As of February 2025, 574 bills that restrict the rights of transgender people have been introduced in 48 states.¹ Many of these bills seek to limit the inclusion of transgender and nonbinary people, including limiting educational discussions (both anti-LGBTQ+ and gender-focused) and limitations on access to public places or services (e.g., bathrooms). Twenty-five states have now banned best practice medical and surgical treatments for transgender youth². More notably, in six of these states, providing some of these best practice treatments is now a felony².

These legislative actions directly contradict the clear positions of leading medical groups, including but not limited to the American Medical Association, the American Academy of Pediatrics, and the World Health Organization, all of which support access to gender-affirming care. The impact of these anti-transgender laws is devastating. Young transgender and nonbinary people living in these states with bans on gender-affirming care are suffering, with suicide attempts spiking by 7% to 72% over the prior year.³ Transgender adults are not immune to the effects of these regressive laws, as they are also experiencing increased rates of depression and anxiety.

Furthermore, while these laws are aimed at impacting transgender and gender diverse populations, they are negatively impacting intersex populations as well. Many of these laws restrict gender-affirming care for transgender, gender nonconforming, and nonbinary (TGD) people, but there are exceptions within these laws that allow non-consensual, non-medically necessary, usually genital-based, surgeries on intersex infants and children to continue. Per the Human Rights Watch, “These surgeries have been deemed human rights violations by the United Nations High Commissioner for Human Rights, the World Health Organization, and other authorities.”⁶

Not only are transgender laws impacting intersex youth, but recent government orders are as well. In  January 2025, the United States government released an executive order that redefined what the words “sex,” “male,” and “female” mean.⁷ InterACT Advocates for Intersex Youth issued a statement that this order “disrespects the complexity of gender by reducing it to the production of eggs and sperm, entirely fails to consider the existence of intersex people.”⁵

InterACT further mentions that even cisgender intersex folx may be impacted by this Executive Order stating “Notably, the Executive Order may invalidate a cisgender intersex person’s understanding of their own gender, too. A woman with Complete Androgen Insensitivity (CAIS) may be assigned female at birth, and identify as a woman all her life while having internal testes – yet the Order would define her sex by her gonads and the reproductive cells they produce.”⁵

Intersex folx historically have had their existence and identities erased, pathologized, and stigmatized. InterACT says that “All people, including young intersex and transgender people, deserve to be respected for who they are.”⁵ The remote course, Intersex Patients: Rehab and Inclusive Care led by Molly O'Brien-Horn, PT, DPT, CLT, addresses how to be an ally in healthcare to and how to provide better, intersex-affirming healthcare to Intersex folx. The next course offering is on May 3, 2025.

The American Civil Liberties Union (ACLU) published a research brief on the impacts of these laws and policies stating in part, “These anti-transgender laws are accomplishing exactly what they were designed to do, i.e. prevent youth from obtaining gender-affirming care, reduce gender-affirming care access for adults, prevent transgender and nonbinary people from using correct facilities or participating in sports, or censor education. These impacts are concerning enough; however, the collateral consequences of these laws are also devastating. A growing body of research indicates that these restrictive laws and the surrounding rhetoric are instilling fear, reducing safety, and increasing violence against LGBTQ+ people and their allies.“ Although it can seem frightening and daunting to step up and be an ally, it is what the world needs of all of us, especially in unprecedented times.

As access to vital care is being challenged, pelvic rehabilitation practitioners have a powerful role in supporting transgender, intersex, and gender diverse people. We can be thoughtful listeners to our patients’ stories, and we can use their chosen names and pronouns. If you’re someone new to chosen names and pronouns, be reassured that no one expects perfection from you when you start out. We all get better with practice. If you need a refresher, check out this simple refresher from the Gay, Lesbian & Straight Education Network. The Herman & Wallace course, Inclusive Care for Gender and Sexual Minorities instructed by Brianna Durand, is also an excellent starting point in learning up-to-date, in-depth knowledge of the various terminology while emphasizing clinical interactions, available research, and professional accountability.

When it comes to pelvic health interventions for trans people who have not had genital surgery, I often encourage clinicians to focus on the basics. The vast majority of pelvic health concerns improve with breathing activities, trunk coordination and strengthening, and mindfulness training. Feel empowered to reach out to rehabilitation forums or mentors for assistance in selecting or adjusting interventions. Also, know who the prescribing medical providers are in your community. Some patients need more testing than PTs and OTs can do.  Make yourself part of a strong team.

Clinicians who are ready to be leaders in gender-affirming rehabilitation can take additional training to better understand the nuances of surgery recoveries and interventions. The remote course, Transgender Health for the Rehab Professional: Genital Gender Affirming Surgery Considerations, led by Sandra Gallagher, PT, DPT, WCS and Ken McGee, PT, DPT is a great step. Typical coursework covers dilator progression after vaginoplasty, return to activity after gender-affirming surgery, and understanding the impacts of hormones on pelvic function. The next offering is on April 12, 2025.

If you are looking for more ways to get involved, consider joining the PT Proud Special Interest Group of the Academy of Leadership and Innovation. Protecting and advancing gender-affirming care requires advocacy outside the clinic. The current legislative climate might seem daunting, but the recent court rulings favoring bodily autonomy and the proliferation of shield law for healthcare workers providing gender-affirming care is heartening.

Each of us has the power to make a meaningful difference in the lives of transgender, intersex, and gender-diverse clients. Let’s commit to our ethical duty of justice—ensuring fair and equitable treatment for all, regardless of gender identity—and beneficence—promoting the well-being of every individual we serve.

References

1. 2025 Anti-Trans Bills: Trans legislation tracker. 2025 Anti-Trans Bills: Trans Legislation Tracker. Accessed February 22, 2025. https://translegislation.com/.
2. Bans on Best Practice Medical Care for Transgender Youth. Movement Advancement Project. February 2025. Accessed February 22, 2025. https://www.lgbtmap.org/equality-maps/healthcare_youth_medical_care_bans.
3. American Civil Liberties Union. (2024, September 11). The Impacts of Anti-Transgender Laws and Policies: Evidence from Empirical Research. https://www.aclu.org/publications/the-impacts-of-anti-transgender-laws-and-policies-evidence-from-empirical-
4. Lee WY, Hobbs JN, Hobaica S, DeChants JP, Price MN, Nath R. State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Nat Hum Behav. 2024;8(11):2096-2106.
5. InterACT Advocates for Intersex Youth. (2025, January 21). Trump’s Executive Order Ignores Science to Push Discriminatory Agenda. https://interactadvocates.org/trumps-executive-order-ignores-science-to-push-discriminatory-agenda/.
6. Human Rights Watch. (2022, October 26). S. Anti-Trans Bills Also Harm Intersex Children. https://www.hrw.org/news/2022/10/26/us-anti-trans-bills-also-harm-intersex-children.
7. United States Presidential Actions. (2025, January 20). Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government Executive Order. https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/.

This week The Pelvic Rehab Report sat down with faculty member Ken McGee, PT, DPT. Ken (they/he) is a queer transmasculine pelvic health physical therapist based in Seattle whose mission is to bring greater awareness to the pelvic health needs of the LGBTQIA2S community. Their practice, B3 Physical Therapy, centers on transgender and perinatal rehabilitation. Ken also provides peer bodyfeeding support and doula care, and can be found on Instagram at @b3ptcob3ptco.

You can join Ken in their remote course, Perinatal Mental Health: The Role of the Pelvic Rehab Therapist, scheduled for October 22, 2022.

Who are you? Describe your clinical practice.
Experiencing inadequate care for my own pelvic health conditions as a teenager motivated me to become a pelvic health physical therapist. Being a member of the queer community further drove me to offer trauma-informed care and develop better access to care through home visits. Currently, I split my time between providing gender-affirming physical therapy and serving as a birth doula.

What lesson have you learned (in a course, from an instructor, or from a colleague or mentor) that has stayed with you?
Very few clients will remember detailed biomechanical explanations or every exercise you teach them. However, each client will remember how you treated them and how you made them feel. Asking clients about their preferences for care and following up go a long way in establishing rapport.

What do you find is the most useful resource for your practice?
One of my favorite resources is Decolonizing Fitness. It is an educational platform by Ilya Parker, PTA, (he/they). It provides a catalog of exercises and trainings for people looking to improve their care of gender-diverse people and People of Global Majority.

What books or articles have impacted you as a clinician?
The healthcare field regularly puts people in boxes to determine care. For example, many providers might determine care based on whether someone is a transgender woman or man. However, gender is actually someone’s individual experience rather than a category. Kate Bornstein’s My New Gender Workbook is a good starting point for understanding gender as uniquely one’s own, rather than part of a treatment algorithm.

What made you want to create this course, Perinatal Mental Health?
I wanted to create this course because, as a parent and physical therapist, I see both the challenges that the perinatal period presents, as well as the ways that rehabilitation providers can support mental health. In developing the content, I drew upon my background as a volunteer for a perinatal mental health warm line.

What need does your course fill in the field of pelvic rehabilitation?
Pelvic rehabilitation providers regularly interact with people who have mental health challenges. However, there are very few courses that specifically address the needs of the pelvic health providers serving folks in the perinatal period. This course looks at perinatal mental health from the perspective of pelvic rehabilitation providers, while offering specific actions providers can take to support their clients.

Who, what demographic, would benefit from your course?
Rehabilitation providers of any experience level would benefit from taking this course. Providers who are new parents or considering becoming pregnant may also find the content personally enriching. While the research discussed in this course focused on the perinatal period, much of it can be extrapolated to other populations.

What is your message to course participants who are just starting their journey?
For people just starting in pelvic rehabilitation, I would recommend focusing on patient education. For me, I find that the greatest amount of client improvement comes through reviewing the basics. It’s okay to still be developing skills in manual therapy.

Perinatal Mental Health: The Role of the Pelvic Rehab Therapist

Price: $150

Contact Hours: 5.75

Course Date: October 22, 2022

Description: This one-day remote course covers mental health considerations in pregnancy and postpartum and is targeted to the pelvic rehab clinician treating patients in the peripartum period. Topics include common mental health concerns in the postpartum period including depression, anxiety, OCD, and PTSD, as well as the connectedness between mental health and physical dysfunction. The course will introduce useful screening tools and how to connect patients to resources and diagnosing professionals. Labs will include partnered breakout sessions to practice listening and dialogue skills. The course also includes a review of coping techniques to support mental health and physical symptoms.