There are moments when a policy debate stops being abstract.

On a recent podcast appearance, Kevin Roberts, president of The Heritage Foundation and chief architect of Project 2025, was asked about gender-affirming care for adults. His answer was blunt: “You outlaw it.”

Not regulate it. Not study it further. Not defer to doctors and patients. Outlaw it.

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I am writing this not only as a political commentator but as a Jewish transgender American woman. When Roberts talks about banning gender-affirming care for adults, he is talking about my health care. He is talking about the health care of every trans adult in this country.

And I need people to understand what that actually means.

Gender-affirming care is not a political slogan. It is evidence-based medical treatment endorsed by the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, and the World Health Organization, among others. It includes therapy, hormone replacement therapy, and, for some adults, surgical interventions. It is provided under clinical standards and with informed consent.

It is also, for many of us, life-saving.

Before I transitioned, I reached what many trans people quietly describe as the “transition or die” point right before Passover 2016. The despair was not theoretical. It was not ideological. It was personal, visceral, and terrifying. Access to care did not make my life harder. It made my life possible.

So when Roberts suggests that there is a “mounting body of evidence” tying gender-affirming surgery to violence, he is not merely misstating data. He is building a pretext for stripping away the care that kept me alive.

The data does not support his claim. Reviews of mass violence consistently show that the overwhelming majority of perpetrators are cisgender men. Transgender people make up a tiny fraction of mass shooting suspects. The attempt to link our medical care to acts of violence is not grounded in science. It is scapegoating.

But even if the statistics were murkier than they are, the underlying principle would remain the same: in this country, competent adults are allowed to make medical decisions in consultation with their doctors. We permit adults to undergo cosmetic surgery, fertility treatments, vasectomies, hysterectomies, and a host of other procedures without federal bans. We do not require cultural unanimity before allowing someone to access care.

If Kevin Roberts had his way and gender-affirming care were outlawed for adults nationwide, the consequences would be devastating. Trans Americans with financial means would flee to friendlier countries. Those without means would lose access. Some would turn to unsafe, unregulated alternatives. Many would spiral into depression. Some would not survive it.

I do not use the phrase “death sentence” lightly. I use it because I know what untreated gender dysphoria can do. I know what it did to me before I transitioned.

Roberts has described himself and his organization as “radical incrementalists,” willing to take “a quarter of the enchilada” now while working toward a broader goal. We have already seen youth bans spread across more than half the states. We have seen Medicaid restrictions for adults in others. The trajectory is not hypothetical. It is visible.

And this is not happening in a vacuum. The Heritage Foundation’s Project 2025 is an explicit blueprint to reshape the federal government—to consolidate power, purge civil servants, and roll back LGBTQ+ protections across agencies. When Roberts talks about outlawing care, it fits neatly within that broader agenda.

This is not a debate about “disagreement.” It is not a polite policy difference about insurance reimbursement. It is a proposal to use the power of the state to deny a class of adults medically necessary care because a powerful ideological movement refuses to accept our existence as legitimate.

Transgender Americans exist whether Kevin Roberts acknowledges us or not. We work, we vote, we pay taxes, we build families, we contribute to our communities. Our lives are not theoretical constructs in a think tank white paper.

If you are not transgender, it may be tempting to see this as someone else’s issue—another culture war skirmish in an already noisy political landscape. But the precedent matters. When the government claims the authority to ban medically endorsed care for one minority group of consenting adults, it is asserting a power that does not stay neatly contained.

I transitioned because I wanted to live.

Outlawing gender-affirming care for adults would not eliminate transgender people. It would eliminate safe, legal pathways for us to exist in our own bodies. And for many, that would mean pushing them back toward the edge I once stood on.

That is not hyperbole. It is lived reality.