‘It’s a Nightmare’: The Human Toll of the Catholic Church’s Trans Healthcare Ban

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Some names and details in this story have been changed to protect sources from retaliation for speaking about their experiences

Last year Beth, a trans woman in the Midwest, wanted better healthcare.

While she lives in a state with a notable number of anti-trans laws, she’s within driving distance to a bordering, relatively safer one. Basic trans medical care is more accessible there, through Planned Parenthood. So she'd schedule appointments well in advance, drive an hour — sometimes much more, if traffic was bad — each way to get HRT and have her hormone levels checked.

“If traffic flares up, I have to schedule these around rush hour or it's going to take half the day,” she told Trans News Network.

But Beth thought she'd finally found a solution, a welcoming clinic closer to home. She knew other trans people who'd received healthcare there. The initial doctor's consultation, last fall, was promising.

“Everything was fine, it was going well,” Beth said. “She was more than willing to work with me and more than happy to, she'd been extremely supportive and always used my correct pronouns and everything.”

As a working class trans woman who — like so many in our communities — struggles with poverty, it seemed a welcome change.

But then, on Nov. 12, the U.S. Conference of Catholic Bishops overwhelmingly passed a total ban on trans care throughout all of its healthcare network.

This was, and remains, the most extensive and draconian trans healthcare ban in the U.S., and one that has gotten far too little attention for how much damage it's done. The bishops' ban includes not just hospitals but many clinics and doctor's practices as well. It bans hormones and surgeries, for adults as well as trans youth. While individual Catholics have a wide range of beliefs, the church hierarchy itself is incredibly reactionary, abusive and a longtime enemy of trans people's very existence.

While the church had never been friendly to trans healthcare, the ban eliminated grey areas that more pro-trans Catholics and others working in their networks had previously used to provide healthcare anyway.

This also didn't just impact a few charity hospitals. The church's network is massive, and in recent decades has grown constantly, including by taking over existing, previously secular practices. This means that even trans people who currently get their care elsewhere may fall under the ban as the church's healthcare holdings continue to aggressively expand.

In some states, a third to nearly half of all healthcare beds are run by it, even in places like Oregon and Washington that — on paper — have protections for trans healthcare access.

It includes not just hospitals but also a multitude of clinics and doctors' practices, including plenty that aren't obviously religious.

Like the one Beth went to.

When she went back for her first appointment in January, after the ban, suddenly everything had changed.

“They were very careful to avoid stating the exact reason. The way they phrased it was 'I thought we could, now it turns out we couldn't,'” she said. “They'd had trans patients before. I got the feeling they were willing to help.”

The practice wasn't advertised as a Catholic Church-run one. During her initial appointment, she saw no signs of it, and “the staff clearly knew how to interact with a trans person.” But even if she'd wanted to find another clinic, for a working class trans person in her area that's nearly impossible, because “where I live, there's exactly one network that's not Catholic and that one network is not covered by a lot of insurances because they're more expensive.”

This is a problem around the country. A 2025 article from healthcare access advocacy org Community Catalyst on the “growing crisis” of the Catholic Church's healthcare networks notes their record of “acquiring more and more independent hospitals.”

“Despite their non-profit status and because of their Catholic directives, they're leaving devastating impacts on access, affordability and basic rights in their wake,” the piece noted.

As of that year, Community Catalyst found, Catholic systems comprised four in ten of the largest health networks in the entire country. Their “directives limit access to critical health care, often going against evidence-based medical standards and clinical guidelines,” especially when it comes to reproductive health and gender-affirming care.

A map from a 2020 Community Catalyst report showing the vast scale of Catholic Church-run healthcare networks. Trans healthcare is now totally banned in all of them

“There's this assumption sometimes of 'oh, just go to a different doctor or a different network,' that isn't how it works. It's still going to be a Catholic network under a different name,” Beth said. “The ones that aren't Catholic are expensive and often not covered by the insurance that you get when you're poor.”

“I'm on [an Affordable Care Act] marketplace plan because I'm poor and I'm self-employed. We don't have the benefit.”

So once again she has to take most of a day off of work, get in her car and head across the state border.

“It's at a point where I've had to consider just how important getting my hormone levels actually checked is,” Beth told TNN. “There's a variety of ways not to have to go in, but the problem with that is that your hormone levels being wrong is not good for you. So is it worth dealing with the risks of my hormones being imbalanced just to save this difficulty?”

The ban has, despite its sweeping impact, gone relatively unremarked on by media and establishment organizations, even those whose purpose is supposedly to protect trans rights. Indeed, progressive media and groups have recently effusively praised the Catholic Church for its mostly symbolic steps against the Trump administration.

Occupy Democrats recently touted Pope Leo XIV as a hero for criticizing the warmongering of Secretary of Defense Pete Hegseth. After the pope made a vaguely positive comment about the right to universal healthcare — something the church he heads has never practiced in the systems under its control — A More Perfect Union and Rep. Pramila Jayapal both praised his stance. Trans care, as it far too often is, was completely ignored.

That erasure, however, does not make the bishops' ban or the damage it's done to trans lives any less real.

“Getting appointments is much harder, even across the border,” Beth emphasized. “I literally have to travel to another state for my healthcare. Sometimes it hits me just how wild that is.”

Over the past four months, since our initial in-depth look at the threat posed by the bishops' ban, TNN has interviewed trans people around the country, like Beth, impacted by the church's attack on life-saving healthcare.

These are some of those stories.

'If we don't do it, it won't happen'

Last Fall, just before the bishops' ban, pharmacy student Blaine Foster began a 12-week rotation at a Catholic hospital in the Rockies.

Foster, who's trans and had grappled with religious environments before, “was really surprised when I got there. I was prepared to spend 12 weeks putting up with whatever the quirks of being at a religious institution are.”

Instead “everyone there” was assertively pro-trans. “In October they were just randomly handing out pronoun pins in the cafeteria. It was an actively affirming culture.”

It also was a hub for getting trans people throughout a wide swath of mostly rural areas — a population far too often ignored — necessary surgeries.

“As pharmacy interns one of our jobs was that, for all surgeries that occurred in the hospital, we made sure that the list of the patients' medications were accurate,” they recalled. “Because of that I ended up, for 12 weeks straight, going over the roster of every single surgery that occurred in the OR. Due to myself being trans, I was interested to notice that almost every week there was a gender-affirming top surgery.”

“For hysterectomies it doesn't really list whether it's for gender-affirming reasons. But I have a friend who had their gender-affirming hysterectomy with a certain doctor who did a lot of hysterectomies at that hospital.”

What Foster encountered is a good example of the reality for trans healthcare in church-run hospitals before the bishops' ban. The church hierarchy was always hostile to trans care. Indeed, that 2025 Community Catalyst report, published several months before the bishops' ban, noted the cases of two trans men whose hysterectomies were suddenly canceled due to the church's theocratic dictates.

One of those, Oliver Knight, had his 2017 surgery halted just minutes before it was about to happen due to an “ethical assessment” by a priest with no medical training. He sued the church-run St. Joseph Hospital in Eureka, California in 2019. While California is a “blue state” that supposedly guarantees access to trans healthcare, the Catholic hospital was the only one in Knight's area, and blatantly ignored the law.

But alongside those horrific cases, before the bishop's ban there were also grey areas and loopholes that pro-trans medical professionals working in parts of the Catholic healthcare network used to secure care anyway.

“A patient told me that [the hospital] would do top surgeries if it's covered by insurance as like a medically necessary procedure,” Foster said. “Any surgery she does that's not covered by insurance and is considered 'cosmetic' [the surgeon] has to do it at the other hospital in town, which is secular.”

“In a way rural Catholic hospitals might have been more willing to work within those grey areas,” they noted. “It creates a different selection if you're a Catholic hospital in Los Angeles, where there's dozens of hospitals in the region. Not only are the people who apply to you more likely to be more Catholic and conservative, but I think there's more of a sense of 'if we don't give this care patients have other options.'”

“Whereas when there's two hospitals in town and the next town is several hours away, there's more pressure that if we don't do it, it won't happen for people.”

So the bishops' ban made an already bad situation even worse.

Rural healthcare, especially for trans people, is already faltering, hit by for-profit chains gutting services and federal cuts to healthcare programs as well as the kind of fundamentalist dogma represented by measures like the bishops' ban.

“A couple weeks before the bishops' ban, the secular hospital in town cut back the number of OR hours they were offering to the surgeon who does the top surgeries,” they said. “That was the only hospital [the surgeon] could do any surgeries ruled 'cosmetic' [by insurance], so now she has to triage which of her trans patients to prioritize for OR time.”

By the time the church imposed its ban, Foster had completed their stint at the hospital, but faced a personal risk: they were already scheduled to get top surgery there. While the surgery was arranged before the ban, it was scheduled to take place afterwards.

“I have to assume it affected that hospital very quickly, because the doctor kept me on the OR schedule, and I can only assume it was because there was a threat to OR time at that hospital. She was really pushing to keep it locked in.”

Fortunately, thanks to that doctor's determination they received the surgery, but note that others will not be so fortunate with the loss of a key hub for trans care in a rural area.

Foster sees the ban as threatening queer and trans employees at those healthcare networks as well.

“I feel like a lot of the issue in rural spaces is that not only are Catholic hospitals some of the only places to provide care, they're some of the only places to work,” they told TNN. “In a lot of small rural towns, if there's a hospital in town it's a major employer. The hospital has queer employees as well. That is also so difficult.”

“When I was on rotation I thought about working there. Now I would feel less comfortable saying that. So it becomes a problem in terms of culture and morale. In general rural hospitals are facing a revenue and recruitment crisis due to cuts to Medicare and Medicaid, So many rural hospitals are already at threat of going under. This is another loss of potential people to employ. It's going to put more strain on these rural hospital systems.”

'Is this medication for gender-affirming care?'

Alison, a trans person living in the Midwest, isn't Catholic. Neither is their employer. Or their doctor. They don't get their healthcare at a clinic or practice run by the church or part of its network in any way, shape or form.

But last year they were still denied testosterone due to the church's hatred of trans people combining neatly with that evil so many Americans face: health insurance bureaucracy.

“I was switching my type of testosterone and sent in the script to a pharmacy I hadn't used in a few years,” Alison told TNN. “They went ahead and ran my insurance, they were just trying to be helpful.”

This was in mid-November last year, just after the bishops' ban took effect. The insurance, with Optum Rx, was shared with their spouse, who “got a call saying their pre-authorization had been denied for me.”

Like Beth trying to get a clear answer out of her doctor, Alison encountered evasive responses, in their case as they tried to navigate the labyrinth of appealing their insurer's denials.

“I called back and talked to three different people through my pharmacy benefit,” they told TNN. “They said the reason it was denied was that they'd asked my doctor for a pre-authorization and my doctor was given a survey. And the two relevant questions that [the insurance company representative] told me were, one, the reason for this medication, and she put 'other' and then the second question was 'is this medication for gender-affirming care?' and my doctor put 'yes.' It was sort of left up to me to conclude that this is why it was denied.”

It's worth emphasizing, again, that in this case it wasn't due to a Catholic network being the only one they could access: Alison gets their healthcare through a doctor and clinic that have no connections with the Catholic Church whatsoever.

“My doctor is part of a network that is secular, they are not Catholic at all. But my insurance is through my spouse's employer.”

And that employer is part of one of the church's many expanding healthcare networks.

“It's a totally different network than what serves me. My providers are not part of that network at all.”

It was still enough to get their medication denied, even though it was a secular doctor sending the prescription to a secular pharmacy, “that's what was kind of surprising to me.”

“I sought to clarify [and asked] 'so this is a covered medication for some medical conditions, just not this one?' and the person on the other end of the line said 'yes.'”

Their doctor helped them file an appeal with the insurer. Over the ensuing two months they tried to get a firm answer in writing, wending through Optum's bureaucracy.

By December they already had “three different letters” from the insurer, referencing two different appeals.

They shared these with TNN, and the letters are notable for their tangled evasiveness. In one case a letter notes simply that their prescription is “excluded” and that “this denial is therefore appropriate and consistent with your benefits” before asserting that “this denial is based on the following clinical guidelines.” The section below that would list those guidelines is completely blank.

In January, they got confirmation that the denial was, indeed, because they were trans. A final denial from Optum in January referenced the company's “prior authorization guidelines” and attached a copy.

The document notes “gender transition, gender dysphoria” as “non-approvable diagnoses.” It then proceeds to spend nine pages noting in detail several conditions for which testosterone can be prescribed — to cis men. It's dated Jan. 1, 2025, though it's not clear if some sections were modified since then.

Secular insurers, of course, aren't immune to similar bigotry. Alison emphasized that a corporate insurance company they'd grappled with in the early 2020s hadn't denied their HRT outright but had set nigh-impossible obstacles for accessing it. But the bishops' ban is far stricter and farther-reaching.

“So it's something I've already kind of struggled with, even without the Catholic order,” Alison said. “People are already having issues, and then with things happening with youth care are so terrible. Adults are being affected as well as young people. They keep trying to find more ways to take healthcare away from us.”

For the time being they are, fortunately, able to afford their testosterone by paying out of pocket, but the experience was a stark reminder of how far the control of the church's networks reaches, and how much of a threat it is to trans healthcare.

“It's basically just really depressing and demoralizing,” they told TNN. “I can get a vial for around $80 out of pocket and that lasts me for several months, and that's affordable for me. It's just emotional. It feels very invalidating, it feels like a slap in the face.”

They also fear the kind of impact this will have on trans people who struggle with more dire poverty.

“So many people are affected. So much of our healthcare in this country is through Catholic health systems and hospitals. It's just pretty devastating. It's just going to make things harder for so many people.”

It's time to fight the church

As is so often the case in any piece about trans healthcare, it is worth emphasizing that these medications and procedures are literally life-saving. In addition to the extreme effects of dysphoria, their sudden denial can cause massive health issues, and even prove fatal.

“It also just is increasingly seeming like I have to think about [HRT] the way I have to think about contraband, just to try to get medicine,” Beth told TNN. “I hear about what's going on in Kansas, and I wonder when it's my turn too. I'm going through all these hoops and it's the same underlying problem.”

She believes that despite the increasing restrictions, trans communities will go to great lengths to find what they need to survive and aid each other, as they have in other periods of intense repression.

“The thing I keep thinking about is that there was a very long period where this stuff wasn't accessible and we still managed to make it work,” she said. “I feel like there's going to be a lot of us here in these more dangerous areas needing to try and get back to our roots as trans people, the things we take for granted: access to hormones and all that.”

“But we're going to start that work. If you can help one of us, please do. We need it.”

Despite media, including some trans media, portraying trans people as affluent residents in a handful of metropolises, the realities of Beth, Alison and Blaine Foster's stories are far more common. Trans people are an overwhelmingly working class demographic. Plenty of us live in rural areas and smaller cities. Indeed, repeated studies over the past decades have found that the largest populations of queer and trans people are in the South. The Midwest is nearly tied with the West for second. That is almost certainly an undercount.

“The popular conception of the trans girl as a fairly well-off programmer is a myth, because those are the ones that are able to get noticed,” Beth told TNN. “No shade to those people, I know some who are doing good work to support others in the community. But it does mean it's easy to overlook that we're mostly working class, often self-employed or unemployed, mostly working in fields where we're serving the public.”

The bishops' ban has a particularly devastating impact, so, she said, “it's frustrating that no one's talking about it.”

Since the 2000s mainline LGBTQ+ organizations — “Gay Inc” in common cultural parlance — increasingly turned away from countering conservative religious organizations in favor of lobbying within the electoral and legislative systems, assuming that non-discrimination laws (like the ones now being blatantly ignored) and increased assimilation would lead to acceptance. Even from religious conservatives. Some Gay Inc figures even praised anti-trans religious conservatives as essentially good people.

This was, of course, a catastrophic failure. That it was an approach concocted by gentry often removed from the realities faced by many in our communities — where fundamentalist violence against us never stopped being a threat — is telling.

The Catholic Church, as well as evangelical Protestant groups, began steadily advancing their attacks on trans rights once it was clear their efforts to stop equal marriage had stalled. Far too often, they went unchallenged by organizations whose supposed purpose was to defend our rights, but who wanted to not upset elites by criticizing religious institutions.

In December 2013 The Advocate named Pope Francis its person of the year. Meanwhile, his papacy further advanced attacks on our existence, and U.S. bishops — as TNN reported in our first article on the ban last year — invoked his anti-trans stances when overwhelmingly supporting the largest attack on our healthcare yet.

As we noted in our December article on the bishops' ban, things weren't always this way. Criticism of, organizing against and mockery of the theocracies opposed to our existence used to be incredibly common in queer and trans movements. A key point in fighting the AIDS genocides was when the militant queer group ACT-UP disrupted services at St. Patrick's Cathedral in New York in 1989 as part of its Stop the Church actions. While they were widely condemned by the establishment at the time, they did it anyway, and their tactics worked.

The lesson is clear: when bigoted religious institutions are actively countered and condemned as a source of oppression, our liberation advances and lives are saved. When they are not, when they are left to gather their power, things get a lot more dangerous for us all, very quickly.

Anticlericalism needs to once again take its place as an indispensable part of the struggle for queer and trans liberation. A society where theocratic fiefs hold direct power over the survival of millions is never going to be a place where our communities are safe.

While it likes to pretend otherwise, ACT-UP's example is a reminder that even institutions like the Catholic Church aren't immune to disruption and public pressure. So get angry and, please, stop praising the damn papacy. Religious figures are not special. Their bigotry is not less repulsive because it's wrapped up in liturgy and ceremony.

“The issue isn't about Catholic people, many of whom disagree with these restrictive policies,” the 2025 report from Community Catalyst, one of the few organizations who has openly criticized the damage done by the church's healthcare networks, declared. “It's about holding large healthcare systems accountable to their non-profit mission, and ensuring healthcare serves everyone, not just some of us.”

That is absolutely true. A notable part of this investigation over the past few months was encountering stories like Foster's, where pro-trans Catholics and others in church-run networks worked around the hierarchy to get badly needed care to those in our communities.

But more, especially now, is needed. If you are Catholic and find the stories above appalling, you have a duty to speak up and act against the oppressions inflicted by the church hierarchy acting in your name. The example of the doctor who kept Foster on the surgery schedule even after the bishops’ ban is the bare minimum.

We are not the only ones facing this evil, of course. Reproductive care for cis and trans people alike has also been extensively targeted by the church. The Community Catalyst report noted that Ascension, one of the largest Catholic hospital systems, disproportionately shut down maternity care in communities of color and those facing poverty. If the bishops' ban on trans care is not stopped, it is likely the church will once again escalate to prior homophobic practices it only backed away from, reluctantly, under significant attack.

Rather than a cause for despair, that should be grounds for solidarity and organizing against a common enemy: an institution that does not respect our rights to our very lives.

Some of that organizing should also be directed against the Gay Inc organizations who, even at this late hour, prefer their significant resources to go to extravagant salaries and perks for their higher-ups rather than fighting a de facto ban on trans healthcare throughout a significant part of the country.

Refusing to confront the bishops' ban is an act of cowardice and collaboration with trans genocide. Queer and trans communities should treat it accordingly.

I am old enough to remember when trans healthcare was even harder to access than it is now, when existing as trans in public was de facto illegal in many places. I do not believe that returning to that is inevitable. Damaging as it is, the bishops’ ban is also a pathetic attempt by a decaying institution to stop a growing tide of trans joy and power.

But the human cost, and the threat of it, are also real. The only way out is to fight like hell.

—Edited by Mira Lazine