Trans Day of Visibility 2026: Still Here. Are We?

There is a passage near the end of The Return of the Native in which Thomas Hardy describes Egdon Heath as a place that “had a lonely face, suggesting tragical possibilities.” It does not yield to the civilization pressing in around it. It endures. I have been thinking about that image a great deal this March, as Trans Day of Visibility arrives in a political environment that has done everything in its power to make transgender people invisible—not through indifference, but through deliberate, coordinated, and legally sanctioned effort.

Trans Day of Visibility (TDOV), observed each year on March 31st, was founded in 2009 by transgender activist Rachel Crandall as a counterpoint to the Transgender Day of Remembrance: a day not for mourning, but for celebrating living transgender people and the communities that sustain them. That original framing—a refusal to let grief be the only public register for trans existence—has never felt more necessary than it does this year.

We are living through a civil rights emergency. That is not hyperbole; it is a descriptive claim about what is happening to a group of American citizens whose rights to healthcare, legal identity, physical safety, and public participation are being systematically dismantled by law. The mechanisms are different from those deployed against other minorities in other eras, but the logic is familiar: identify a group, define them as a problem, and use the machinery of government to restrict their ability to exist fully in public life. Transgender people are not a problem to be solved. They are human beings, possessed of the same inherent dignity and the same civil and human rights as every other person in this country. That should not require argument in 2026. The fact that it does tells us something important about where we are.

What Has Happened

If you have been following my recent writing, you know I have tried to document the evidentiary record. The science on gender-affirming care is robust and consistent: it reduces psychological distress, lowers rates of depression and suicidality, and improves quality of life across the developmental span. The American Psychological Association reaffirmed that consensus in February 2024, through a vote of more than 160 representatives , and held its ground again in early 2026 when journalist Erin Reed reported that the APA explicitly rejected characterizations that it had retreated from that position. “APA continues to support unobstructed access to evidence-based care for transgender and gender-diverse individuals of all ages,” a representative told Reed in late February of this year—a statement the organization issued in direct response to misinformation circulating in mainstream media.

The political landscape, meanwhile, has moved in the opposite direction with unusual speed. In 2025 alone, 1,022 anti-trans bills were introduced across 49 states and the federal government. As of January 2026, 648 active bills sought to restrict healthcare, ban inclusive curricula, and constrain trans people’s participation in public life. Researcher C. Q. Quinan, writing in the peer-reviewed journal Crime Media Culture, argues that this legislative wave represents something qualitatively new: a pivot from the criminalization of gender-diverse people toward their erasure—”erasure and dehumanization of trans life in all its forms” . That language is precise. To erase is more than to punish. It is to deny the existence of something as a legitimate category of human experience, to treat a person’s identity as a clerical error in need of correction.

The United States now carries a “Do Not Travel” rating for transgender people on Erin Reed’s national legal risk assessment map —a designation she does not make lightly. Kansas enacted a bounty-style law allowing private citizens to sue transgender people encountered in restrooms for substantial damages, becoming the first state in over a year to earn that designation. The same state sent letters invalidating the driver’s licenses of thousands of transgender residents overnight, a sweep so indiscriminate that it ensnared people who had never changed their gender marker—only their name. Iowa moved in 2025 to remove “gender identity” as a protected class from its Civil Rights Act; when cities responded by extending local protections, the legislature passed a bill to strip those as well. A state representative, opposing the measure, called it precisely what it was: an “enhanced civil rights removal act.”

The Tennessee legislature added its own chapter to this story on March 26th—the day before this post was written. The state House passed HB 754, a bill that would require health care providers and insurance companies to submit data on transgender patients and their treatments to the Tennessee Department of Health for publication as a publicly accessible statewide report. This is not the first time Tennessee has used data as a weapon: in 2023, the state Attorney General compelled Vanderbilt University Medical Center to produce 106 transgender patient records, two of which prompted lawsuits from the patients themselves over fears for their safety. Earlier this year, Vanderbilt stopped offering gender-affirming surgeries for adults entirely. Advocates for trans Tennesseans were direct about what HB 754 means in practice: because trans people are a small and identifiable population, a report containing age, sex, county of residence, medications prescribed, and neurological or behavioral diagnoses—even without names attached—functions as a registry. “When you create a new tool to collect data about such a specific and targeted group, you can’t not call that a registry of specific people,” said Dahron Johnson, co-chair of the Nashville committee of the Tennessee Equality Project. “If a community has been this vilified, this monstrified, we’ve got to be concerned about whose hands that’s going to fall into, what ways it’s going to be used.”

The history of government data collection targeting stigmatized minorities is not ambiguous on this point. During the HIV/AIDS crisis of the 1980s and 1990s, public health advocates fought state-level name-reporting proposals for precisely this reason: gay and bisexual men, already facing discrimination in housing, employment, and medical care, would avoid testing and treatment if a positive diagnosis created a government record of their identity. The fear was not abstract—people with AIDS were being fired from jobs, evicted from homes, and turned away by hospitals . The surveillance itself became the harm. Earlier still, the internment of Japanese Americans during World War II was made administratively possible in part by years of census data and community records that the government had compiled on a population it had already decided to treat as a threat. A registry precedes a rounding up. It provides the infrastructure. Opposing HB 754 during the Senate committee hearing, Tennessee state Sen. Jeff Yarbro put the principle plainly: “You cannot find many examples in history where increasing the amount of record-keeping that you’re doing on unpopular populations or politically disfavored populations goes well.” That amendment failed.

The Tennessee bill is not primarily a data bill. It is a surveillance bill—and it arrived just days before Trans Day of Visibility, at a moment when the Tennessee Equality Project and allied organizations were already at the state capitol protesting it. The state troopers who carried a protester bodily from the House gallery that afternoon offer their own summary of who is actually visible to the government, and under what terms.

On March 11th, a panel of the Fourth Circuit Court of Appeals extended the Supreme Court’s Skrmetti decision—which had upheld care bans for transgender youth—to transgender adults, making it the first federal appeals court to directly state that adult care bans are legal . In endorsing West Virginia’s exclusion of gender-affirming surgery from Medicaid, the court went further still, declaring it rational for a state to restrict access to such care in order to “encourage citizens to appreciate their sex.” That language—sanitized, almost pastoral—describes the coercive redirection of a person’s relationship to their own body as a legitimate legislative interest. The court’s logic mirrors, almost exactly, the reasoning the Supreme Court rejected in Loving v. Virginia: a formally neutral rule that targets a need unique to one group is not neutral at all. Justice Sotomayor said as much in her Skrmetti dissent, and the Fourth Circuit applied the same flawed symmetry anyway.

I am a clinician, not a legal scholar. But I have spent fourteen years providing care in a primary care setting, and I understand what it means to withhold treatment from someone who needs it. There is no version of that decision that is medically neutral.

What Remains True

Bill sponsor Rep. Jeremy Faison (R-Cosby), asked to justify HB 754, offered this summary of his view of gender-affirming care: “I believe that we as a society are going to look back on this time and think, ‘Dear God, what were we thinking? This was as dumb as frontal lobotomies.'” That comparison—delivered days before Trans Day of Visibility, from the floor of a state legislature—is worth sitting with. The frontal lobotomy was a procedure whose abandonment was driven by the accumulation of evidence: evidence that it caused catastrophic harm, that it served institutional interests over patient welfare, and that the people subjected to it had no meaningful say in the matter. Rep. Faison has inadvertently chosen an analogy that describes the current legislative project rather precisely, only with the roles reversed. In his analogy, it is the legislators—not the clinicians—who are overriding the evidence, dismissing the people subjected to the policy as having no voice in its design, and serving institutional interests over patient welfare.

What has not changed is the evidence. The research on gender-affirming care is not a political position; it is the accumulation of decades of careful inquiry by clinicians, psychologists, endocrinologists, and public health researchers across multiple countries. The American Psychological Association, the American Academy of Pediatrics, the Endocrine Society, and the World Health Organization have all reached the same conclusions through independent scientific review processes. When the American Society of Plastic Surgeons recently issued a statement appearing to question gender-affirming surgical care, Baum’s investigation, published in Erin in the Morning , revealed that the statement had bypassed the organization’s own membership and scientific review process, and that board-certified surgeons in the field explicitly stated it did not represent their views or the evidence. “Members should practice a method of healing founded on a scientific basis,” reads the ASPS’s own Code of Ethics—a standard its leadership failed to meet in that moment.

The consensus is not cracking. It is being pressured, misrepresented, and occasionally hijacked by leaders acting under political duress. Those are different things, and the distinction matters for every clinician trying to make sense of what they are reading.

A Civil Rights Moment

In February 2026, Senator Ed Markey and Representative Pramila Jayapal reintroduced the Transgender Bill of Rights, a resolution affirming that transgender and nonbinary people are entitled to healthcare, shelter, safety, and economic security—and that denying them these things is a civil rights violation. “Trans rights are human rights,” the resolution states. The framing is not rhetorical flourish. It is a precise claim about what kind of movement this is and what the historical record will ultimately say about it.

International human rights law has reached the same conclusion. Dicklitch-Nelson and Rahman , in a peer-reviewed cross-national analysis examining 204 countries, open with the foundational claim: “Transgender rights are human rights.” By virtue of being human, they argue, transgender people are entitled to the full enjoyment of all the same rights as all other human beings, regardless of gender identity or expression. Those rights, grounded in the Universal Declaration of Human Rights, include freedom and equality in dignity, the right to physical security, the right to health, equal protection under the law, and the right to privacy. They are not conditional on gender conformity. They are not revocable by executive order. They exist because trans people are people.

Philosopher Judith Butler, in Who’s Afraid of Gender? —the most widely discussed scholarly account of the current political moment—argues that the anti-gender movement is most precisely understood as an authoritarian project. “The weaponization of this fearsome phantasm of ‘gender’ is authoritarian at its core,” Butler writes, and the movement’s aim is nothing less than the restoration of what Butler calls a “patriarchal dream of settled and hierarchical gender binaries, an order that can be achieved only by destroying the lives of others.” What presents itself as a cultural dispute is, in Butler’s analysis, the shoring up of state power against people whose existence challenges that dream—giving the state full license to negate the lives of those who represent, in this phantasmatic logic, a threat to the nation. Butler’s diagnosis matters clinically, not only philosophically: it explains why ordinary legislative compromise has proven so inadequate to this moment. You do not compromise with a framework whose aim is the destruction of the lives it cannot accommodate.

We have been in this place before. The legal structures used to deny Black Americans full citizenship, to confine people with disabilities to institutions, to criminalize same-sex relationships were all, in their time, defended with procedural neutrality and legislative legitimacy. In each case, the eventual verdict of history was unambiguous. Getting there required people who understood that procedural neutrality in the face of substantive injustice is not neutrality at all—it is a choice. As Congressman Maxwell Frost put it at the 2025 TDOV rally on the National Mall, speaking directly to the reticence of his own party: “We weren’t loud enough. We have to lead the conversation.”

I do not raise these parallels to diminish the particular suffering of any of those communities, nor to suggest that trans people’s experiences are identical to theirs. I raise them because the logic of civil rights movements is recognizable across contexts: a government that targets its own citizens on the basis of who they are, rather than what they have done, has exceeded its legitimate authority. The obligation to say so clearly belongs not only to advocates but to everyone with a platform and a professional credential.

A Note to Healthcare Providers

Last year, I closed this post with a call to action drawn from Flynn and colleagues’ argument for civil disobedience in psychology—the position that there are circumstances in which the ethical obligations of clinical practice require a clinician to refuse complicity in legal regimes that harm the patients they serve. That argument has not weakened in the intervening year.

What I want to say this year is something slightly different, and it is addressed specifically to the primary care providers, behavioral health consultants, and other clinicians who read this blog. TDOV is, among other things, a day to remember that visibility is not only a matter of politics. It is a matter of clinical relationship. Transgender patients who feel seen by their providers—who do not have to brace for misgendering, who do not have to explain their identity before they can address the reason they came in, who do not have to wonder whether their chart accurately reflects who they are—experience meaningfully better health outcomes. That is not sentiment. It is the finding that emerges consistently from the research on affirming care environments, and it belongs in any honest accounting of what good primary care looks like.

The civil rights frame is directly relevant to clinical practice. When a state strips a patient’s right to access medically necessary care, that is not a policy disagreement to remain neutral about—it is an injury to your patient. When a court rules that it is rational to withhold treatment in order to “encourage citizens to appreciate their sex,” it is not engaging in medical reasoning—it is imposing a political ideology on the clinical relationship. Clinicians have ethical obligations that predate and supersede the political fashions of any administration. The obligations to do no harm, to respect patient autonomy, and to provide care based on evidence rather than political pressure are not negotiable provisions of the professional contract. They are its foundation.

Providing affirming care in the current environment requires courage. It also requires preparation: knowing the relevant guidelines, documenting carefully, staying current on both the clinical literature and the legal landscape in your state, and building the kind of collegial relationships in your clinic that allow for honest consultation when cases become complex. None of that is beyond the capacity of a well-functioning primary care team. It is, in fact, exactly what good primary care has always required.

They Are Still Here

I want to return to where I began—not with Hardy’s heath, exactly, but with what it represents. There are things that endure because they are older than the forces arrayed against them, and because the pressure to erase them only reveals how much those forces fear what they cannot eliminate.

Erin Reed, whose daily reporting on anti-trans legislation has documented the scope of what we are living through with more rigor and more courage than almost any other journalist in the country, ended her year-end reflection with an observation that I keep returning to: “When history does bend toward justice—as it always eventually does—it will be because people like us were there, hands on the arc, bending it.” I find that framing clarifying. It is not a counsel of despair. It is a description of what resilience looks like when it is not performing itself for an audience—and it is an accurate description of how every civil rights movement in American history has advanced.

Transgender people have been present in human communities throughout recorded history, documented across cultures and across centuries. “No matter how hard the government tries to erase us, they simply do not have that power,” said Rodrigo Heng-Lehtinen, Executive Director of Advocates for Trans Equality, at the 2025 TDOV rally on the National Mall. The rally was the largest in TDOV history. I do not expect this year’s to be smaller.

Trans Day of Visibility is a day for celebration—of the people who continue to show up, to build lives, to seek care, to organize, and to be known. It is also a day for the rest of us to examine what we are doing with the access and privilege we have, and whether we are using it in ways that are proportionate to the moment. In a civil rights movement, bystanders are not neutral. They are participants whose inaction carries its own moral weight.

They are still here. The question is whether we will be, too.

Call to Action

Everyone: Consider supporting PFLAG, GLAAD, the ACLU, or Advocates for Trans Equality. Subscribe to Erin in the Morning to stay informed on current legislation. Contact your congressional representatives in support of the Transgender Bill of Rights.

Healthcare providers: Know your state’s current legal landscape. Know the WPATH Standards of Care, Version 8 and the APA’s 2024 policy statement on affirming care. Make the clinical environment a safe one. These are not aspirational goals—they are the baseline.

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