What RFK Jr. could mean for LGBTQ health care
Robert F. Kennedy, Jr. has expressed opposition to gender-affirming health care for transgender minors and questioned evidence linking HIV to AIDS, two issues that critics say should give senators second thoughts about confirming him as Health and Human Services secretary.
While Kennedy's vaccine skepticism has received more attention, his remarks on LGBTQ issues, including comments during a podcast last year that chemicals in drinking water could be making children gay or transgender, have also raised serious alarms.
“RFK Jr.'s history of denying basic scientific truth, from the cause of AIDS to the legitimacy of transgender health care, they represent a grave threat to the health and well-being of the LGBTQ+ community, and he is poised now for one of the most powerful and consequential positions in shaping the nation's health care and public health policies. In this context, disinformation isn't just harmful, it is deadly,” said Alex Sheldon, executive director of GLMA, an association of LGBTQ health care professionals.
Trump has said he plans to let Kennedy “go wild on health,” unnerving some LGBTQ health care providers and researchers, given Kennedy’s past statements and policy proposals.
In December, Kennedy told the conservative political commentator Patrick Bet-David that transgender minors should not be able to access medications like puberty blockers and hormones “without permission,” but fell short of opposing gender-affirming care altogether or endorsing federal restrictions.
By May, however, Kennedy’s position had become more conservative. He wrote on the social platform X that while individuals diagnosed with gender dysphoria “deserve compassion and respect,” he’d become “troubled” by the idea of giving puberty blockers to minors, labeling them as “repurposed castration drugs.” He also referred to transition-related surgery as “mutilation" and said such treatments should be postponed until adulthood.
Major professional medical organizations say gender-affirming health care for transgender adults and minors is medically necessary and can be lifesaving — several studies link puberty blockers and hormone replacement therapy to lower rates of suicidality in transgender adolescents.
Surgical procedures are not often recommended for trans youths under 18, according to the World Professional Association for Transgender Health, and the only form of gender-affirming care for children before puberty is social support, such as allowing a child to choose clothing, hairstyles or a name that more closely aligns with their gender identity.
“[Kennedy’s] comments on transgender health care, in a lot of ways, reflect a confusion that is very widespread right now among a lot of people in U.S. society who don’t know what it means to be transgender, and how deep and long-standing both the evidence and clinical practice on this topic are,” said Kellan Baker, executive director of Whitman-Walker Health, a Washington-based nonprofit focused on LGBTQ health care.
Kennedy’s skepticism of established medical and scientific consensus extends to areas outside LGBTQ health. He has a long record of promoting misleading claims about vaccines and recently called for water systems to remove fluoride from public drinking water, hailed as one of the greatest public health achievements of the 20th century.
“Having an individual with a clear ideological bent on health care is going to make everyone unhealthy,” said Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale School of Medicine. “The damage done by the metastasis of scientific disinformation will land most squarely on kids — kids who need vaccines, kids who need gender-affirming care.
“With the megaphone that he will have and the false legitimacy that this appointment would give him, I am deeply concerned that people will become even more steeped in misinformation, and even more swayed by the outlandish things that he says,” said McNamara, a co-founder of Yale Law School’s Integrity Project, which disseminates scientific and legal knowledge in support of LGBTQ youth.
Kennedy’s suspicion over whether HIV causes AIDS — he’s suggested the party drug poppers might be the real culprit — has also concerned public health experts. In his 2021 book “The Real Anthony Fauci,” Kennedy claimed that Fauci, who led the response against the HIV epidemic in the 1980s, had sabotaged effective treatments for AIDS.
“HIV prevention and care research has been incredibly important for our communities — it's kept millions of people alive around the world,” said Sean Cahill, director of health policy research at the Fenway Institute in Boston. But “there's still a lot of work to do in terms of HIV prevention and HIV treatment, and the idea that he's questioning whether HIV causes AIDS is very perplexing.”
Kennedy has also said he intends to shake up the National Institutes of Health, a division of HHS that includes the Office of AIDS Research, by firing 600 federal employees, a move that threatens to stymie medical advances in treating the disease. As head of HHS, Kennedy would also help oversee the President’s Plan for Emergency AIDS Relief (PEPFAR), a program first authorized in 2004 that provides HIV prevention and treatment in more than 50 countries.
Beyond Kennedy, physicians and public health experts said policies proposed by the president-elect and the incoming administration would drastically reshape the health care landscape for LGBTQ Americans, not necessarily for the better. The agenda on Trump’s website says he plans to reverse Biden-era policies and guidance supporting gender-affirming health care for transgender minors and sign an executive order instructing federal agencies to cease programs “that promote the concept of sex and gender transition at any age.”
The agenda also promises to declare that any hospital or clinician who provides gender-affirming care to minors would “no longer meet federal health and safety standards for Medicaid and Medicare — and will be terminated from the program immediately.” Cutting federal funding to hospitals, many of which rely on government money to remain operational, would disrupt health care for everyone, not just trans people, said McNamara, of Yale Medical School.
“It’s impossible to discriminate against a single group of people without hurting everyone else, and bans, restrictions and threats that target evidence-based health care will show us that over time,” she said.
It is expected that Kennedy, a close Trump ally, will honor the expectations of the president-elect, meaning HHS rules expanding access to gender-affirming care and prohibiting sexual orientation and gender identity discrimination in health care settings will likely be on the chopping block in the next administration. A rule finalized by the department in April strengthening protections for LGBTQ foster youth could also be targeted.
The federal rulemaking process is often lengthy, and it could take several years to completely reverse and replace rules instituted by the Biden administration. But hospitals and clinicians that provide gender-affirming care, anticipating the administration’s actions, are likely to respond well before the new rules are finalized, said one physician in Massachusetts, who requested their name not be published because of safety and privacy concerns.
“There will definitely be health care systems that are proactively seeking to minimize their risk of retribution by the Trump administration. So, that means, even before rules go into effect, health care systems will roll back access to care and will roll back research infrastructures around this,” the physician said. "Their goal is to use federal structures to eliminate this care and silence researchers.”
Baker, of Whitman-Walker Health, said he’s hopeful that career scientists and health care experts at HHS, a sweeping agency that employs more than 80,000 federal employees across the U.S. and around the world, will help rein in some of Kennedy and the Trump administration’s proposals.
“There's a lot of concern that different parts of the administration's agenda will be driven by things other than science,” he said. “At the same time, we're all hoping that the realities of running a federal agency like HHS will encourage the Secretary and the entire administration to rely on the people who know that science the best.”