This post concludes a series on the law and political economy of trans healthcare. Read the rest of the posts here.
** ** **
Mainstream media and political debate often frame transgender healthcare bans as part of an isolated “culture war” affecting only a small sexual minority. As previous posts in this series have explained, this framing fails to account for the role that these bans play in the broader right-wing assault on access to healthcare, organized healthcare professionals, and the redistributive state. In this brief post, I situate these bans as a core component of another right-wing project: white nationalism.
Transgender Erasure and White Nationalism
Since 2023, a wave of transgender healthcare bans for minors has swept across conservative states. These bans—much like Trump’s recent executive orders that, among other things, restrict access to gender-affirming care, eliminate the concept of “gender identity” from public laws and records, bar transgender people from public spaces and activities such as restrooms and sports, and prohibit education about gender and sexuality in public schools—are part of a broader campaign of transgender erasure. The goal, as Project 2025 put in no uncertain terms, is to eliminate “gender ideology,” which “poisons our children.”
Yet “gender ideology” wasn’t alone in supposedly corrupting the youth. Project 2025 also aimed to purge racial equity initiatives (including “critical race theory”) from public education. In order to understand how these policies work in tandem, it is essential to view trans healthcare restrictions and other mechanisms of transgender erasure within the broader white nationalist project. Along with the administration’s attempt to dismantle DEI programs and its aggressive immigration policies—targeting birthright citizenship, attempting to increase deportations, and expanding border restrictions—transgender erasure is one tool among many to maintain and rebuild traditional hierarchies of race, gender, and nationality.
In stark contrast with traditional conservative principles of “small government” and “free markets,” trans healthcare bans impose governmental authority over healthcare decisions to enforce a rigid gender binary. By criminalizing certain medical practices, constraining provider and patient autonomy, and overriding parental decision-making, these laws substitute political determinations for professional medical consensus. The consequences are both discriminatory and economically disruptive: cisgender minors retain access to treatments denied to transgender peers (for example, breast augmentation), while legal liabilities force providers to shutter entire programs regardless of demand. The market distortions are profound and far-reaching. Political authorities supersede medical organizations as arbiters of legitimate care, rejecting evidence-based guidelines from professional associations. Geographic healthcare deserts emerge, requiring costly interstate and possibly international travel. Federal economic pressure threatens even protective state policies, as seen when hospitals nationwide canceled appointments following executive actions threatening to withhold federal funds. Insurance coverage restrictions further disadvantage targeted providers and patients, fundamentally altering the economic viability of transgender healthcare for minors.
Laws criminalizing transgender healthcare also share ideological and political foundations with abortion restrictions. Both emerge from a white nationalist, patriarchal, pronatalist framework that enforces a rigid male-female binary, traditional gender roles, and state control over reproduction. Moreover, in both cases, the speculative fear of future “regret” serves as a rhetorical tool in restricting access to care. These policies install the state as arbiter of a biologically deterministic order—privileging cisgender, reproductive heterosexuality and rendering intersex and transgender bodies either pathological or invisible. When legislators warn about “permanent sterility” from trans healthcare, they echo anti-abortion narratives about women regretting childlessness—revealing coordinated political and legal efforts to enforce the male-female binary and maternal roles as essential components of citizenship.
To achieve these ends, the current white nationalist regime has waged war on medical-scientific knowledge and research. A central rationale justifying trans healthcare bans is the notion of “social contagion.” Its proponents contend that the increase in youth seeking gender-affirming care stems not from better access to affirming environments, diagnostic clarity, or decades of research on gender and sexuality, but from ideological indoctrination and peer influence. “Gender” is not real. It is “junk-science.” Trans people do not exist. They are only a consequence of indoctrination. The anti-trans healthcare executive order invokes this logic directly, calling for investigation into “rapid onset gender dysphoria” and claiming that “activist physicians and therapists” are manipulating children into irreversible medical interventions. By dismissing professional medical experts and instead pathologizing transgender existence as “gender ideology” and “social contagion,” these bans and their proponents justify extreme interventions in healthcare markets, family autonomy, and public education.
These policies, along with those that prioritize aggressive measures on immigration, abolishing DEI initiatives, and erasing transgender existence, threaten the health, citizenship, employment, and mobility for the multitudes who do not fall within the tightening American hegemony of male white nationalism. Transgender erasure functions as a tactical component within a broader white nationalist effort to establish authority over the terms of social reproduction. Trans healthcare bans deprive families of necessary medical care and increase emotional distress and healthcare costs. At the same time, governmental attacks on DEI measures in public school and higher education, as well as in private and public sector employment, dismantle structures that have promoted greater gender and racial justice and inclusion. What emerges is a racialized and gendered restructuring of social, legal, and economic institutions.
Against Transgender Exceptionalism
A key obstacle to resisting transgender healthcare bans is “transgender exceptionalism”—the tendency to treat attacks on transgender existence as isolated assault on a small sexual minority. While conservative media and commentators relentlessly demonize transgender people, liberal media and commentators often relegate transgender rights to the margins—treated as a niche concern, overshadowed by economic or national security priorities. This exceptionalism also permeates legal strategies, where challenges to healthcare bans are frequently framed narrowly as issues of sex-based discrimination rather than as part of a systemic assault on civil rights and democratic institutions.
Yet, as with other targeted minorities in history, the persecution of transgender people—though numerically small—is central to today’s political and economic realignments. These attacks are not ancillary but entangled with broader efforts to reassert control over race, gender, and migration. By framing healthcare bans as efforts to “protect children from mutilation,” politicians and lawmakers construct medical markets that pathologize certain bodies while naturalizing others—reinscribing cisgender, reproductive normativity as the baseline for investment and care.
The stakes extend far beyond individual autonomy. These laws restructure who receives gender affirming care (only cisgender minors), who exists (if there are only two sexes, those who are born intersex are written out of existence), who wields authority (conservative politicians), and who counts as socially desirable (cisgender, reproductive heterosexuals). They do not operate in isolation but emerge alongside aggressive immigration restrictions, attacks on DEI programs, and reproductive control—each reinforcing the others. They are central to the economic, racial, and gender hierarchies that white nationalism seeks to restore—structuring who counts as economically productive, socially legitimate, and worthy of public investment. They should be resisted as such.
