There’s No Gotcha Here

Calling Hegseth’s testosterone program "gender-affirming care" trivializes trans healthcare and misreads what we’re up against. Speaking only for myself: knock it off

On Wednesday, Secretary of Defense Pete Hegseth posted a video announcing that the military will start testing the testosterone levels of every service member aged 30 and up as part of their annual health checkups. Anyone whose numbers come back low gets offered hormone replacement therapy. Troops under 30 can volunteer for testing if they want in early. He captioned the whole thing “The High-T Department of War” and pitched it as a way to keep troops on the “leading edge of lethality.”

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And because this is the same Pete Hegseth who spent his first weeks in office moving to purge trans people from the military and cut off their hormone therapy, you already know what happened next. Rep. Pramila Jayapal declared the program gender-affirming care and said it “completely debunks all of Republicans’ attacks on trans people.” Tammy Duckworth, my own senator here in Illinois, said it sounded “like gender-affirming care to me.” One viral post cracked, “Babe wake up, they’re transmascing the military.” Common Dreams ran a whole roundup of the dunks under the headline “’Literally Gender Affirming Care’: Hegseth Mocked for Plan to Offer US Soldiers Testosterone.” Within hours, “Hegseth is doing gender-affirming care” was the take.

Pete Hegseth speaks at the Pennsylvania Defense and Innovation Summit at U.S. Army War College on July 15, 2026 in Carlisle, Pennsylvania. (Photo by Alex Wong/Getty Images)

I get the impulse. I really do.

And I wish everyone would knock it off.

A few disclaimers before anybody gets mad at me. I’m speaking for myself here, one trans woman with a newsletter, and I don’t claim to represent anyone else. I know these jokes come from allies. I know the point is to call out the cruelty of banning care for one group while handing it out to another. I know plenty of trans people make the same joke, and I’m not interested in running a purity test. But I wince every single time I see it, and I want to explain why. Again, I am just speaking for myself here.

Two things happen whenever somebody fires off this particular gotcha. The first is that healthcare I spent years fighting to get becomes a punchline. The second is that a political movement with a perfectly coherent plan for people like me gets talked about as if it simply made a logic error. Both are bad. The second one might be worse.

The punchline is my healthcare

Start with the healthcare. Gender-affirming care is the medical treatment for gender dysphoria: hormone therapy, sometimes surgery, prescribed under clinical guidelines built over decades and recognized as medically necessary by dozens of major medical organizations, including the AMA and the American Academy of Pediatrics. If you’ve never felt dysphoria, I can only tell you how it felt to me: wrong, all the time, in a way I couldn’t reason my way out of. A depression with no obvious floor. Sick at the sight of my own reflection. A flinch at every “he.” This care is what helped make that stop. For a lot of us, it’s the thing that made everything else in life possible.

Getting it is a whole other story. I’ve been through the gatekeeping myself. Separate letters from separate providers certifying that I was who I said I was. A years-long waitlist. Insurance fights over care that the people writing the checks would clearly rather not pay for. It’s grueling.

Now picture the 42-year-old staff sergeant whose bloodwork comes back a little low on testosterone next spring. Nobody’s asking him for evaluation letters from therapists. There’s no legislature holding hearings about his prescription, no lawsuit trying to stop his refills. Under Hegseth’s program, he won’t even have to ask. The Pentagon is coming to him.

So when a member of Congress looks at that program and declares it the same thing I went through the wringer for, I understand the point she thinks she’s making. But here’s the message a casual reader actually takes away: transition care belongs in the same drawer as testosterone boosters, Botox, and Elon Musk’s hair plugs. And once it’s in that drawer, it’s about as “medically necessary” as anything else in there. Which is to say: completely optional.

That phrase, medically necessary, is doing far more work than it gets credit for. It’s the standard insurers use to decide what they’ll cover and what they’ll wave off as cosmetic, and “cosmetic” is already their favorite exit ramp when a trans patient’s claim hits the desk. It’s the finding those dozens of medical organizations put their names behind. It’s the thing my three letters existed to establish in the first place. The entire miserable apparatus I climbed through exists because this care has to keep proving, over and over, to skeptical people holding checkbooks, that it’s necessary. The joke hands that hard-won word away for free.

I’m far from the first trans person to notice this. Back in January, after a publication described Karoline Leavitt’s lip filler as gender-affirming care, Woodlief McCabe wrote in Autostraddle about how insulting the comparison feels from the receiving end, and where the logic ends up if you follow it: “If everything is gender affirming care, then nothing is.” He’s right. A category that stretches to cover lip filler and hair plugs is a category insurers and legislators will be delighted to treat like lip filler and hair plugs. They’ve been trying to file us under “cosmetic” for years. The gotcha does the paperwork for them.

There’s no contradiction to catch

The assumption buried inside every one of these dunks is that Republicans oppose gender-affirming care because they think hormones are dangerous, or because they think the government shouldn’t be in the hormone business. Catch them handing out testosterone to soldiers and you’ve caught them breaking their own rule.