rights to teach, learn, and practice inclusive care, particularly in politically sensitive environments. Schools must also decentralize gender health education, embedding it throughout required coursework and core clerkships rather than siloing it into electives. Lastly, it is key to train students and medical professionals on how to properly document about LGBTQ + patients in their chart and how to write about their concerns in medical notes. This includes training on proper pronoun usage and general gender-affirming care terminology.

5. Establishing Continuing Education after Medical School: Ongoing medical education should include formal training on LGBTQ + health, offered through CME programs and institutional workshops. This is essential for providers to maintain competency in care for gender and sexual minorities and bring education and perspectives to providers who have graduated from medical training prior to the awareness of LGBTQ + health topics. This can also be furthered with ongoing optional certification for providers who want more knowledge to get involved in. Providers should also be encouraged to work with local and national LGBTQ + organizations to strengthen the relevance and impact of their knowledge and proper patient care practices. Though EO 14168 attempts to restrict how gender is defined and discussed in federally affiliated institutions, medical educators can still uphold evidence-based standards of care by rooting their efforts in local community needs, ethical responsibility, and academic freedom.

Figure 1.

Recommendations for Increasing Medical Education in Gender Affirming Care.

Recommendations for Medical Education and Institutional Practice

In response to Executive Order 14168 and the broader socio-political environment, it is important that medical education systems respond not with hesitation, but with coordinated, thoughtful strategies that uphold the integrity of evidence-based care. Given that experiential learning may now be constrained due to increased marginalization and risk within transgender communities, curricular innovation must prioritize trauma-informed and simulation-based methods.^38,39 Medical schools can adapt by centering case-based learning, simulated patient scenarios, and robust online modules that allow for depth of engagement without placing undue burdens on vulnerable individuals.

Institutional partnerships with LGBTQ +  health experts and community organizations should be pursued with intention, ensuring these collaborations are ethically grounded, compensated, and designed to reinforce trust. These partnerships offer opportunities to co-create educational content that reflects the lived realities of individuals who are transgender within the community while also modeling allyship and inclusive professionalism for trainees.

Furthermore, to ensure long-term sustainability, faculty development programs should be emphasized. Many educators lack formal training in teaching transgender health topics, particularly in politically charged climates. Faculty-focused programs should equip instructors with the confidence and pedagogical tools to deliver content related to gender-affirming care, while navigating restrictions that may exist in certain jurisdictions. AAMC's forthcoming foundational competencies represent an important opportunity for alignment; schools should prepare to integrate these guidelines and tailor them to reflect local demographic needs and institutional capacities.

Medical students and trainees also play a critical role in shaping the future of inclusive care. Encouraging students to engage in community outreach, advocacy efforts, and CME courses can amplify institutional efforts. Trainees should be supported in developing more inclusive clinical habits from the outset, such as respectful history taking skills, affirming language, and sensitivity to systemic barriers that patients who are transgender often face. Additionally, they can be encouraged to form or join advocacy groups within medical schools to push for curriculum reforms and learn about local LGBTQ +  issues and developments in transgender care sphere.

Beyond training, clinical environments must actively reflect the values of inclusive care. Hospitals and clinics should adopt administrative policies that affirm the identities of transgender patients—for example, by allowing chosen names and gender markers in medical records—and provide regular staff training on cultural humility and gender-affirming practices. These inclusivity measures, whether in policy, signage, or staff behavior, contribute to safer, more affirming healthcare experiences.

Healthcare institutions should also implement protocols for navigating care under restrictive legislation, ensuring providers have clear guidance when legal ambiguity arises. Where feasible, outreach programs can gather feedback directly from transgender patients, enabling care practices to evolve responsively and responsibly.

Visible signals of acceptance, such as displaying LGBTQ +  flags, inclusive symbols, and affirming signage, help foster a welcoming atmosphere. ⁴⁰ Staff training on sexual orientation and gender identity (SO/GI), transgender health, and the use of inclusive language further supports this goal. ⁴¹ Finally, partnerships with community organizations can provide holistic support and reinforce the institution's commitment to equitable care for transgender patients.

Taken together, these recommendations offer a pathway for medical education and healthcare systems to uphold their ethical and professional duties, even in the face of political opposition. By focusing on adaptability, collaboration, and accountability, institutions can help safeguard access to gender-affirming care and ensure that future healthcare professionals are trained to meet the needs of all patients with dignity and competence.

Conclusion

In the wake of Executive Order 14168 and the escalating sociopolitical backlash against gender-affirming care, the role of medical education has become increasingly significant. Medical institutions must not only resist efforts that curtail access to transgender healthcare but also affirm their ethical obligation to train providers equipped to deliver inclusive, evidence-based care. The future of healthcare for individuals who are transgender depends on our collective willingness to adapt curricula, protect academic freedom, and foster learning environments that uphold the dignity and humanity of all patients.

This paper calls on educators and academic leaders to take intentional and sustained action. Prioritizing transgender health in medical education reflects a commitment to professional standards and patient well-being. By embedding gender-affirming care into the core of medical training, institutions can prepare future physicians to meet the realities of their practice with competence, compassion, and courage. While medical education must continue to expand its focus on gender-affirming care, that alone is not enough. To truly honor and support transgender communities, we need systemic change that goes beyond the classroom. It is time for local and federal policymakers to step up, by enacting inclusive policies that protect transgender rights and ensure equitable access to care, so that we can build a country that truly values every person's identity and well-being.

The current moment presents not just a challenge but an opportunity for strategic institutional commitment. By embracing concrete strategies, from simulation-based curricula to protective institutional policies, medical education can lead by example, fostering a generation of physicians who are equipped to care for all patients, regardless of political turbulence.