It is a difficult time for the transgender community in Kentucky and those who support them. Less than two years ago, the state legislature, gripped with anti-trans hysteria, passed a ban on gender-affirming care for transgender youth. And in recent weeks, an onslaught of executive orders from President Donald Trump further imperiled access to gender-affirming care nationwide.

But Oliver Hall, director of trans health at the Kentucky Health Justice Network, knew how to respond. When the state decimated care for vulnerable youth, they helped families connect with providers out of state. When Trump released his anti-trans orders, Hall pressed to make sure those providers held the line.

“One of the first things we needed to do was call the clinics in other states, making sure they weren’t going to start preemptively complying, and stop providing care,” said Hall.

Immediate mobilization isn’t new to the staff at the Kentucky Health Justice Network. In addition to connecting LGBTQ people to services, it also serves as an abortion fund. When the Supreme Court overturned Roe v. Wade, it triggered a near-total abortion ban in the state — changing the landscape for abortion access almost overnight.

“We prepared to just kind of shift on a dime to be able to do more of the travel support,” Hall said.

As Hall and others in the reproductive justice and LGBTQ rights space know all too well, the assaults on transgender Americans are occurring against the backdrop of a wider war on bodily autonomy.

In 2025 alone, state legislatures have already passed 11 anti-trans bills, and roughly 614 bills are under consideration that could negatively impact trans and gender-nonconforming people. In 2024, 87 anti-trans bills were introduced in Congress, according to the Trans Legislation Tracker. Despite many conservatives’ attempts to create distance from anti-abortion politics, many of the states that moved to restrict access to gender-affirming care have some of the strictest abortion bans. The same president who issued a slew of executive orders targeting transgender youth also appointed the Supreme Court nominees who made it possible to overturn Roe. And the court he reshaped is expected to make a ruling on gender-affirming care for transgender youth this spring.

For decades, abortion providers, advocates, and funds have persisted under an ever-shifting and intentionally vague legal landscape dead set on, if not outright, banning abortion care, making it as difficult as possible for abortion providers to effectively and ethically treat their patients.

Now, providers who offer gender-affirming care find themselves in that same landscape, working tirelessly for their patients as the proverbial sand shifts constantly beneath their feet.

But if these fights are inextricably linked, so are the solutions.

“We have to be more imaginative of what care can or may need to look like.”

“In both the gender-affirming care space and abortion care space and again, broadly even immigrant health, we have to always be prepared for the ground to shift and change underneath us,” said Dr. Lakshmi Sundaresan, a family medicine physician in Michigan. “And I think that is the hardest thing.”

Sundaresan, who like many provides both abortion and gender-affirming care........

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