A father of a trans man voted for Trump. Now he fears an order targeting gender-affirming care will upend his son’s treatment

(CNN) — After undergoing surgery, Ashton Colby was confined to bed and couldn’t move his arms or carry out basic tasks.

But his father Rick Colby was there every step of the way, helping him recover from his top surgery – support that meant the world from his conservative Republican father after Ashton came out as transgender and underwent the operation.

Surgery is an option that some, but not all, trans people choose as a part of the broader gender-affirming care they may receive to help them with their transition. Ashton was 19 at the time.

“He was there in the hotel room while helping me recover and drink protein shakes when I couldn’t use my arms. He’s made, literally, a life-or-death difference in my life,” Ashton, now 32, told CNN.

Ashton had been tormented by fear that he would be rejected by his family in the weeks leading up to his coming out in 2012. But his father stood by him through therapy and doctor’s appointments, ensuring he would get the specialized care he needed to affirm his gender and thrive, which Ashton says: “Saved my life.”

Rick voted for President Donald Trump in 2024, and he describes his role as an “offensive lineman” in a greater mission to fight misconceptions and legislation attacking transgender rights and health care.

Now, there’s a new challenge to face: an executive order from Trump denying federal funding for providers of gender-affirming health care for minors. The order threatens to upend even care for Ashton, who is an adult, and for many others.

While the executive order only applies to gender-affirming care for those under 19 and has been temporarily paused by two federal judges, it’s still affecting patients of all ages. Many clinics and hospitals around the nation temporarily halted gender-affirming care before the order was blocked by the judges, and while care has returned at many locations, providers concerned about losing federal funding worry they will have to stop care altogether in the future, experts in the field of gender-affirming care told CNN.

Ashton has received gender-affirming care from the same Ohio clinic since 2015 as an adult. Last year, Ohio banned some parts of gender-affirming care for minors. While gender-affirming care for adults is still legal in Ohio, Ashton was warned last month by his provider that patients might have to drive across the state line to Pennsylvania to access care in the wake of Trump’s order, Ashton said. His medical center relies on millions of dollars in federal support to treat all its patients.

The executive order has plunged medical providers and their patients in the field into chaos, even in blue states where the care was previously safeguarded.

The disruptions to gender-affirming care after the order are already palpable. Patients on puberty blockers who need to transition to hormone therapy have already experienced or are fearful of interruptions to their treatment and are facing 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 targeting gender-affirming care that have been pushed in recent years – along with a record number of anti-LGBTQ bills introduced in 2023– across the United States, largely by Republicans.

Rick Colby says he can’t support the Trump administration’s moves targeting the transgender community.

“I agree with just about everything Trump is doing except for transgender people,” Rick told CNN.

For Ashton, undergoing gender-affirming care allowed him to be in “a great place and be the person he was always meant to be, which is a man,” his father said.

“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 said.

Anxiety over upended treatment plans

Ashton Colby takes testosterone as a weekly injection in an ongoing treatment plan to manage the gender dysphoria he says, “I now luckily don’t have.”

But he worries his treatment plan will be upended for the first time since he’s transitioned. When patients undergoing hormone therapy stop taking testosterone, some of the physical changes can be reversed, according to the Mayo Clinic.

“I’ve been really worried that, even as an adult, my care might be taken away or made much harder to access,” Ashton said.

He’s not alone. Multiple health care professionals told CNN they’ve been hearing from anxious patients and parents of trans children who have already experienced or anticipate disruptions to their children’s medical care.

The future of their treatment is uncertain no matter which state they live in, experts say, as clinics and medical institutions take a “risk-averse” approach due to the threat of losing essential federal funding to treat all patients and conduct research.

In the week after Trump signed the order, clinics and hospitals around the country made public announcements they were suspending gender-affirming care for those under the age of 19 but later in February resumed the care after state attorneys general warned denying the treatment could violate states’ anti-discrimination laws. A few of those medical institutions included Denver Health, Children’s Health Colorado, Children’s Hospital Los Angeles and Corewell Health in Michigan.

Two federal judges have paused Trump’s order, including US District Judge Brendan Hurson in Baltimore who on March 4 extended a temporary restraining order that was previously entered in the case, saying health care disruptions for trans youth could be “potentially catastrophic” and noting the risks of heightened gender dysphoria and suicide uncertainty.

A group of 15 attorneys general also issued a joint statement in February to “reaffirm their support” for gender-affirming care and said they “will continue to enforce state laws that provide access to gender-affirming care.”

But even as some hospitals and clinics reverse course, the volatility of the medical treatment is keeping anxieties high as providers and families deal with the fallout from the order and the pending legal case.

Many institutions are pausing care “in secret” without documenting the changes formally but instead telling providers to cancel quietly because they fear backlash, according to Alex Sheldon, executive director of GLMA, one of multiple LGBTQ groups suing the Trump Administration over the executive order.

“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,” Sheldon said.

Many medical institutions have decided to “err on the side of fear,” Sheldon said.

“It’s cruel because you must choose who’s going to suffer. We know it will be the transgender patients because they’re a smaller number,” said the pediatric doctor 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?”

Providers are already responding to “frantic calls” from their patients’ parents, the doctor said.

“They’re asking us, ‘What’s going to happen? Are you going to close? Can you get a refill of prescriptions as soon as possible before you close?’ There are patients scheduled for puberty blockers a month from now and they’re worried that they’re not going to get there.”

Some families are making plans to move out of the country, including those without many resources, the physician said.

The human cost of pausing care

Healthcare providers in the field say they are facing an impossible choice between maintaining ethical standards of care and risking their livelihoods, as legislation could mean they’ll lose their jobs or medical licenses for following established medical guidelines backed by every major medical association.

One major concern is for children on puberty blockers who won’t be able to access hormone therapy if care stops suddenly, the doctor explained.

“They can’t be going into their late teens without hormones because then there’s significant medical risks,” the doctor added.

Patients on puberty blockers have implants under the skin that can only be surgically removed, 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,” the doctor said. “But then if we remove the implant, they’re going to go backwards. The endogenous puberty will start and that’s going to be pretty traumatic – what do we do?”

Not all providers will halt services if Trump’s order is enforced.

A non-profit health center that receives federal funding is still providing gender-affirming care to youth but will look to secure alternative funding if the order is enforced, according to its leadership team who agreed to speak with CNN anonymously due to safety and privacy concerns.

Hospitals, especially academic medical centers, commonly receive research funding from the federal government. It varies more for clinics, but they typically get funds from sources that charge insurance companies, have a sliding scale fee and may also receive federal grants, according to the health center’s CEO.

“There are hundreds of us who provide hormone therapy to patients. We all understand this is primary, routine care for people and there’s great evidence on it. For many of us, it’s essential to keep doing because we just think it’s primary care,” the CEO said.

Supporting a party that doesn’t understand what’s at stake

For Ashton Colby, support from his loved ones helps him cope with the fear and uncertainty surrounding care during the Trump administration.

Ashton’s father fiercely contests claims by Republicans that “people are becoming transgender on a whim.” He cites his first-hand experience witnessing Ashton suffer from gender dysphoria.

“He suffered immensely through his formative years and as a teen… the depression, the anxiety, the stress.”

For Ashton and other transgender and nonbinary people, uncertainty now looms over their future appointments and the continued treatment regimen they rely on.

“I shouldn’t have to have an exit plan with my provider in this way. I’ve been nervous,” Ashton said.

Rick believes the “extreme right” of his party does not “believe being transgender is a real thing at all” and says they engage 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.”

The path forward, he says, is for the Republican party to listen to the transgender community and the physicians who care for them.

Rick said the most hate he receives is when “I identify myself as a conservative Republican who’s a dad of a transgender son who I love and support. That sets them off, because it doesn’t fit the narrative, which is, ‘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 actually is an objective truth to it.”

While Ashton says he disagrees with many of his father’s conservative beliefs and they didn’t vote for the same candidate, they’ve been brought closer by “answering the call to advocacy.”

He knows he’s safe at home and in his community, which is why he decided to stay in Ohio after considering moving to a bluer state with more laws protecting his rights.

Ashton said of his father: “Because he has had to repeatedly say it and declare it publicly that he loves me… I feel it in my heart more. I’m safe with him here.”

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CNN’s Kristen Rogers and Jen Christensen contributed to this report.