Two T-Boys Witnessing the Collapse of TGI Healthcare and its Impact on Tobacco Prevention – by Sol Lagos and River Wu

Intro

Fear. Transgender people throughout America have been living in fear as we see our basic rights being stripped under the current administration. One of the biggest being our access to healthcare. Transgender, Gender Diverse, and Intersex (TGI) Healthcare includes access to affirming health spaces where identities are respected and cared for, hormone replacement therapy (HRT), mental health support, puberty blockers, voice therapy, resources for social transitioning, and much more. Even being in California, dubbed one of the most accepting states to be LGBTQ+, we have seen attacks on healthcare occurring throughout the past year.

Throughout our article, we will be discussing the state of gender affirming care in California, what it means to lose access to care, and how the intersection of immigration status places further stress on access to care.

The State of TGI Health in California

Last year, Governor Newsom vetoed SB 418. This bill would have secured up to a 12-month supply of HRT, which could have been dispensed all at one time and would have been covered by Medi-Cal. SB 418 would have ensured that trans people would have been guaranteed their HRT for the entire year, no matter if they lost coverage or if the current administration had found a way to cut off their future refills. The veto demonstrates that even in California, TGI Healthcare is never secure and is consistently at the whims of how politicians feel about trans people.

Another demonstration of the delicacy of TGI healthcare in California is CHLA (Children’s Hospital of Los Angeles) rolling back its gender affirming care for its patients. This rollback was alongside many other California hospitals that are shuttering their gender affirming care programs for youth in response to executive orders (which are not laws) and threats of funding being pulled. Youth TGI Healthcare includes mental health support, support with social transition (using preferred pronouns, name, gender expression, etc), and sometimes puberty blockers (a reversible medication used to halt puberty, when stopped, puberty continues). Surgeries seldom happen for those 15-17, and never happen to those under 12. WPATH has laid out the criteria for youth accessing these surgeries. They must go through a lengthy, intensive biopsychological assessment from medical professionals (to confirm gender dysphoria and emotional and cognitive maturity), have consent from guardians (for many, this is a large barrier due to unsupportive parents), and written documentation/letter from the person’s team of medical and mental health professionals. This comprehensive process bars most youth from being able to access surgery until they are 18, therefore making the amount of adolescents accessing gender affirming surgery so low.

In April of 2026, Attorney General Bonta found the Kennedy Declaration (cuts to federal healthcare funding if gender affirming care is provided) unlawful. Thereby proving that gender-affirming care for youth is legal and urging the reopening of their programs. As of May 2026, no hospital programs that closed have re-established their gender-affirming care.

We are Losing the Care Keeping Us Alive (River)

As people continue to lose access to their healthcare amid growing uncertainty, many TGI individuals turn to tobacco use as a coping mechanism. This is not because tobacco replaces the care they need, but because it is one of the few consistently accessible forms of relief available to them. In the face of structural violence (including barriers within healthcare systems, government policies, and broader institutions), people naturally seek stability and ways to cope. For many, tobacco becomes that accessible outlet. The larger issue is the significant lack of accessible mental health support; when tobacco remains readily available while care does not, it is unsurprising that people may rely on it to manage stress, anxiety, and unprecedented times.

Where We Are Now: Our Most Vulnerable are Being Attacked aka We are Dying (Sol)

This fear is not solely anticipatory, for many within the TGI community, it is a current reality. As demonstrated by the current lawsuit filed on the Adelanto ICE Processing Facility, detainees report not being granted medically necessary health care among other basic necessities. For TGI detainees, this can include HRT, resulting in forced “de-transition” in its withholding. What this cruelty causes is the furthering of deep rooted wounds for the TGI community. The psychological and physical harm of detransitioning can not be recovered from quickly. Healing often requires extensive cross-sector support and resources that many of the most vulnerable people are systematically denied access to. The grief of many Trans lives lost to forced impoverishment, state-permitted violence, and the weight of living with fear will require culturally-centered healing and also, time, lots of it. Until these needs are met, it is natural for short-term and accessible “remedies” to be taken up by the TGI community, often being tobacco. Therefore, to understand tobacco prevention in TGI communities, one must understand what TGI folks are experiencing: we are dying. The Lemkin Institute warned, the U.S. is in early stages of genocide against TGI folks. This is not meant to scare but rather to address a reality that many outside of the TGI community refuse to see or have the ease of not seeing. As part of the TGI community and tobacco prevention advocates, it is our duty to honor the lives lost not as merely fear for ourselves, but as drivers for the injustice that is here and the fight that must continue in their name.

How We Keep Moving

We remind ourselves this is a moment in a long history of Trans resilience and existence. We move with honesty and honor to the need in our current reality to truly address it both in our daily lives and the passion behind our work. Tobacco prevention, at its best, is holistic healing work. This moment requires us to look at all the factors and conditions that create substance use and addiction, not as individual failure but as a choice to cope. We must meet our vulnerable communities with support and empathy to foster care in our most difficult moments of now. That is how we keep moving together.