On March 17, 2025, the U.S. Department of Veterans Affairs (VA) announced that it will immediately cease providing gender-affirming care to transgender veterans—or any veteran with gender dysphoria. The VA has never covered gender-affirming surgeries, but now vital care like hormone-replacement therapy (HRT) and voice training therapy will no longer be provided. This move follows a series of executive orders (EO) signed by President Donald Trump targeting transgender people, including EO 14183—which seeks to ban transgender people from serving in the military—and EO 14168, which attempts to exclude all transgender people from the federal government’s definition of gender. Notably, Secretary of Veterans Affairs Doug Collins sidesteps EO 14183 and points instead to EO 14168 in his statement on this latest policy change.
Notably, while the VA claims in the press release that “less than one tenth of a percent” of the 9,100,00 veterans receiving VA health care are transgender, he does not provide how many trans veterans are receiving gender-affirming care through the VA.
In the release announcing the policy, Secretary Collins claimed he “doesn’t mean to disrespect anyone” by banning access to transgender medical care—but he’s actually doing something far worse. He’s removing access to lifesaving medical care for veterans who honorably served our country. VA health care is a lifeline for millions of veterans, including transgender veterans, and it ensures that those who served get the care they need.
As the VA does not cover gender-affirming surgeries, the bulk of the costs being cut relate only to hormone replacement therapy (HRT). The estimated cost to commercial health insurers for HRT provided to transgender people only averages between $121 and $153 per patient per year. According to the VA’s own release about this policy change, there are less than 9,100 transgender veterans enrolled in VA health care. If just under half of them receive (roughly 44 percent of transgender people report that they receive HRT), the maximum total cost to the VA would amount to only $500,000 per year.
Policies that attempt to define gender based on biological sex, like those in EO 14168, are part of a larger far-right authoritarian campaign promoted by Project 2025 to regulate gender. These policies fly in the face of best practice standards for medical care, harming transgender people and women.
This means that the VA likely spends less than one nickel per veteran enrolled in VA health care each year—or just 0.001 percent of the VA’s 2024 budget—on nonsurgical, gender-affirming HRT. In comparison, the VA requested $10 million to research artificial intelligence in 2025.
Cutting high impact services that will result in minimal savings seems to be a theme of the Trump administration. If the VA follows through on severing access to gender-affirming services for veterans, Secretary Collins would save very little—but the cost to transgender veterans will be steep. Veterans may not be able to afford the gender-affirming care recommended by their doctor out of pocket, potentially leaving thousands without access to best practice and lifesaving care.