History Repeating: A Nurse’s Guide to the US Government’s Trans Genocide
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“There is no neutral middle ground when it comes to trans rights and trans people’s access to healthcare. ‘Not getting political’ is an illusion that allows the privileged to remain comfortable. Conflict is hard, and avoiding it will always be easier. But nurses know how to navigate discomfort; we do it every single day.”
Jess Romeo, Psychiatric Nurse Practitioner, Clinical Social Worker, Founder of OutPsych
The Lemkin Institute of Genocide Prevention and Human Security has issued its third warning that the US is currently perpetrating a genocide against trans, non-binary, and intersex people.
As part of this war, the far-right has unleashed an all-out assault on gender-affirming healthcare. The rate and intensity with which this persecution has escalated is dizzying, and now, US nurses and other healthcare professionals face a critical decision: do we capitulate to fascist forces and aid in dehumanization and violence? Or do we fight for the lives of our patients and the soul of our profession?
The American Right’s Anti-Trans Obsession
Republicans are obsessed with trans people.
In 2026 alone, 747 anti-trans bills were introduced in 42 states. 23 have passed, and 677 are still active. These bills seek to legislate every aspect of trans Americans’ existence, from blocking their access to healthcare, education, and legal recognition, to bathroom and pronoun use.
Here are just a few of the bills and rulings that have passed recently:
- Tennessee House Bill 754 passed in the house on March 26, 2026, and would require the state to create a registry of trans people using detailed medical information given to them by healthcare clinics, violating HIPAA.
- Kansas just passed SB 244, a law that immediately invalidated the IDs of anyone whose gender marker does not match their assigned birth gender and allows them to be sued for using public restrooms. This move effectively criminalizes life for trans Kansans who now face large fines or imprisonment for merely existing in public, driving to work, etc.
- In February, Secretary of War Pete Hegseth vowed Scouting America (Formerly Boy Scouts of America) would be eliminating all DEI initiatives and forcibly outing and segregating transgender scouts from their peers.
- New Hampshire just advanced an aggressive anti-trans bathroom bill, HB 1442, which would require trans people to use the bathroom of the gender they were assigned at birth, and violation of that paradigm could result in a ‘willful trespass’ charge and a fine, up to $5,000 per incident.
- The International Olympic Committee just banned trans women from competing at the Olympics, despite 22 years of including them with no issues. They plan on using a genetic test that screens for the SRY gene, which is typically found on the Y chromosome. This use directly contradicts the advice of the scientist who discovered this gene, who explicitly cautioned against using it for this exact purpose, as the biological basis of sex is more complicated and cannot be determined by any single test.
- Idaho just passed the most extreme anti-trans bathroom bill to date, which could result in trans people receiving a five-year prison sentence, just for using the bathroom.
Despite ample statistics showing that trans people are four times more likely to be victims of violent crime than the general population, the narrative has been pushed that trans, non-binary, intersex people (and LGBTQIA+ people more generally) are devious and a unique threat to Americans (and children specifically). Politicians like Florida governor Ron DeSantis, Senator Ted Cruz, and Secretary of State Marco Rubio, and extremist media figures like Matt Walsh, have all built their careers around anti-trans rhetoric.
The narrative that trans women are unique sexual predators is especially insidious, given the dark history in the US of that particular accusation being used as an argument to justify extreme violence against marginalized groups, such as Black men and boys, under the guise of ‘protecting’ white women’s purity. It gets even more vile when you examine the rates of sexual violence—sometimes state-sanctioned—that trans people, especially trans women, face today.
For example, the Trump Department of Justice plans to remove rape protections for trans and intersex inmates, according to a leaked memo. Human rights activists warn that this move greatly endangers trans women in particular, who have long been used as sex slaves in a well-established carceral practice by prison wardens called V-Coding. This horrific practice is when a trans woman is ‘gifted’ to a violent male intimate in an attempt to satiate the male inmate’s violent urges.
Mountains of criminology evidence show with clarity that women and girls are exponentially more likely to be abused by a priest or youth pastor than a trans woman (in a bathroom or anywhere else). The data is clear: the most imminent threat to the lives of cisgender girls and women is, and has always been, cisgender men.
And yet, the anti-trans hysteria has increased year after year.
A Historical Perspective on Transphobia & Who Weaponizes It
The American Right’s obsession with eliminating trans people is not new. In fact, its centrality as a Trump policy focus is a political strategy that other authoritarian powers have used before, like Nazi Germany.
In the interwar period before WWII, trans and other LGBTQIA+ people in Germany enjoyed a thriving subculture. For its time, the country was quite progressive, serving as the global leader in medical excellence. Berlin, its capital, boasted the world’s first medical clinic dedicated to transgender care, the Institute for Sexual Research.
It is difficult to understand, then, how such a socially progressive, scientific nation could fall to the evil barbarity and wanton cruelty seen in the Holocaust just years later. Understanding how the initially subtle political, economic, and media forces laid the groundwork for atrocity over time is crucial to preventing it from happening again.
Essential Genocide Ingredients: Scapegoating, Dehumanization, and Apathy
Western media has done us no favors by portraying the Nazis almost exclusively as cartoonishly evil soldiers who sadistically murdered and maimed for the pleasure of it. Instead, perhaps they should have shown us the banality of evil and the manufacturing of consent orchestrated by the bureaucrats, politicians, newspapers, and filmmakers. Better still, we should have seen the crucial role doctors and nurses eventually played in the mass killings.
Because it was nurses who murdered hundreds of thousands of disabled children and infants for the Nazi’s T4 euthanasia program, for example.
In just a few short years after gaining power in 1933, the Institute for Sexual Research was shuttered, and the Nazis all but eliminated trans and other LGBTQIA+ people from public life. They started by destroying their culture through queer book burnings and closing down queer bars and clubs. Later, they expanded laws like Paragraph 175 and issued a nationwide crackdown, leading to the death of tens of thousands of gay men in concentration camps.
Though trans and other LGBTQIA+ people were a small population and represented no material threat to the Nazi regime, they were targeted because their very identities were made a threat to the concept of German ‘racial health.’ They believed these identities were both a contagious disease and a ‘Jewish conspiracy’ meant to weaken their race.
Countless scholars have sought to understand how everyday people could have taken part in such grotesque cruelty and overwhelming violence. The truth is, populations experiencing economic depression and political unrest are ripe for charismatic leaders to swoop in and promise easy solutions to complex problems by providing avenues to vent their rage.
Then, the Nazi regime targeted Jewish, disabled, LGBTQIA+, Roma, and Slavic peoples, amongst others. They called them deviant and pathological. They claimed they were dangerous, criminal, and had to be eliminated from society.
Today, the Trump regime is targeting immigrants, trans, non-binary, and intersex people. They call them deviant and pathological. They claim that they are dangerous, criminal, and must be eliminated from society.
The target may have shifted slightly, but the tactics are the same. Attack marginalized groups, cast them as the villain of the story, so the masses don’t go after the true architects of their misery, and consolidate power every step of the way.
Genocides don’t require supervillains; they need a small group of extremists willing to whip up a violent frenzy against a minority group so they can divide the masses and seize power. And perhaps more importantly, for the majority of people around them to let that dehumanization and violence go unchallenged. Above all, genocides require individual apathy and institutional cowardice.
Trans Panic: Extremist Rhetoric, Not Evidence-Based
Extremist politicians and raving social media personalities are not new. History is full of absurd social theories, fad diets, and fringe beliefs—so it begs the question: how did this violent dehumanization of trans people become mainstream in our modern society? Because these beliefs are now truly mainstream.
It didn’t happen overnight, and it isn’t evidence-based.
The American far right has led an all-out assault on trans people that has been wildly successful thanks to their favorite rhetorical trick: casting trans and other gender diverse people as pathological deviants and framing their persecution as necessary to protect the children.
The Republican Party, whose policies have taken food away from millions of children and stripped millions more from having healthcare coverage, has positioned itself as the great moral protector of American women and children.
Over the past decade, through a dedicated smear campaign executed through the right-wing media machine, they have slowly shifted the Overton Window—a concept that describes what ideas are considered politically safe by the public—through a four-step plan:
- Cast doubt on the very idea of being trans, calling their existence a ‘gender ideology.’
- Conflate gay and trans identities with pedophilia despite zero evidence to support that claim.
- Claim that trans women hurt ‘real’ women and girls by using the bathroom with them or by playing sports with them.
- Claim that gender-affirming healthcare is dangerous or harmful for children.
Through a dedicated, extremely well-funded political campaign run by theocratic extremist groups like The Heritage Foundation, the Overton Window regarding trans rights was pushed extremely far to the right. Though this campaign of dehumanization and brutality against trans people is based on nothing more than the violent rhetoric of far-right extremists, its success shows the power of propaganda in a ripe populace.
The Truth About Gender-Affirming Healthcare
Though nearly all major medical and nursing organizations, including the American Medical Association, the American Nurses Association, National Nurses United, the American Psychiatric Association, and many more, have firmly defended gender-affirming medical care (GAC) for trans, non-binary, and intersex people as evidence-based, essential, and medically necessary, their statements seemed to fall on deaf ears.
When the far-right lasered in on gender-affirming medical care for children, National Nurses United, the American Academy of Pediatrics, the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and dozens of others affirmed that GAC for minors is evidence-based and improves kids’ mental health outcomes.
And yet, Americans’ views on GAC and trans people in general are becoming increasingly supportive of these violent, dehumanizing laws that seek to eliminate trans Americans from public life, according to data from the Pew Research Center.
Jess Romeo is a psychiatric nurse practitioner, founder, educator, and trans man who serves the LGBTQIA+ community. He attributes much of the current political climate to a lack of education among the public and healthcare workers.
“I like to explain GAC for minors by splitting available options into three different buckets: reversible interventions, partially reversible interventions, and irreversible interventions. Reversible interventions include things like pronouns, names, social transition, and puberty blockers. Partially reversible GAC interventions include hormone therapy, and irreversible or difficult to reverse GAC interventions include surgeries.” Romeo says.
According to Romeo and every leading medical organization, all of the above are evidence-based medical interventions for trans folks, including children, with different interventions used for different age groups under different circumstances—like any other medical treatment. Gender-affirming surgeries for trans minors, for example, are and have always been exceptionally rare, though it is frequently cited in corporate media. So, since that is the case, republicans have built up puberty blockers as their favorite GAC strawman target.
“Puberty blockers are low-risk medications that have been used since the 1990s, which essentially delay the formation of bone mineralization (without making bones weaker). This reversible intervention acts as a pause button for puberty, which is an irreversible change, and allows kids to figure out who they are,” Romeo says.
“If people were truly worried about kids making permanent medical decisions based on temporary emotions, they would joyfully support gender neutral bathrooms, changing pronouns, and social transitions. These are reversible things that allow kids to explore their identities. But, of course, they don’t do that. Because none of this has ever been about protecting children. It’s about legislating trans people out of existence,” Romeo says.
The alt-right has worked tirelessly to attack GAC, especially for minors, despite years of use, evidence supporting it, and life-changing patient outcomes. For example, the White House ordered the National Institutes of Health to research ‘regret’ and ‘detransitioning’ after trans-affirming surgical interventions, despite a large body of evidence that already exists, which shows regret after GAC surgeries and other interventions is incredibly low, at less than 1 percent. This is significantly lower than many common surgeries, such as knee replacements and breast augmentation.
Another reproductive health nurse practitioner who provides GAC agreed to speak with me but asked not to be named due to frequent death threats and doxxing attempts in the past years: “I am trans and nonbinary, and working with transgender patients helped me live more authentically myself,” they say.
Speaking to the increasing violence trans patients and their healthcare providers face, they say, “The anti-trans hysteria whipped up by the Right is supposedly in response to ‘child safety,’ from drag queen story hours, puberty suppression medications, youth sports, or trans femmes using a public toilet. But trans kids are at much higher risk for self-harm or suicide than the imagined harms of so-called ‘gender ideology.’ The research shows that listening to, trusting, and respecting kids is the best way to care for them and keep them safe,” they say.
The evidence is in, and the experts have spoken: GAC is lifesaving, evidence-based, and access to it gives trans and other gender expansive people a lifeline in a world that pathologizes them from birth.
Dylan Thomas Cotter is a publicist, activist, author, and trans man who advocates for GAC access: “I was six years old the first time I tried to kill myself. I wasn’t able to transition until much later in life, and I can honestly say the care I received from the team of women at the LGBT Center in LA and all the organizations that made it possible, especially Queercare, saved my life.”
Regarding the politicization of his very existence, Cotter says, “My identity as a trans person has been politicized into a slur, so when nurses hear corresponding words like ‘cisgender,’ they may interpret it as a slur. I’ve had an exceptional situation where my healthcare providers have honored their oaths, but a lot of healthcare workers have been conditioned by the media to view us as a punchline.”
He goes on to say, “Trans people aren’t asking for special treatment. We just want to be able to access healthcare and experience the same respect and kindness that all patients deserve.”
A Call for Courage & Bold Action
Today, as then, nurses are highly trusted by the public. Year after year, we rank as the most trusted profession. The nursing profession is notorious for fiercely guarding its reputation by enforcing strict ethical and cultural standards throughout nursing school, but enforcement becomes much trickier once the nurse leaves the program.
While organizations like the American Nurses Association have created a code of ethics, it notoriously lacks any enforcement mechanism. Instead, the policing of the profession is left to individual employers, institutions, and a motley patchwork of state-run professional nursing boards that exist to protect the public from nurses, not to shape nursing culture or policy.
This leaves a conspicuous void: who shapes the hearts and minds of nurses? Who rallies our considerable numbers to their cause?
In the absence of strong leadership—rooted in true health equity, not just representation—history shows that the masses usually follow the loudest voices, not those backed by empathy or evidence.
Genocide doesn’t start with bullets and bombs; it begins with accusations, othering, and blame. The seeds of hate are sown early, tended carefully, and pushed willfully. By planting doubt and discomfort about perceived differences between groups, the soil becomes fertile for violence.
The front lines of the genocide against trans Americans are not found in distant lands but in every clinic, conference hall, and board room where the humanity of trans people is allowed to be debated. Each time nurses allow extremist talking points to push out evidence-based practice, we cede ground to barbarity and hysteria. Each time we allow licensed medical professionals to weaponize their faith to dehumanize and degrade our patients, a battle is lost.
The time for position statements and research papers is long past. The time for direct action and fierce courage is now. Our trans, non-binary, and intersex patients are counting on us to fight for their rights as only we can. How will history remember us?
“There are going to be days when you, as a nurse, treat a trans patient and you will be the only person who has treated that person with kindness or respect all day, or all week, or all month. We look forward to our healthcare appointments because that is supposed to be one of our only safe spaces in society,” Cotter says.
Romeo says plainly, “The war on trans people is not new. It’s happened countless times throughout history, and it’s not about us. Queer and trans people were some of the first to be targeted in Nazi Germany. And then, as now, it was just another step of many they took to consolidate power. There is no neutral middle ground when it comes to trans rights and trans people’s access to healthcare. ‘Not getting political’ is an illusion that allows the privileged to remain comfortable. Conflict is hard, and avoiding it will always be easier. But nurses know how to navigate discomfort; we do it every single day.”
What nurses need today is the courage to show up for our patients and fight for their right to care, dignity, and safety. The ethics of our duty are clear here.
Dr. Cornel West said it best: “We need the courage to question the powers that be, the courage to be impatient with evil and patient with people, the courage to fight for social justice. In many instances, we will be stepping out on nothing and just hoping to land on something. But that’s the struggle. To live is to wrestle with despair, yet never allow despair to have the last word.”
Meg Lambrych, RN
WriterMeg Lambrych is a registered nurse, writer, and nursing advocate from Upstate New York.
After leaving clinical care due to burnout, she dedicated her life to covering issues in healthcare, nursing, and health in the digital space. She reports on nursing culture, policy, and history and interviews nursing innovators and leaders shaping the profession and challenging the status quo.