Transgender Americans’ experiences of anticipated anti-trans legislation after the 2024 election

Background Anti-trans legislation has increased substantially in the United States, particularly policies targeting access to gender-affirming care (GAC). Although evidence links hostile policy environments to poorer mental health among transgender and gender-diverse (TGD) people, little qualitative research has examined how anticipated threats to GAC shape lived experiences during periods of political uncertainty.Aim We aimed to understand TGD American adults’ beliefs about their access to GAC between the 2024 general election and 2025 presidential inauguration.Methods Participants (N = 531), aged 18 or older and residing in the US, were recruited via social media to complete an anonymous survey. They were asked about their perceptions of access to GAC during the second Trump administration. Participants averaged 25·6 years and represented every US state. Data were analyzed using Braun and Clarke’s reflexive thematic analysis.Results Four themes were identified: (1) Atmosphere of Fear depicted chronic anticipatory anxiety about access to GAC; (2) Lifesaving/Life-Enriching Care, in which GAC was described as essential to survival, wellbeing, and authentic embodiment; (3) Weaponized In/Accessibility, highlighting concerns about legislative restrictions, insurance barriers, and healthcare access; and (4) I Could See Myself Happy, reflecting participants’ hopes for futures marked by gender euphoria despite political uncertainty. Anticipated legislative threats influenced healthcare decision-making before policy changes occurred, prompting participants to accelerate or delay transition-related care, consider relocation, or prepare alternative pathways to obtain hormones.Discussion Anticipated threats to GAC functioned as a chronic form of minority stress, shaping mental wellbeing, healthcare decisions, and future planning even before policies were enacted. These findings suggest that hostile political environments influence health through enacted legislation and through the uncertainty they create. Recognizing anticipatory political stress as a structural determinant of health has important clinical, research, and policy implications.