This story was originally published April 3, 2026 by the Nashville Banner. Sign up for their newsletter.
Jordan was finishing the first of three phases of his gender-affirming surgery when he learned that Vanderbilt University’s Medical Center (VUMC) would stop offering gender-affirming surgeries in February.
Because his surgery was already underway, VUMC will complete the rest of his surgical process. But Jordan said that experiencing that whiplash was terrifying. Other transgender patients seeking gender-affirming surgeries will have to look elsewhere, and now, it will have to be in a different state.
“It’s just been hard to watch every aspect of our community be essentially shut down,” said Jordan, who asked to use his first name only due to privacy and safety concerns. “It’s like our care doesn’t matter.”
In a statement, VUMC spokesperson John Howser cited “operational limitations and lack of surgical coverage,” and added that the institution will continue to provide nonsurgical gender affirming care for adults 19 and up.
Ceasing to offer surgeries is just the institution’s latest move that significantly limits the care it provides to transgender patients. Last summer, VUMC cut its longstanding LGBTQ Health Program and its four person staff with little to no notice. These actions have left transgender residents feeling they have nowhere to turn.
Nowhere left to turn in Tennessee
A patient who requested to remain anonymous was preparing for surgery and had finished her consultation when she got the news. After as many as eight laser hair removal sessions, she would have been set to undergo surgery by the fall.
In a note sent to her patient portal, the source learned that her surgeon had left Vanderbilt.
“We care deeply about your health and well-being, and we understand this is disappointing news,” the note read. “We can help you find other programs that may be accepting new patients.”
Now she’ll have to find a provider who can do her surgery out of town, which will require her to stay for four-six weeks and to bring someone to take care of her in recovery.
“My plan is the same,” she said. “It just made [receiving my surgery] exponentially harder.”
She feels the changes are fueled by funding concerns and political pressure on the administrative side.
“If the government withholds funds from the hospital, there is no hospital,” she said. “If transgender people are hovering around 0.9 to 1 percent of the general population, that means we are also 0.9 to 1 percent of Vanderbilt’s patient group. Are they going to get rid of 80 percent of their revenue for less than 1 percent of their patient population? Probably not.”
While Vanderbilt is no longer an option for surgery, she said she still receives her hormone therapy prescriptions and mental health care from VUMC. She doesn’t fault the health care providers for the change, but instead thinks it’s a larger issue from administrative authorities.
“The people who actually provide my care just want to be able to take care of their patients,” she said.
Former Vanderbilt physician Hayden Shafer left after the layoffs and elimination of the LGBTQ Health Program last summer. He joined Music City Physicians Group and now works as an assistant medical director at Chosen Family Medicine.
“I, checking in with myself at the time, recognized the need to stand up for our community, and that LGBTQ+ health care is something that we deserve here in Nashville,” he said. “[My new workplace] had that focus on community integration. … It really was a community-driven decision.”
Shafer said VUMC’s latest decision is a devastating loss for patients in the region.
“The surgical loss from Vanderbilt is enormous because we certainly do not have any other availability for full-spectrum, gender-affirming surgery anywhere else in the state of Tennessee,” he said.
A damaged Vanderbilt University Medical Center sign on 21st Ave. South and Blakemore Ave. The closest options patients are left with are in Atlanta and Chicago. When they travel for surgery, patients have to take off from work for weeks for recovery and post-surgery check-ins.
“It’s such a huge ask on anybody,” he said. “That’s really where the loss comes in for our patients. It’s going to increase the inequity of who can get the surgery because people who can afford it are still able to travel and do it, which is great. But so many people are not going to be able to do that anymore.”
Shafer estimated he served around a 2,000 patients, not all LGBTQ-identifying, while at VUMC. Some left VUMC and are receiving care from him at Chosen Family Medicine. At Chosen Family Medicine, Shafer and his colleagues serve around 2,200 patients. More than 50 percent of them identify as transgender or gender-diverse.
Shafer said that many patients are traveling to Nashville from other states to access the facility’s care. And with the amount of patients wanting to receive inclusive and informed care, it can result in long wait times. Patients have to wait up to two months just to see Shafer for primary care.
Not only are surgeries no longer available at Vanderbilt, hormone therapy is also restricted in Tennessee for patients under 18.
In the spring of 2025, federally qualified health centers like Neighborhood Health stopped offering hormone therapy, which created a gap in accessibility to these services for patients without insurance.
Shafer speculated that the end of Vanderbilt’s gender-affirming surgeries stemmed from funding concerns, and that institutions are worried they won’t be able to accept Medicare and Medicaid coverage while also offering gender-affirming surgery.
While there isn’t a law that restricts this, Shafer said, “it’s an existential threat that puts pressure on institutions and what the future of gender-affirming care looks like.”
“I do not know the exact reason why they are no longer offering that surgery, but I know that the pressure is still there,” he said. “The pressure is certainly on me, even not at an institution.”
As a health care provider serving LGBTQ+ patients in Tennessee, it often feels like “you’re under a microscope,” he said. More employer-based insurance companies are denying coverage for hormone therapy and medical visits related to gender identity.
Navigating shifting and increasingly restrictive policies is a challenge for health care providers, institutions and patients, Shafer told the Banner.
“As a physician, it creates a big moral injury,” he said. “It really hurts to see this huge inequity spreading. I never went into medicine to be a politician or to argue politics in an exam room. I wanted to take care of patients. … I’m here to take care of my people.”
The moral injury he referred to is deep, as immigrants also fear deportation, affecting their day-to-day lives. Shafer said watching the LGBTQ+ community struggle with how policies are impacting their health and wellbeing makes him feel powerless.
“You want to do the best job you can for your patients at the end of the day,” he said.
Mutual aid seeks to fill in the gaps
As health care access decreases for trans residents, the community is coming together to fill in those gaps.
Trans Aid Nashville was founded in 2023 to help trans residents with health care access, housing and economic stability.
“We see mutual aid not only as survival work, but as a long-term commitment to protecting trans life, dignity, and community self-determination in the face of systems that have historically failed or harmed us,” a Trans Aid representative, who asked to remain anonymous, told the Banner via email.
Over the years, the organization’s disbursements have grown as need has grown. In 2023, Trans Aid Nashville answered 44 monetary requests — that number was 165 in 2025. Last year, the organization allocated $13,315 toward gender-affirming health care, which made up 26 percent of its total distributions.
The organization said that mutual aid and crowdfunding are often the only solutions for a patient to mitigate their health care costs without ending up in debt. Because gender-affirming surgery can be long, patients often have to schedule and pay for multiple sessions. And now that VUMC doesn’t offer surgeries, there’s the added cost of paying for multiple flights, housing and other necessary costs to travel out of state for care.
But, the organizers said, Vanderbilt’s decision is the tip of the iceberg when it comes to healthcare access for the trans community.
It comes as the state continues to push a slew of anti-LGBTQ legislation. On Monday, the Tennessee General Assembly passed a bill declaring that the state will only recognize two sexes: male and female. Its sponsors seek to require local governments and entities, including universities, to do the same, or risk funding loss if they don’t comply.
With the recent passing of HB 754 — a bill that would require health care providers and insurance companies to submit transgender patients’ data and treatments to the state department of health — and the spate of other anti-transgender bills circulating the Tennessee Legislature, Jordan told the Banner that it feels like the LGBTQ+ community is getting attacked from all fronts.
“You just have to question, when is enough enough? We’re supposed to all be human and take care of each other. That doesn’t seem to be what Tennessee is doing,” he said.
Trans Aid Nashville said that in order to elicit any type of change, clinics need to continue to stand by their patients and doctors to continue providing gender-affirming care. Jordan said for change to happen, community members need to stand together and advocate for their needs and the needs of their neighbors.
“Hoping to find a solution in a tough situation isn’t really forthcoming in a lot of ways,” Jordan said. “I think the community standing together is really what it’s going to boil down to, but we really needed Vanderbilt to stand with us, ultimately.”
Resources for trans residents
- Trans Aid Nashville said the organization’s primary need is sustainable funding. In 2025, 80 percent of the organization’s funding came from individual donations. Community members can sign up at different levels to fund the organization’s critical work. To learn more about how to donate or apply for assistance, visit their website.
- The organization also supplies free Gender-Affirming Hormone Therapy supply kits for those who have been prescribed for Hormone Replacement Therapy. Each kit contains six months of over-the-counter supplies. Use this form to learn more and arrange a kit pick-up and drop off.
- Chosen Family Medicine is an LGBTQ-affirming clinic in Nashville that provides comprehensive primary care and continues to serve trans patients.
- The Queer Trans Project supplies free gender-affirming items for trans folks.
- Where to Turn in Nashville also has an array of different services depending on need.
- The Campaign for Southern Equality compiled a list of various resources for those seeking gender-affirming care or legal assistance in the South.
This article first appeared on Nashville Banner and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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