Gender-Affirming Care as a Mental Health Provider in 2025

Many mental health professionals dedicate their services to the transgender community as they face the many manifestations of discrimination and rejection. They have noted, with great alarm, the wholesale assault on their clients’ rights and very existence coming from the Federal government and a significant number of states. The ongoing threats to gender-affirming care are of particular concern since they target the practitioners’ ability to provide support to their clients. Continued vigilance is indeed warranted as a number of this year’s Federal measures are being challenged and will make their way through the court system. 

There have been some encouraging developments.

Earlier this month, a Federal judge at the District Court of Maryland issued an unequivocal rebuke of Executive Order 14,168, which aimed at denying federal funds to any medical institution, medical school, and hospital providing gender-affirming medical care to patients under nineteen. In ordering that the Executive Order be temporarily enjoined, the Court found, among other things, that the President’s action was unconstitutional because it sought to infringe on powers reserved to Congress, and it violated federal law by pursuing discrimination on the basis of transgender status.

However, even though a preliminary injunction means the Court was convinced that opponents of the Executive Order are likely to prevail on the merits of their claims, this is only one round on one of several judicial fronts. This case, like the others, may have only just started its appellate climb. Concerns about the current Federal administration’s penchant for disregarding court orders have also surged in recent weeks, further clouding the prospects of an imminent end to this issue. 

A number of State attorneys general had responded to the Executive Order by publicly affirming their respective states’ commitment to gender-affirming care. In the case of Massachusetts and Colorado in particular, the supportive stance was consistent with existing legislation: generally, in these states, gender-affirming care is considered a “legally protected activity”, and there are statutes protecting professionals engaged in this area of practice from adverse action, including actions initiated by other states, provided they operate in their home state, and their practice does not violate state law.

For example, Chapter 127 of the Acts of 2022 in Massachusetts codifies gender-affirming health care as a legally and constitutionally protected right. Among other things, this law expands the definition of “Gender-affirming health care services" to include “all supplies, care, and services of  . . . behavioral health, mental health, psychiatric, therapeutic, and diagnostic" . . . This means therapy, psychiatric care, and related behavioral health services tied to gender-affirming care are explicitly protected under the law. The law also expands protection for mental health providers, including therapists, psychologists, and social workers, who are protected from out-of-state legal actions when offering legally protected services such as gender-affirming care. Specifically, they are shielded from discipline, license revocation, or censure within Massachusetts, even if targeted by other states, and are safeguarded against out-of-state civil or criminal actions, provided their services comply with Massachusetts law. Moreover, ​behavioral health providers in Massachusetts are granted specific civil protections against abusive litigation from other states. They have the right to file lawsuits seeking damages and injunctive relief if they are targeted by such litigation. Additionally, these providers can move to quash subpoenas or court orders that conflict with Massachusetts law.

These laws make clear that behavioral health professionals are considered essential providers in the delivery of gender-affirming care—and this law ensures they can continue to do that work without legal risk, disciplinary threats, or discrimination based on out-of-state policies.

Similar to Massachusetts’s Chapter 127, Colorado’s Senate Bill 23-188 affirms that gender-affirming and reproductive health care—including behavioral, mental health, and therapeutic services—are legally protected. Both states explicitly shield mental health professionals from discipline, licensure threats, or civil/criminal action when providing such care in accordance with state law, even if other states attempt to intervene. However, while Massachusetts gives providers the right to actively countersue and quash out-of-state subpoenas, Colorado emphasizes broader system-wide protections—barring courts, agencies, and law enforcement from cooperating with out-of-state investigations altogether. In both cases, mental health professionals are recognized as essential to gender-affirming care and are legally empowered to continue that work without fear.

Similar laws exist in what are commonly known as “Sanctuary States,” including California, Connecticut, Illinois, Michigan, Minnesota, New Jersey, New Mexico, New York, Vermont, and Washington. 

In contrast, many other states impose restrictions on gender-affirming care for minors. Some also limit access for adults by prohibiting the use of state Medicaid funds to cover gender-affirming care, which disproportionately affects low-income transgender adults who rely on Medicaid for their healthcare needs. Additionally, a number of states have enacted more severe laws, including making it a felony to provide gender-affirming care to minors. One of these laws, enacted in Tennessee and Kentucky, was temporarily left in effect by the U.S. Court of Appeals for the Sixth Circuit (United States v. Skrmetti) while waiting to be heard by the U.S. Supreme Court during the 2025 session.

With the flurry of executive orders being issued from the current administration, it is important for providers to keep up to date with where their local laws stand. The Massachusetts Attorney General's Office issued guidance affirming that gender-affirming care remains legal and protected in Massachusetts despite recent federal actions, including a January 2025 Executive Order and a February 2025 federal guidance rollback. State law continues to protect access to gender-affirming care, bar discrimination, and ensure Medicaid and insurance coverage. Similarly, the Colorado Attorney General issued a statement protecting access to gender-affirming care.  It is important to seek legal support if you run into a situation that you are unsure of, as each situation is unique and requires special consideration of the facts and circumstances involved. 

All this makes for a complex, sensitive, and fraught environment for mental health professionals and organizations involved in gender-affirming care. Lawyers for Therapists hears your concerns and stands ready to support you through legal representation, advice, or simply an explanation. We will continue to follow up on those issues and provide updates as they come. Do not hesitate to reach out to us.