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Physicians in the Veterans Affairs medical system are quietly resisting policies that harm their transgender patients.
“We’re building the underground as fast as we can,” one Veterans Affairs medical center doctor told The Advocate.
In whispered hallway conversations and encrypted texts, and with rainbow pins discreetly clipped to lanyards, an underground resistance is taking shape within the U.S. Department of Veterans Affairs. After the Trump administration stopped providing gender-affirming care for transgender veterans in March, some physicians within the VA system around the country are risking their careers — and safety — to defy the rollback quietly, chart by chart, patient by patient.
The underground resistance to the department's anti-trans policies was described to The Advocate in interviews with three different VA doctors and one transgender patient, who all spokeon the condition of anonymity. The doctors fear retaliation from supervisors and the Trump administration; the trans patient fears harassment.
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“This is Lavender Scare 2.0,” said a senior VA doctor. “We’re being surveilled. We’re told to report each other for using the word ‘transgender.’ But we’re resisting — strategically, quietly — because our patients’ lives are on the line.”
VA press secretary Peter Kasperowicz did not respond to The Advocate’s request for comment.
Related: Veterans Affairs clinicians sign letter against Trump's ban on trans vets' care: ‘There is resistance’
President Donald Trump’s return to power has brought the end of nearly every trans-inclusive health policy enacted during the Biden administration. In March, VA Secretary Doug Collins rescinded federal coverage for transition-related hormones, voice therapy, and electrolysis for patients not already receiving the care. He rolled back dignity protections, which allowed trans vets to use gendered facilities that correspond to their gender identity. He also imposed exhaustive restrictions on what providers are allowed to do for their patients — even in private notes — and withdrew agency support for Pride celebrations.
“I mean no disrespect to anyone,” Collins said in a press release that one veteran rolled their eyes at, “but VA should not be focused on helping veterans attempt to change their sex.”
After this story was published, Veterans Affairs spokesperson Macaulay Porter responded by email, defending the policy changes. “VA is phasing out treatment for gender dysphoria. Frankly, this commonsense reform should have been made years ago, but only President Trump and VA Secretary Doug Collins had the courage to do it,” she wrote.
She also claimed that “VA has received almost no criticism in response to this decision – proof that the vast majority of Veterans and Americans support it.”
But just days earlier, a transgender Army veteran filed a federal lawsuit over that very policy, arguing the VA’s decision to cancel her hormone therapy is discriminatory and unlawful, Military Timesreports. The case, brought by Yale Law School’s Veterans Legal Services Clinic, seeks an emergency injunction to restore care to veterans.
The petitioner, whose name has not been released, served two years on active duty and nine years in the Army National Guard. She transferred to VA care with the understanding that her hormone therapy — vital to her physical and mental health — would continue uninterrupted. Now, attorneys warn, she is at risk of running out of medication this summer.
Filed in the U.S. Court of Appeals for Veterans Claims, the suit challenges the legal foundation of the Trump administration’s rollback and calls for a return to policies in place before March, when gender-affirming care was standard VA practice.
Related: We are Veterans Affairs clinicians. Our leadership is failing veterans
A transgender Army veteran who served five years on active duty said the VA’s framing of the debate around providing care to some veterans for their conditions and not others weaponizes misunderstanding.
“They clearly have no idea how a veteran lives or operates,” she told The Advocate. “One vet doesn’t want to take care away from another vet. We are people who were willing to die for others. Why the hell would they think we’d want to take care away from each other?”
She added, “I’ve never met a veteran who thought another veteran didn’t deserve care. Cis guys at the VA tell me, ‘I don’t care what you do — I just want my back surgery.’ Most vets don’t hate us. They just want their own care.”
In her case, access to gender-affirming care wasn’t just lifesaving — it was historic. She was among the first in the VA system to get voice therapy and one of the few patients to get [surgical care. She said in addition to fighting for her care, she joined forces with others who fought “so a trans woman in Idaho could get the same care as one in New York. And we were so close.”
Inside VA facilities, doctors say the new rules have chilled not only clinical care but workplace trust.
Related: Trump administration announces end to gender-affirming care for transgender veterans
“It’s a crushing blow, but a familiar one,” said a second doctor in VA medical center leadership. “[The Trump policy] violates both the Hippocratic Oath and my oath as a federal employee to defend the Constitution. I’ve fought for patients with HIV, addiction, and needing abortions—and this feels exactly the same. Politics interfering with evidence-based, humanistic medicine.”
That doctor described the current climate as “McCarthyistic,” with staff self-censoring out of fear of being reported.
“There’s a hotline to the White House and another to the Inspector General,” they said. “You can be investigated for wearing a rainbow pin or displaying a Pride flag. We’ve had to train ourselves to speak in code again.”
Related: Transgender vets deserve access to gender-affirming care, Veterans Affairs providers say (exclusive)
A third VA provider, also being kept anonymous to protect them from adverse employment actions by the federal government, told The Advocate they had made the conscious decision to resist as visibly as possible.
“I go to work dressed like I’m going to Pride,” the physician said. “Rainbow earrings, trans flag pins, my badge lanyard is basically a beacon. And I do that because I can — and because my patients need to see someone who is still here for them.”
The doctor said they’ve seen other queer and trans colleagues “disappear themselves from the system,” scrubbing pronouns from email signatures or avoiding hallway conversations out of fear. “It’s exhausting,” they said. “Being queer in the world is exhausting enough. Being queer in the VA right now feels like carrying a torch in a storm. But someone has to do it.”
Despite the risk, all three physicians described a rapidly growing but carefully hidden network of VA staff committed to ensuring that trans veterans still receive care, often through unofficial channels, coded referrals, or creative documentation workarounds.
Some doctors are finding ways to subvert the restrictions quietly. One doctor in a leadership role described helping trans veterans access care through “back channels” and “personal connections,” including community providers and informal care networks. “We’re building the underground as fast as we can,” they said. That includes continuing to write surgical referral letters, directing veterans to LGBTQ-affirming free clinics, and slipping prescriptions through while they still can. “If I get fired, I can’t help anyone. So I stay. I resist," the doctor said. "I try to keep the door open.”
Related: VA psychologist resigns over worry about Trump’s ‘unethical’ orders restricting care for trans vets
In May, The Advocatepublished an open letter from 116 VA clinicians across 21 states and Washington, D.C., declaring the Trump administration’s orders “unethical” and “a betrayal of our veterans.” The letter cited mass firings, anti-trans surveillance, and censorship directives banning staff from using terms like “LGBTQ+” or “gender” in official materials. “It happened in small steps, as oppression often does,” the signatories wrote. “Staff pronouns were eliminated from bios. Education resources were axed. Pride flags were stripped from clinics.”
The authors warned that transgender veterans now live in fear, not just of losing health care but of losing disability benefits, housing access, and the trust they once placed in the agency charged with honoring their service.
Related: Trump's VA rescinds policy treating transgender vets with dignity (exclusive)
“To our Veterans,” the letter read, “please know that we vehemently oppose these orders and that even in this darkness, there is resistance.”
The Army veteran who once fought to expand VA care said she sees that resistance — and it gives her hope. “They erased us. Again. But I know who’s still fighting. And they know I’ll never stop," she said.
Though she remains technically enrolled in VA care, the veteran no longer sets foot in the facilities. “If I have to go to the VA, it’s a hellish day,” she told The Advocate. “You’ll see so much pro-Trump signage everywhere.” For now, she continues accessing care remotely, but that care is increasingly fragile.
Because her body does not generate estrogen or testosterone, if her hormone therapy is cut off, she said, “I will die.” Her future is uncertain. She’s begun researching clinics outside the VA system and has considered what steps she might take to ensure access to hormones and follow-up care. “As long as this country is as deep in fascism as it is, I don’t see [trans people] getting the care we need,” she said.
Editor’s note: This story has been updated to include a statement from Veterans Affairs Department spokesperson Macaulay Porter.
