{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T15:15:14Z","timestamp":1783264514088,"version":"3.54.6"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007270","name":"University of Michigan","doi-asserted-by":"publisher","award":["Women's Health Innovation Fund"],"award-info":[{"award-number":["Women's Health Innovation Fund"]}],"id":[{"id":"10.13039\/100007270","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gender\u2010affirming care (GAC) improves the mental health, quality of life, and social functioning of gender\u2010diverse patients. In spite of this, GAC in the United States (as elsewhere) has become a major focus of debate, with several federal policy changes enacted through Executive Orders and legislation creating major restrictions on transgender (trans) Americans' ability to obtain the care they need.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to understand how trans Americans are responding to the anticipated changes in their access to GAC and to provide healthcare professionals with strategies to support this population in an environment of restricted access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We surveyed trans people in the United States to elicit their concerns and planning considerations. We used descriptive statistics to characterise coping strategies and content analysis to describe support strategies that the trans community requested from the healthcare community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Participants<\/jats:title>\n                    <jats:p>We recruited participants from December 2024 through March 2025 using snowball sampling and direct outreach to LGBTQ+ organisations. Participants self\u2010identified as trans and were 18 or older.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 157 respondents, 96.2% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009151) expressed concern about access to GAC. We describe five strategies for healthcare support: mental health support\/suicide prevention, financial support, connections with community organisations\/mutual aid, GAC education, and advocacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The current politicisation of transgender healthcare is affecting trans people, with the vast majority concerned about barriers that will make this care unattainable. It is essential for clinicians to understand the responses to these policy changes from the trans community and to act on their calls for support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Healthcare providers stand at a crossroads with the trans community. If clinicians fail to stand up for the rights of trans patients, we risk irrevocably harming the medical trust and long\u2010term health of the trans community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>Patients and people with lived experience were heavily involved in the design, conduct, and analysis of this study. The authorship group included a range of gender identities and expressions, including people accessing GAC as patients and clinicians providing GAC. Analysis was guided by participant feedback and iterative discussion among the authorship group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70716","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:22:51Z","timestamp":1781252571000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u2018I Would Feel Failed By the Medical Community Entirely\u2019: Transgender Americans' Calls for Advocacy From Health Professionals in a Care\u2010Restricted World"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6831-5412","authenticated-orcid":false,"given":"Kay","family":"Wallace","sequence":"first","affiliation":[{"name":"University of Michigan Medical School Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayne","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Krikorian","sequence":"additional","affiliation":[{"name":"Department of Family Medicine University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaines","family":"Blasdel","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Byrnes","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphna","family":"Stroumsa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jendso\/bvab011"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03625.x"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/trgh.2020.0094"},{"key":"e_1_2_11_5_1","unstructured":"AACE Position Statement: Transgender and Gender Diverse Patients and the Endocrine Community. American Association of Clinical Endocrinology accessed July 31 2025.https:\/\/pro.aace.com\/recent-news-and-updates\/aace-position-statement-transgender-and-gender-diverse-patients."},{"key":"e_1_2_11_6_1","unstructured":"H\u2010185.927 Clarification of Evidence\u2010Based Gender\u2010Affirming Care | AMA accessed August 7 2025.https:\/\/policysearch.ama-assn.org\/policyfinder\/detail\/Clarification%20of%20Evidence-Based%20Gender-Affirming%20Care?uri=%2FAMADoc%2FHOD-185.927.xml."},{"key":"e_1_2_11_7_1","unstructured":"Care for the Transgender and Gender Nonbinary Patient accessed July 31 2025.https:\/\/www.aafp.org\/about\/policies\/all\/transgender-nonbinary.html."},{"key":"e_1_2_11_8_1","unstructured":"APA Policy Statement on Evidence\u2010Based Inclusive Care for Transgender Gender Diverse and Nonbinary Individuals.https:\/\/www.apa.org accessed August 7 2025.https:\/\/www.apa.org\/about\/policy\/transgender-nonbinary-inclusive-care."},{"key":"e_1_2_11_9_1","unstructured":"GLAAD. Medical Association Statements in Support of Health Care for Transgender People and Youth | GLAAD. June 26 2024 accessed July 31 2025.https:\/\/glaad.org\/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory\/."},{"issue":"19","key":"e_1_2_11_10_1","first-page":"8615","article-title":"Executive Order 14168 of January 20, 2025 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government","volume":"90","journal-title":"Federal Register"},{"issue":"21","key":"e_1_2_11_11_1","first-page":"8771","article-title":"Executive Order 14187 of January 28, 2025 Protecting Children From Chemical and Surgical Mutilation","volume":"90","journal-title":"Federal Register"},{"key":"e_1_2_11_12_1","unstructured":"United States v Skrmetti. 605 1 (Supreme Court of the United States 2024)."},{"key":"e_1_2_11_13_1","first-page":"1","volume-title":"How Many Adults and Youth Identify as Transgender in the United States","author":"Herman J. L."},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540261.2022.2093629"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1102348"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/trgh.2020.0017"},{"key":"e_1_2_11_17_1","unstructured":"A.Rastogi L.Menard G. 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Mass.) | Civil Rights Litigation Clearinghouse accessed March 31 2026 https:\/\/clearinghouse.net\/case\/46942\/."},{"key":"e_1_2_11_34_1","volume-title":"Early Insights: A Report of the 2022 U.S. Transgender Survey","author":"James S.","year":"2024"},{"key":"e_1_2_11_35_1","unstructured":"A.Kirzinger A.Kearney A.Montero G.Sparks L.Dawson andM. B.PublishedKFF\/The Washington Post Trans Survey. KFF. March 24 2023 accessed July 31 2025 https:\/\/www.kff.org\/report-section\/kff-the-washington-post-trans-survey-trans-in-america\/."}],"container-title":["Health Expectations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70716","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hex.70716","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70716","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T14:50:40Z","timestamp":1783263040000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hex.70716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/hex.70716"],"URL":"https:\/\/doi.org\/10.1111\/hex.70716","archive":["Portico"],"relation":{},"ISSN":["1369-6513","1369-7625"],"issn-type":[{"value":"1369-6513","type":"print"},{"value":"1369-7625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70716"}}