Trans people with Long COVID navigate a new “dark age” in trans health

We spoke with and surveyed dozens of trans people navigating gender-affirming care and Long COVID during Trump’s second term.

A person in a high quality mask holds a sign at a protest that reads, "Silence=Death" with a trans flag in an equilateral triangle. The person stands in the streets of Los Angeles outside of Children's Hospital Los Angeles during a 2025 protest. — Aaron Robey / The Sick Times

Key points you should know:

Both Long COVID disability and anti-trans policies limit access to gender-affirming care through varying mechanisms, including increased medical stigma, upcoming Medicaid work requirements, and symptom pathologization.
Unreliable electronic health records, funding constraints, and cisgender-centered research all contribute to the lack of research into trans people with Long COVID.
Trans people with Long COVID face similar medical, financial, and social barriers as people with HIV during the early years of the AIDS epidemic, necessitating a closer look at patient-first care models.
Solidarity from queer community members and trans health advocates is needed to bolster documentation, and subsequent social services, for this growing, vulnerable group.

This story was supported by the Trans Journalists Association.

In September 2023, Georgia Rising, a Chicagoan and transmasculine person with Long COVID, began hormone replacement therapy (HRT), a medical treatment providing gender-affirming care by adding hormones that don’t align with the person’s gender assigned at birth. At the time, they were in denial of their Long COVID.

In the absence of reliable public health reporting, the 27-year-old discovered their condition similarly to many others with Long COVID: “A lot of googling,” Georgia said. (The Sick Times is referring to Georgia by their stage name. Some sources requested to be referred to by only their first names, initials, or pseudonyms for privacy purposes.)

Though they had experienced chronic fatigue that could be related to Long COVID, they halted researching the disease as they were in “survival mode,” unemployed and unable to pursue healthcare. Once starting HRT, Georgia realized they could not continue ignoring their ongoing symptoms.

While taking testosterone, their symptoms worsened as their body began changing. As their voice grew deeper and fat was redistributed, they observed their fatigue and chest pains amplifying as their body began “morphing and shifting in a way that [they] really couldn’t keep up with.” Georgia continued taking testosterone and got referrals for various tests to find answers for Long COVID but remained hesitant to follow through, fearing doctors may discredit them.

People with Long COVID are “presenting comorbidities that tend to be seen in older folks [in] younger ages,” said Gabriel San Emeterio, senior fellow at and co-founder of Long COVID Justice, and lead of the organization’s HIV Complexities Project, which tackles the intersections between HIV and aging. Unlike HIV, which can be diagnosed by blood testing and prevented by pre-exposure prophylaxis (PrEP), Long COVID lacks its own approved tests and treatments. Therefore, San Emeterio says, trans people with Long COVID require nuanced care in the interim.

But healthcare for this group is becoming harder to access under the Trump administration.

While threatening Long COVID research and frontline HIV preventive programs, federal leaders continue their assault on gender-affirming care, threatening to bar health plans covering gender-affirming surgeries and HRT. Alongside these national threats, 27 states have passed policies that are “prohibiting or restricting minor access to gender-affirming care,” according to the Kaiser Family Foundation. Adding fuel to the fire, draconian work requirements for food and medical assistance have prompted outcries from disability and trans advocates.

Amid these attacks, Long COVID disability and medical gaslighting present unseen barriers to healthcare for trans and gender-diverse people, who navigate higher rates of houselessness, poverty, and unemployment than cisgender people. Federal survey data from the Household Pulse Survey showed that 27.6% of transgender individuals had experienced Long COVID as of 2024, compared to 13.7% of cisgender men and 21.8% of cisgender women.

History shows that when scientists and doctors deny care to people with HIV, it’s queer and lesbian communities that adopt and fight for patient-first care — reflecting the ever-present need for changes in medical, research, and social systems. HIV/AIDS and Long COVID are also directly connected, as studies have found people living with HIV are at higher risk for severe symptoms and chronic disease after SARS-CoV-2 infections and other opportunistic infections.

For this article, I interviewed 16 transgender people with Long COVID and surveyed dozens more. I also spoke with Long COVID and HIV activists and medical providers, finding how neglect within healthcare and the queer community both contribute to the medical and social erasure of trans people.

An incomplete body of research

Two and a half months after starting testosterone, Ella Gardner, 25, whose pronouns are it/its, noticed irritation around the injection sites. Garner is an Austin, Texas–based transmasculine person with Long COVID who was, until recently, unhoused.

“It would get red, itchy, and swollen [and] I got a bizarre rash that was in the exact shape of where the T must have traveled through my arm,” said Gardner, who decided to discontinue hormone treatment as its fatigue and food sensitivities worsened.

Of the 30 transgender people with Long COVID who responded to my informal survey, 26 are currently taking HRT while three had to stop HRT due to Long COVID symptoms.

Confusion following negative responses to HRT can occur when both provider and patient misunderstand Long COVID in the realm of gender-affirming care, said Tina D’Amato, an osteopathic family physician with Evergreen Family Health in Vermont.

Higher doses of hormones could exacerbate biological issues within Long COVID — but if physicians don’t understand that connection, D’Amato said they may tell patients to “cut back on hormones rather than [treating] the underlying issue,” a phenomenon known as the trans broken arm syndrome.

For transgender people, HRT promotes secondary body changes and sex characteristics through injections, gels, transdermal patches, and pills. It is also used to treat perimenopause and menopause symptoms, among other conditions.

Some research suggests hormones play a role in Long COVID symptoms. One 2024 non-peer-reviewed study found different immunological processes between cisgender women and men with Long COVID. The researchers wrote the study’s findings suggest that these differences are “not an unmovable dichotomy but a dynamic spectrum of which hormones like testosterone may help dictate the immune landscape.” Other research has found that cisgender women are more likely to experience Long COVID as well as autoimmune diseases, which can overlap, than cisgender men.

A study that monitored the immune systems of transgender people taking testosterone, published in 2023 in the Journal of Reproductive Immunology, found that the hormone increased inflammation and decreased the body’s ability to combat viral infections. This research did not focus specifically on transgender people with Long COVID, however. There is little research assessing immune responses to estrogen and progesterone, the primary sex hormones adjusted by hormone therapy that also regulate menstrual cycles, in trans femmes and women with Long COVID. Researchers who authored these studies were contacted and either declined to comment or never responded.

Medical research deprioritizes trans and gender-expansive populations, leading to an absence of robust clinical care and public health programming. This includes limited guidance for trans people with Long COVID. According to D’Amato, HRT’s impact on Long COVID symptoms is understudied because medical researchers “want to have as bland [and] homogenous a population as possible.”

D’Amato has not “seen trans humans included in a lot of research studies unless it’s something specifically related to trans health,” she said.

Support independent Long COVID journalism

There is also racial bias in medical spaces. A recent study in Health Affairs found white people were more likely to be diagnosed with Long COVID than Black people due to clinical bias and the absence of adequate diagnostic criteria for Long COVID. These findings suggest that white trans people living with Long COVID are likely more visible, more willing to disclose their conditions, and more represented in electronic health data.

D’Amato has developed her own protocols to serve people with Long COVID seeking gender-affirming care, based on her decade-plus experience researching the autonomic nervous system and mast cell activation syndrome (MCAS).

When D’Amato’s transgender patients initiate gender-affirming hormones following a COVID-19 or Long COVID diagnosis, D’Amato finds some medications can worsen issues that occur with Long COVID. One common issue is MCAS, in which the cells responsible for fighting infections become overprotective and release chemicals, like histamine, that cause inflammation. For example, she’s found trans patients with Long COVID had more severe issues utilizing estrogen than those utilizing testosterone, because estrogen destabilizes mast cells while testosterone stabilizes them, D’Amato explained.

She has also observed that spironolactone, commonly used as an androgen blocker for transfeminine and female patients, can reduce blood pressure — worsening orthostatic hypotension and postural orthostatic tachycardia syndrome (POTS), common in Long COVID. D’Amato recommends bicalutamide, a mast cell stabilizer, as an alternative to spironolactone, though she noted some providers may not “be comfortable prescribing bicalutamide [because] it is mostly used for prostate cancer.”

Many of the people with Long COVID D’Amato sees, regardless of gender, may have had POTS and mast cell issues before getting Long COVID, but “COVID poured gasoline on the fire.”

Jamie, 28, a genderqueer butch with Long COVID in Los Angeles, experienced complex symptom changes after they started taking testosterone via topical gel in 2023. The hormone helped alleviate their fatigue — for a period.

“The beginnings of those changes that I was so excited about for health reasons got dampened by getting sick,” Jamie said, recalling a 2024 SARS-C0V-2 infection that reversed their progress.

But Jamie describes their overall experience with HRT as positive. Testosterone ended their menstrual cycle, which had exacerbated other chronic health conditions like premenstrual dysphoric disorder (PMDD).

“I feel physically weaker than before testosterone because of my escalating disability but still more embodied and more well resourced because of HRT,” Jamie said.

Since gender-affirming care is based on individual goals, which vary from person to person, there is no “one-size-fits-all” approach, D’Amato said. And she sees it as intimidating to many healthcare providers when combined with complex chronic illness: “Now you’ve got the intersection of a newly recognized, global-scale issue — Long COVID — which doesn’t have any great validated blood tests with it [and is] compounded with gender-affirming hormones,” said D’Amato. “So it’s an area that many people in medicine hate.”

Now you’ve got the intersection of a newly recognized, global-scale issue — Long COVID — which doesn’t have any great validated blood tests with it [and is] compounded with gender-affirming hormones. So it’s an area that many people in medicine hate.
Tina D’Amato, Evergreen Family Health

A fraught pathway to gender-affirming care

Demonstrators stand in the streets of Los Angeles outside of Children's Hospital Los Angeles during a 2025 protest. Two people toward the front of the photo hold signs reading, "HRT SAVES LIVES" and "PROTECT TRANS KIDS" against the colors of the trans Pride flag. Another demonstrator is wearing this flag as a cape. Many of the people pictured are wearing high-quality masks. — Aaron Robey / The Sick Times

Another photo from the 2025 protest outside of Children's Hospital Los Angeles; here, a demonstrator wearing a black N95 mask holds up a box with a pink sign reading, "Mascarillas gratis" ("Free masks"). — Aaron Robey / The Sick Times

The impact of hormone therapies on symptoms is only one of many challenges that transgender people with Long COVID face in finding healthcare. Those I interviewed described biased attitudes from clinicians, high medical costs for specialized care, upcoming Medicaid changes, and additional hurdles from other intersecting identities.

Some transgender people with Long COVID omit the disease’s name with medical providers, opting for individual symptom treatment. BV, 26, a Houston-based Mexican American transmasculine person with Long COVID, employed this tactic to be believed. Among many providers they have seen, only two, a cardiologist and endocrinologist, identified a correlation between BV’s POTS symptoms and Long COVID.

Healthcare providers’ inexperience in diagnosing Long COVID and “taking their symptoms seriously” was a barrier to care for BV. They believe providers blamed their symptoms on their mental health, rather than looking for underlying biological issues.

Like BV, Gardner, in Austin, does not mention Long COVID in medical appointments out of an abundance of caution and the feeling that there isn’t enough time in a 15-minute appointment to adequately discuss it.

“I saw it as more useful to go after possible diagnoses for the specific conditions,” Gardner said.

Even for those who have insurance, high costs are a challenge and other biases appear when dealing with clinicians. That’s true for L.B., 33, a nonbinary person with Long COVID. Losing hormone access, SNAP, and Medicaid are looming threats that may force them to relocate from their current city of St. Louis, Missouri, to live with family.

“I’ve had to fight to get testing done, even though I know that it’s covered,” said L.B. They reported that doctors automatically rejected further testing when Medicaid appeared on their file. Twelve out of 30 respondents (40%) to my survey said they will be negatively impacted by the Trump administration’s new federal work requirements, which would mandate Medicaid recipients work 80 hours a month through formal employment or community service to maintain benefits. The requirements will go into effect on January 1, 2027.

L.B. considers the new requirements a double-edged sword. According to L.B, even if they volunteer, they “might as well get a paying job” because it will impact their body similarly. On the other hand, losing Medicaid will result in increased medical emergencies as they lose access to medication that assists pain relief. If they lose Medicaid, they will “instantly become more disabled.”

Jamie in Los Angeles has the finances to receive multifaceted care, but faces fatphobia from clinicians. In June 2026, Jamie requested a consultation with a private surgeon highly rated in the top surgery community. After looking at their patient intake form and calculating Jamie’s BMI, the provider denied them further consultation. Other providers have told them, “If you weighed less, things would be easier.”

“I wasn’t only a trans patient. I wasn’t only a trans disabled patient, but I was a fat trans disabled patient,” Jamie said.

I wasn’t only a trans patient. I wasn’t only a trans disabled patient, but I was a fat trans disabled patient.
Jamie, a genderqueer butch with Long COVID in Los Angeles

For some people with Long COVID who developed myalgic encephalomyelitis (ME), symptoms are too severe to attend appointments, further restricting access to specialty care. Alex, 32, who is based in New York City, has been “100% housebound for the past 2.5 years and 95% bedbound for almost as long,” they said in written responses. Though their PCP prescribed testosterone, care was discontinued when they became too sick to visit the office.

Alex faced staff threatening to withhold prescriptions, refills on HRT, referrals, and outright care for being “unwilling” to be physically in-person. Ultimately, the center dropped them as a patient. After months of medical bureaucracy, Alex found a new in-home PCP, but these visits are limited only to blood pressure checks — nothing more.

For Alder Disher, 33, an agender intersex Bostonian, navigating Long COVID and gender-affirming care alongside other complex health issues was especially harrowing.

Disher attempted HRT in July 2025 but showed an intolerance to testosterone injections and topical gel. They initially believed testosterone injections had caused a combination of severe fatigue, pelvic pain, and weight gain. But the truth was more complex.

A June 2026 pelvic MRI for endometriosis exposed a new horror: Disher’s organs had fused together. The pelvic pain thought to be a result of HRT was actually associated with endometriosis, which absorbs testosterone and converts it to estrogen. Disher is now able to take testosterone because of progesterone, which helps negate this conversion.

“I couldn’t get physicians to help me understand what might be going on [and I thought] hormones had been responsible,” Disher said. “I was under the impression that I would have to figure out how to get well before I could transition again.”

According to Disher, many healthcare providers assumed his Long COVID symptoms were psychological because of a previous mental health diagnosis. This pathologization had consequences resulting in coercive — and at points involuntary — hospitalization, with Disher spending upward of half a year committed to outpatient and inpatient care.

Disher said ongoing care and recovery programs are inaccessible, priming online health gurus to take advantage of an already medically neglected community.

Long COVID unrecognized in broader LGBTQIA+ activism

For some trans people, Long COVID not only interrupts comprehensive access to proper medical care, but limits access to the most critical survival tool: broader queer community. If the same patterns follow from HIV history, without proper recognition and solidarity, robust care and social services will remain absent for this group.

Georgia Rising became the first disabled drag artist to win Freshman 15, a weekly drag competition in Chicago. Success meant more gigs but did not translate to safety. Georgia later created Shooting Star, a collective of disabled drag performers, as a response to a largely inaccessible drag scene. According to Georgia, finding producers and venues invested in COVID-19 mitigation is difficult.

“If it doesn’t serve capitalism at large” and a specific venue’s success, show organizers believe mask-required events “detract people from coming,” Georgia said. “It’s been harder to make those spaces unless you are someone with a position of power.”

While LGBTQIA+-centered safe havens offer lifesaving community, these spaces are often inaccessible: marked by steep, mobility-restrictive staircases and clean air–averse nightlife. This inaccessibility, coupled with inadequate reporting of Long COVID by public health officials and mainstream media, has resulted in a social blackout of trans people with Long COVID.

Isha Popenoe, 29, a Black trans woman with Long COVID residing in the Bronx, said Long COVID “makes it really tough” to connect with the city’s broader queer community. She’s found masking made her appear unapproachable in a largely image-oriented scene.

“Queer culture is so party-oriented [that] people who aren’t able to go out get forgotten,” Popenoe said.

Queer culture is so party-oriented [that] people who aren’t able to go out get forgotten.
Isha Popenoe, a Black trans woman with Long COVID in the Bronx

This is reminiscent of the early years of the AIDS epidemic, said Cecilia Chung, civil rights leader, trans elder woman living openly with HIV, and senior director of strategic initiatives and evaluation at the Transgender Law Center.

“We [went] through a period of dark ages” with little public awareness of “the virus and whom it actually was impacting,” said Chung. It wasn’t until Ryan White, a non-gay teenage AIDS advocate whose death spurred the 1990s CARE Act, that the Bush senior administration felt comfortable publicly naming the virus.

Slowly, activists and community groups stepped in to fill the gaps in healthcare for gay and transgender people. Then holistic HIV care models developed to meet patients where they were, Chung said. In the early 2000s, for example, San Francisco’s HIV Community Planning Council developed a Centers of Excellence model which provided baseline guidance for low-income HIV patients across multiple providers, informed by a diverse advisory council.

But this type of care is largely absent for Long COVID outside of a few specialists like D’Amato. Since securing HIV funding has relied on targeted surveys documenting certain HIV populations, Chung believes trans people with Long COVID would benefit from measures that adequately record them so continuums of care may be established.

However, as Chung described, transgender people remain in a new but familiar dark age, signaling a need for cultural shifts in trans health advocacy.

“I understand that doctors manage liability, are overworked, and have very little time,” said San Emeterio, “but that’s why we need this major shift in how healthcare care is organized, how we treat our healthcare workers, and how we treat people accessing healthcare.”

We need this major shift in how healthcare care is organized, how we treat our healthcare workers, and how we treat people accessing healthcare.
GAbriel San Emeterio, Long COVID Justice

Khalil (Kae) Dennis is a Black trans artist, writer, and freelance journalist based in Chicago, IL. When energy permits, she can be found writing stories, cooking delicious meals, and watching hours-long video essays.

Khalil received a Reporting Fellowship from the Trans Journalists Association, which supported this story.

Editor’s note: The Sick Times collaborated with Long COVID Justice to develop the Long COVID Essentials resource sheets. Our newsroom operates independently of financial supporters.

All articles by The Sick Times are available for other outlets to republish free of charge. We request that you credit us and link back to our website.