On April 11, trans people, especially in Arizona, were hit with yet another shock in the ongoing barrage of attacks on basic human rights. That morning, Planned Parenthood Arizona declared that they were “pausing Gender Affirming Care services” due to a letter sent to Medicaid agencies from the Centers for Medicare and Medicaid Services.

The letter in question invoked no new law, regulation or court ruling. or court ruling. Indeed, while full of the combination of outright lies and propaganda we’ve come to expect from openly transphobic governments, it only referred to trans care for youth. It was the conscious choice of Planned Parenthood Arizona to go above and beyond, cutting off care across the board, to adults as well.

Grimly, as trans policy analyst Corinne Green pointed out on Bluesky, the yellow notice denying care was posted over the regular website’s promise of “Care. No matter what.” Except, apparently, when it might make someone in power mad.

The existential threat of having one’s medical care suddenly denied is one that many trans people have faced for decades, pushed with particular aggression by Republican administrations but, far too often, enabled by Democrats in power as well.

Cis people often fail to appreciate the stakes of such bans, due to the sadly widespread (and bigoted) perception that our care is merely cosmetic or about “validation.” In fact, trans care is literally lifesaving, and its denial no less deadly than denying insulin to a person with diabetes.. The effects of denial range from massively increased suicide risk from the pain of watching our bodies detransition, to our bones literally crumbling due to abrupt menopause.

In short, ending trans healthcare on a large scale is a recipe for mass death, and the clear intention is to push society towards our genocide. That is the point of it.

Indeed it fits, on multiple fronts, the definitions of genocide used by the Lemkin Institute, founded by Raphael Lemkin, the Polish Jewish lawyer who developed the term. One of their ten patterns of genocide, “genocide by attrition,” specifically involves the following:

“Medical care is substandard or non-existent, life-saving medications are in short supply or absent, and medical facilities, as well as schools and other institutions important to collective health are closed or intentionally destroyed.”

Indeed on March 13 of this year, the Lemkin Institute issued a Red Flag alert for anti-trans genocide in the US. due to increasingly genocidal rhetoric from president Donald Trump, and others in the government, directed against trans people.

“The Lemkin Institute for Genocide Prevention and Human Security condemns the anti-trans agenda of the second Trump Administration and warns Americans that the recent spate of executive orders, which are in line with a genocidal process against the transgender community that has been emerging in the United States for over a decade, are meant to pave the way for greater state repression against all individuals and other groups in the future.”

While genocide is often thought of as directed towards national, religious or racial groups, the institute pointedly notes that it is a broader threat than that, “genocide can be and has been committed against political, social, economic, sexual identity and gender groups.”

This should not be surprising, as trans genocide was a key component of the Nazi atrocities that played a major role in Lemkin developing the framework.

The intended impact of cutting off our healthcare is annihilation. While that hasn’t rolled out across the country yet, Planned Parenthood Arizona’s rush to comply demonstrates the threat certainly is looming closer and closer.

As we’ll get to later, the Planned Parenthood branch reversed itself within 48 hours due to rapidly growing public pressure, but this is just one of many escalating attacks on this front. Banning federal support for trans healthcare may well end up what the next government shutdown fight (and Democratic capitulation) revolves around. This is what conservatives at the highest levels of power are trying to incite.

While the recent escalations are a threat to our very existence, we have also been here before. The attempted denial of essential healthcare with the intention of wiping out queer and trans people have a long history, especially in the U.S.

Properly, the AIDS crisis of the ’80s and ’90s is more accurately viewed as the AIDS genocides, something we’re reminded of as USAID cuts to basic care once again murders people. Pointedly letting a deadly disease devastate an entire group those in power view as subhuman is exactly that.

The sheer toll on queer communities from those atrocities is so immense it’s hard to fathom. We see it in photos of the handful of survivors from a gay chorus and the fact that psychologists had to develop new terms and practices to treat survivors because the scale of the loss was similar to wartime and ethnic cleansing.

The hysteria of that era also mirrors attacks on trans healthcare today. In an infamous 1986 New York Times column, respectable establishment conservative writer William F. Buckley called the disease “the special curse of the homosexual” and asserted people with HIV should be sterilized and forcibly tattooed “on the buttocks.”

In 1981 the Reagan administration banned transgender healthcare coverage from Medicare and Medicaid, prompting many private insurers to follow suit. Notably, this was the product of conservative collaboration with a rabidly transphobic set of “feminists.” Janice Raymond, whose 1979 hate screed The Transsexual Empire directly called for trans people to be “morally mandated out of existence,” played a key role, with her work extensively cited by the government as justification for the denial.

The result was the shuttering of clinics and health programs that had supported trans people, especially poor and working class ones. We may never know the full scale of the death and devastation this caused, but it’s telling that when cis people hyperventilate over the sudden rise in the number of out trans people it follows a time of far, far more of us dying in the shadows. That, too, is part of genocide.

In both the AIDS genocides and the de facto barring of trans healthcare, even the liberals and Democrats that didn’t directly collaborate in these efforts often remained silent. There is a reason ACT UP’s most famous slogan was “Silence=Death.” The federal prohibitions on trans healthcare were largely maintained throughout subsequent Democratic administrations. They weren’t loosened until 2014 and didn’t fully end until 2016.

Genocide does not just require death squads and demagogues so often in the spotlight, but the legions of collaborators behind them who, for apathy or cowardice or their own gain, are happy to let the atrocities advance.

Here too, history repeats itself. In the face of escalating attacks on trans people, many Democrats are staying quiet or even taking part in the genocidal fervor. Despite the evidence overwhelmingly showing that turning on trans rights is more likely to lose them elections, plenty are using the results of 2024 as a long-awaited excuse to throw trans people overboard as fast as possible.

The New York Times has pushed a full-on moral panic meant to destroy trans healthcare, whitewashing anti-trans bigots and publishing open hatred against our communities under the guise of “just asking questions.” Republican legislators have cited these articles to excuse draconian anti-trans legislation, especially healthcare bans. The publication’s attacks on trans people are so blatant The Onion even satirized them.

California Gov. Gavin Newsom has fully embraced transphobia, despite it leading to plummeting approval ratings and poll numbers, by bringing far-right figures on his new podcast and agreeing with them on the need for sports bans, the denial of healthcare, and the abuse of trans prisoners.

Other Democrats have been less blatant, but no less devastating, grousing about basic trans rights as being “far-left” and quipping anonymously that the attacks on our very existence are a “distraction” that isn’t worth expending effort to fight. Even the first transgender member of Congress, Delaware Rep. Sarah McBride, has embraced this rhetoric, offering only tepid defenses of the very lives of her community.

As a trans friend of mine who survived the AIDS genocides once warned, “never forget conservatives want to kill you and liberals want you to die quietly.”

If Planned Parenthood Arizona were alone among healthcare providers their haste to abandon the trans patients in their care would still be a worrying sign. But the days after Trump’s inauguration saw a wave of hospitals cut off trans youth care based on little more than the bluster of executive orders.

Keep in mind, there is no national ban on trans healthcare for any age group, and Trump’s executive order banning care for those under 19 remains blocked by a nationwide preliminary injunction. The statewide bans that do often target youth are bad enough, but are still being fought in court. The threat of a new HHS rule ending ACA coverage still remains just that. But even in “blue” states with specific laws protecting trans care, hospital after hospital folded.

In February three sexual abuse non-profits — RAINN, NSVRC and NCMEC — erased nearly all mentions of trans and non-binary people on their websites, throwing our communities under the bus in a craven attempt to keep federal funding. It didn’t work–RAINN lost a $700,000 grant this year despite their fascist collaboration.1

Too often coverage of these betrayals — and that is what they are — will parrot their excuses that they were “forced” when no police showed up at their doors and no doctor spent the night in jail.

Even nonprofits who supposedly defend trans communities have repeated the lie of this false dilemma. Alex Sheldon, executive director at the GLMA (an association of LGBTQ+ health professionals), recently claimed to QueerNews “that the executive order forced providers to make an extremely hard choice” between trans patients and “keeping their doors open.”

But some organizations have shown there is a third path, and have at least sued instead of rushing to obey a transphobic regime. So the executive order did, in fact, do no such thing.

We must refuse to indulge these excuses, especially from the same “Gay Inc” gentry whose catastrophic incompetence in the face of our enemies got us here. Folding at the first hint of trouble isn’t being coerced, it’s just being a coward.

Fortunately, both history and current experience show that there are other alternatives.

The mass demonstrations outside hospitals that denied trans care earlier this year led many to reverse course, from metropolises like New York, Los Angeles and Chicago, to smaller cities like Norfolk, Va and even “red state” cities like Phoenix, Ariz.

Trans survival has long demanded everything from mutual aid and DIY HRT to mass protests and outright riots. We will need all of those old tactics, and new ones, to defend our communities through these times.

Queer and trans people must return to the tactics used, from the Stonewall era on, to take the fight to anti-queer and anti-trans media. Most of the pressure for the destruction of our healthcare comes not from the broader public, but from a rabidly bigoted section of the elite — including tech oligarchs, media barons, Christian nationalist gentry, TERFs, and the political establishment — who have collaborated across borders and oceans to push relentless lies and hysteria to the fevered pitch of a genocidal fervor.

As the history of genocides has made clear, media are not exempt from their culpability in furthering it. Julius Streicher also swung at Nuremberg.

Fortunately, pressure and widespread outrage against Planned Parenthood Arizona led to the quick resumption of lifesaving care. This victory should be taken as a reminder that when we fight back, we can win.

While the path of resistance has its risks, healthcare providers and other institutions have far more resources to fight back than the individual trans people who face risks far more grave than any nonprofit CEO. They just need to muster a fraction of the courage we do every time we walk down the street. We should make sure they have no other option.

David Forbes (she/they) is a trans journalist and writer with over 20 years experience delving into history, politics and injustices at multiple levels of government. They are the editor of the Asheville Blade. She lives in Asheville, where she drinks too much tea and schemes for anarchy.

–Edited by Mady Castigan