The Role of Medical Training in Ensuring Gender-Affirming Care Access in 2025 and Beyond.

The evolving landscape of transgender healthcare in the United States has become more fraught with challenges following the 2024 presidential election and associated policy shifts, especially with the implementation of Executive Order 14168 (EO 14168). EO 14168 mandates a binary understanding of gender based on biological sex assigned at birth and imposes constraints on federal funding, academic freedom, and access to medical training related to gender-affirming care. Although the order is currently under legal challenge and its implementation remains uneven, it has already caused tangible disruptions in academic medical settings, with transgender clinics reporting increased patient anxiety, reduced visibility of LGBTQ +  content in federal resources, and institutional self-censorship of curricular content, even moreso in areas struggling with LGBTQ +  inclusion prior to EO 14168. Medical education, which has historically lacked comprehensive training on transgender health, is now at heightened risk of inadequate preparation for future physicians. Many medical schools continue to struggle with core curricula on gender-affirming care, leaving providers unprepared to meet the unique needs of transgender patients. This paper provides concrete examples of how EO 14168 has affected medical education and offers 5 evidence-based strategies, including as faculty development programs, protected simulation-based curricula, and institutional policy adaptations, to resist censorship and preserve high-quality, inclusive care training.