When lawmakers and insurance companies label gender-affirming care as “non-essential” or “cosmetic,” they aren’t just using bland bureaucratic language. They’re weaponizing that language to deny lifesaving care to transgender people—care that reduces depression, curbs suicidal ideation, and improves quality of life across the board.
The consequences of these denials aren’t abstract. They’re fatal. The issue isn’t a debate about aesthetics. It’s a matter of survival.
The Myth of “Cosmetic” Care
At the heart of the argument against trans health access is the claim that procedures like hormone replacement therapy (HRT), puberty blockers, chest surgery, or facial feminization are “cosmetic” rather than medically necessary. This framing is convenient; it allows insurance providers to deny claims and lawmakers to sidestep responsibility under the guise of cost-saving or “protecting children.”
But the science doesn’t back them up. Multiple studies have shown that gender-affirming care isn’t about appearance; it’s about treating gender dysphoria, a serious and often debilitating condition that, when left untreated, leads to higher rates of depression, anxiety, substance abuse, self-harm, and suicide.
A 2022 study published in JAMA Surgery found that trans people who received gender-affirming surgeries had significantly lower odds of experiencing psychological distress and suicidal ideation compared to those who had not. Likewise, HRT has been repeatedly linked with improved mental health outcomes, including reduced anxiety and better emotional regulation.
So why the persistent labeling of this care as “non-essential”? Because “non-essential” is cheaper. And cruelty, frankly, costs nothing.
The Human Cost of Denial
For transgender people, being denied healthcare isn’t just frustrating; it can be catastrophic. A recent report by The Trevor Project showed that over 50% of transgender youth seriously considered suicide in the past year. Among those who wanted gender-affirming care but could not access it, those rates were even higher.
These aren’t hypotheticals. These are young people, our siblings, children, and friends, staring down a world that tells them their lives are too expensive to save.
And when adults face these denials, the devastation doesn’t go away. It festers. Trans adults in states without access to gender-affirming care face delays in treatment, are forced to travel across state lines, or go without care altogether. For many, that leads to worsening dysphoria, lost jobs, unstable housing, and shattered mental health.
If that sounds like a crisis, that’s because it is. And lawmakers know it.
“The One Big, Beautiful Bill” That’s Anything But
Yesterday, President Trump’s administration celebrated the passage of what it calls “The One Big, Beautiful Bill” through the House of Representatives, a sweeping legislative package packed with far-right priorities, including targeted attacks on transgender rights and healthcare access.
As we reported, the bill redefines “non-essential procedures” to exclude gender-affirming care from coverage under both public and private insurance systems. It gives states unprecedented leeway to classify such care as “elective,” “immoral,” or even “unlawful,” all under vague moral or religious exemptions.
Now that the bill has passed the House, it heads to the Senate, where its fate is uncertain but its momentum is dangerous. If enacted, this legislation would strip away healthcare access for transgender individuals not just in red states, but nationwide. And it wouldn’t stop with youth—the bill’s language explicitly targets adults as well.
This isn’t just another political talking point. It’s a direct legislative assault on our right to exist, and to survive.
Validated But Still Denied
Opponents of gender-affirming care often argue there’s not enough evidence to support it, especially for youth. But that claim doesn’t hold water.
A new study commissioned by the Utah Department of Health and Human Services reaffirms what major medical organizations have said for years: gender-affirming care for adolescents improves mental health outcomes. The study found that youth who received timely access to puberty blockers or HRT had lower rates of depression and were significantly less likely to experience suicidal thoughts.
This isn’t fringe science. The material is data-backed, and aligned with the positions of the American Medical Association, American Psychiatric Association, American Academy of Pediatrics, and the World Health Organization.
Yet those in power still shrug and say, “It’s cosmetic.”
The Profit Motive Behind the Cruelty
Let’s not pretend this is just about politics or religious values. There’s money in this cruelty, too.
Labeling gender-affirming care as cosmetic allows insurance companies to deny coverage, saving them billions. They don’t have to cover testosterone or estrogen therapy. They don’t have to pay for gender-affirming surgeries. They don’t even have to provide adequate mental health services for trans patients if those services are tied to gender identity.
It’s easier to ignore us. It’s cheaper to let us suffer. And when we die, they quietly move on.
Cis People Don’t Need to Jump Through These Hoops
There’s a glaring double standard in how gendered procedures are covered for cis people vs. trans people.
A cisgender man with low testosterone? He gets HRT, no questions asked. A cis woman with breast cancer? Mastectomy covered. A cis woman requesting hormone therapy during menopause? Covered again.
But a trans person requesting those exact same treatments as part of gender transition? Suddenly, it’s “experimental.” Suddenly, it’s “controversial.”
Healthcare shouldn’t depend on identity politics. But in this country, it always has—and still does.
This Isn’t Just About Adults
Let’s be clear: while much of the current legislation targets youth, the anti-trans healthcare movement is expanding to all age groups.
The One Big, Beautiful Bill doesn’t stop at minors. It now permits states to deny gender-affirming care to adults, classifying it as outside the scope of “standard medical practice.” This opens the door for adults to be denied coverage, prescriptions, and surgical care, even if they’ve been on hormones for decades.
It also sets a chilling precedent. If the government can strip healthcare rights from one marginalized group based on political whims, it can do it again to others.
Resisting the Narrative: Telling the Truth
We must fight back against the lie that transition is cosmetic. It isn’t.
It’s therapy. It’s treatment. It’s medically necessary. And for many of us, it’s the difference between life and death.
Every time a policymaker says otherwise, they are lying to the public, to their constituents, and to themselves. They are cloaking their cruelty in polite language, hoping that the trans people affected will be too exhausted to keep fighting.
But we’re still here. And we are not cosmetic.
What Allies Need to Know and Do
If you are a cis ally reading this, know that your voice matters. Trans people are already doing the heavy lifting, fighting legal battles, organizing mutual aid, and caring for one another. But we need backup.
Here’s how you can help:
- Call out insurance discrimination. If your employer offers a healthcare plan that excludes gender-affirming care, raise hell about it.
- Support national and local legislation that mandates coverage of transition-related care under public and private insurance.
- Educate your peers on the realities of gender-affirming healthcare—especially when they regurgitate talking points about it being “elective.”
- Vote with trans people in mind. Don’t just vote for someone who isn’t openly anti-trans. Vote for candidates who are proactive in defending our rights.
The Bottom Line
There is nothing “elective” about wanting to stay alive. There is nothing “cosmetic” about wanting to feel whole in your own body. And there is nothing “non-essential” about affirming someone’s identity and humanity.
When we call transition “cosmetic,” we’re not just mislabeling care; we’re feeding a narrative that has life-or-death consequences. Trans people are dying, not because of who we are, but because the systems around us treat us like we’re optional.
We are not optional. And if our graves must bear witness to that fact, then so be it.
But we’d much rather be here, living, breathing, and unapologetically alive.
