After surgery, Ashton Colby was confined to bed, unable to move his arms or perform basic tasks.
But his father, Rick Colby, was there every step of the way, assisting him in recovering from his top surgery – his conservative Republican father’s support was invaluable after Ashton came out as transgender and underwent the surgery.
Some trans people, but not all, choose surgery as part of their overall gender-affirming care to aid in their transition. Ashton was 19 at the time.
“He was there in the hotel room to help me recover and drink protein shakes when I couldn’t move my arms. “He literally saved my life,” Ashton, 32, told CNN.
In the weeks leading up to his coming out in 2012, Ashton was haunted by the fear of rejection from his family. But his father stood by him through therapy and doctor’s appointments, ensuring he received the specialized care he required to affirm his gender and thrive, which Ashton describes as having “saved my life.”
Rick voted for President Donald Trump in 2024, and he describes himself as a “offensive lineman” in a larger mission to combat misinformation and legislation that threatens transgender rights and health care.
Now there’s a new challenge to face: Trump’s executive order denying federal funding to providers of gender-affirming healthcare for minors. The order has the potential to disrupt even Ashton’s adult care, as well as that of many others.
While the executive order only applies to gender-affirming care for people under the age of 19 and has been temporarily suspended by two federal judges, it continues to affect patients of all ages.
Experts in the field of gender-affirming care told CNN that many clinics and hospitals temporarily halted gender-affirming care before the order was blocked by judges. While many locations have resumed care, providers are concerned about losing federal funding and may have to stop care entirely in the future.
Ashton has been receiving gender-affirming care from the same Ohio clinic as an adult since 2015. Last year, Ohio prohibited certain aspects of gender-affirming care for minors.
While gender-affirming care for adults is still legal in Ohio, Ashton’s provider warned him last month that patients may have to drive across the state line to Pennsylvania to receive care in the wake of Trump’s order, he said. His medical center receives millions of dollars in federal funding to treat all of its patients.
The executive order has caused chaos for medical providers and their patients in the field, even in blue states where care was previously protected.
The disruptions to gender-affirming care following the order are already palpable. Patients on puberty blockers who need to switch to hormone therapy have already experienced or are concerned about interruptions in their treatment and face significant medical risks, according to one pediatric doctor who spoke with CNN anonymously due to threats to her safety.
The order is part of a wave of measures aimed at gender-affirming care that have been pushed in recent years across the United States, including a record number of anti-LGBTQ bills introduced in 2023, primarily by Republicans.
Rick Colby says he cannot support the Trump administration’s actions against the transgender community.
“I agree with just about everything Trump is doing except for transgender people,” Rick told CNN on Wednesday.
For Ashton, receiving gender-affirming care enabled him to be in “a great place and be the person he was always meant to be, which is a man,” according to his father.
“It doesn’t matter what your political affiliation is, my main concern is how to keep your child alive and help them to be happy and thrive and be productive members of society,” Rick told me.
Anxiety over upended treatment plans
Ashton Colby takes testosterone as a weekly injection as part of an ongoing treatment plan to manage the gender dysphoria he says, “I now luckily don’t have.”
However, he is concerned that his treatment plan will be changed for the first time since transitioning. According to the Mayo Clinic, some physical changes can be reversed when patients undergoing hormone therapy discontinue testosterone use.
“I’ve been really worried that, even as an adult, my care might be taken away or made much harder to access,” she said.
He is not alone. Multiple health care professionals told CNN that they’ve heard from concerned patients and parents of transgender children who have already experienced or anticipate disruptions in their children’s medical care.
Experts say that the future of their treatment is uncertain regardless of where they live, as clinics and medical institutions take a “risk-averse” approach due to the threat of losing critical federal funding to treat all patients and conduct research.
Clinics and hospitals across the country announced in the week following Trump’s signing of the order that they would suspend gender-affirming care for those under the age of 19, but later resumed the care after state attorneys general warned that denying the treatment would violate states’ anti-discrimination laws.
Some of the medical institutions included Denver Health, Children’s Health Colorado, Children’s Hospital Los Angeles, and Corewell Health in Michigan.
Two federal judges have halted Trump’s order, including US District Judge Brendan Hurson in Baltimore, who on March 4 extended a previous temporary restraining order in the case, stating that health care disruptions for trans youth could be “potentially catastrophic” and highlighting the risks of increased gender dysphoria and suicide uncertainty.
In February, a group of 15 attorneys general released a joint statement to “reaffirm their support” for gender-affirming care, stating that they “will continue to enforce state laws that provide access to gender-affirming care.”
Even as some hospitals and clinics reverse course, the uncertainty of medical treatment is raising concerns as providers and families deal with the consequences of the order and the pending legal case.
According to Alex Sheldon, executive director of GLMA, one of several LGBTQ organizations suing the Trump administration over the executive order, many institutions are pausing care “in secret” without formally documenting the changes, instead telling providers to cancel quietly out of fear of backlash.
“If funding is conditioned on not providing care to a very small patient population — trans and non-binary young people — losing that funding would force many hospitals to shut down completely,” said Sheldon.
Many medical institutions have decided to “err on the side of fear,” Sheldon explained.
“It’s cruel because you have to choose who will suffer.” We know it will be transgender patients because they are in smaller numbers,” said the pediatrician, who spoke anonymously. “Do you stop this care that’s so crucial and life saving for these kids, or do you put at risk the care of all these patients that also need it?”
The doctor reported that providers are already responding to “frantic calls” from their patients’ parents.
“They are asking us, ‘What will happen?'” Are you planning to close? Can you get your prescriptions refilled as soon as possible before you close? Patients have puberty blockers scheduled for a month from now and are concerned that they will not be able to get there.”
According to the physician, some families, particularly those with limited resources, are planning to leave the country.
The human cost of pausing care
Healthcare providers in the field claim they face an impossible choice between maintaining ethical standards of care and risking their livelihoods, as legislation could result in them losing their jobs or medical licenses for adhering to established medical guidelines supported by every major medical association.
The doctor expressed concern that children on puberty blockers will be unable to access hormone therapy if care is abruptly discontinued.
“They can’t be going into their late teens without hormones because then there’s significant medical risks,” according to the physician.
Patients taking puberty blockers have implants under their skin that can only be removed surgically, according to the doctor.
“So, we right now have the ethical question of: If we keep it in but they don’t get any hormones, they’re going to have issues with their bone density, maybe brain development,” said the clinician. “But if we remove the implant, they will go backwards. Endogenous puberty can be a traumatic experience. What should we do?
If Trump’s order is carried out, not all service providers will cease operations.
A non-profit health center that receives federal funding continues to provide gender-affirming care to youth, but will seek alternative funding if the order is enforced, according to its leadership team, who agreed to speak with CNN anonymously for safety and privacy reasons.
The federal government frequently funds hospital research, particularly at academic medical centers. Clinics receive funding from sources that charge insurance companies, have a sliding scale fee, and may receive federal grants, according to the health center’s CEO.
“Hundreds of us administer hormone therapy to patients. We all understand that this is primary, routine care for people, and there is ample evidence to support it. For many of us, it is critical to continue doing because we believe it is primary care,” the CEO stated.
Supporting a party that doesn’t understand what’s at stake
Ashton Colby finds that support from his loved ones helps him cope with the fear and uncertainty surrounding care under the Trump administration.
Ashton’s father strongly refutes Republican claims that “people are becoming transgender on a whim.” He cites his firsthand experience watching Ashton suffer from gender dysphoria.
“He suffered immensely through his formative years and as a teen… the depression, the anxiety, the stress.”
Ashton and other transgender and nonbinary people face uncertainty about their future appointments and treatment regimen.
“I should not have to have an exit strategy with my provider in this manner. “I’ve been nervous,” Ashton admitted.
Rick believes his party’s “extreme right” does not “believe being transgender is a real thing at all” and engages in efforts to “erase them and make life difficult, even though transgender people are American citizens and are trying to participate in the American dream and live their lives to be left alone like everybody else.”
He believes the Republican party should listen to the transgender community and the doctors who care for them.
Rick stated that he receives the most hate when he identifies as a conservative Republican father of a transgender son whom he loves and supports. That irritates them because it contradicts the narrative that ‘everybody’s on the left doing this.'”
But, to him, it proves the point: “It shows this is really an issue that transcends a political ideology, that there is actually an objective truth to it.”
While Ashton disagrees with many of his father’s conservative beliefs and they did not vote for the same candidate, they have become closer by “answering the call to advocacy.”
He feels safe at home and in his community, which is why he chose to stay in Ohio rather than move to a bluer state with more laws protecting his rights.
According to Ashton, his father has had to publicly declare his love for him. I can feel it in my heart more. “I am safe with him here.”
