From questions about discrimination and injustices, conservative legislation in not just the U.S. but around the world, and thoughts on fleeing the U.S., to advice, resources, and ways to support the queer community, transgender nurse Sam Lee speaks on the importance of transgender healthcare, rights, and what the future looks like for the community. To learn more about Sam Lee and her thoughts on these topics as a professional in the healthcare field and individual a part of the LGBTQIA+ community, read on.

Where are you based?
I am a proud resident of Baltimore, MD.

What inspired you to pursue a career in the healthcare field?
Two things inspired me to turn everything upside down and go into nursing:

The first reason was the pandemic. I was working for Johns Hopkins University as an administrative professional when the COVID19 pandemic began. Unfortunately, I was still required to be physically present at work regularly. At that time, not a lot was known about COVID 19 yet. I remember walking the back hallways in the hospital at my workplace and hearing the various healthcare workers talk about their concerns with the pandemic.. I remember the fear they had over being exposed, the lack of support they felt, and the genuine terror over whether they would be the next one being ventilated. It was a genuinely frightening experience for those healthcare providers.

What was worse was that I felt helpless through it all. There I was, sitting in my office, setting up virtual meetings for our conferences, doing paperwork, answering emails; while nurses, healthcare workers, and doctors were out there putting it all on the line. My work felt insubstantial compared to the tangible effects they were having on the pandemic. It made me feel helpless to affect real change in my life and the world around me, and I never wanted to feel that helplessness ever again.

The second thing that convinced me to go into nursing was a conversation I had with a friend of mine. She was trans, she couldn’t get an appointment with a healthcare provider. She was running out of hormones for hormone replacement therapy and she told me how scared she was that she was going to lose all the progress she made.

I’m a trans woman and I, too, have that same fear that I’ll be forced to detransition through lack of healthcare coverage and I imagine it is the same for most of the trans community. With that in mind, I don’t want anyone in my community to ever have to be afraid of not having access to someone who can help them get the care they need.

So, given those reasons, I figured, why not be a nurse? Why not a nurse practitioner? So, that is the path I’m on, though I still have a ways to go.

You are in a unique position as a transgender woman and nurse. What are some hardships you have had to face? How have you been able to overcome them? Do you find your industry supportive?
It can be, understandably, difficult sometimes to balance my identity as a trans woman and my work as a nurse. As a nurse, when a patient is placed under my charge, it’s my duty to care for that patient to the best of my ability, regardless of their belief regarding whether or not someone like me deserves equal rights or even just the right to exist. And make no mistake, I adhere diligently to that duty.

All that to say, as diligent as I am to my duty, it doesn’t mean that it’s always easy to retain that sense of compassion I strive for when faced with transphobic patients who openly deride and mock the trans community. For instance, as a bedside nurse during the 2024 election, I inevitably had to listen to extremely hateful rhetoric about me and my community, from both patients and the media they watched; rhetoric that ranged from simple ignorance to complete and utter cruelty.

When you hear that people in the trans community are discussing emergency evacuation plans, plans that require them to upend their lives and flee to another state or even another country, and are openly struggling depression and suicidal thoughts aggravated by the current political climate; it makes it difficult to offer the same level of compassionate care to patients who are rooting for a Trump victory and rooting for the erasure of trans people. But I still have to do my duty. I still have to provide the same level of care as I would for any loved one — so, I do.

For example, I actually began my nursing career working in an oncology ICU, taking care of patients that have needed extensive amounts of care, from chemo reactions, bone marrow transplant patients, patients with graft vs host disease, patients who have neutropenic fever, to just patients who have simply wasted away. I recall one patient, an ardent Trump supporter, receiving a slow infusion of bone marrow; this procedure was literally his last resort. He told me that he couldn’t wait for trans people like me to be put in camps; all the while, I am carefully monitoring that delicate procedure, watching his vital signs, giving him non stop antihistamines, and carefully watching the drip rate of bone marrow. That patient hated me, not for anything I’ve done, but for just existing, yet still, I was fighting tooth and nail to keep him alive.

Another area that I face difficulty in is that as a trans woman, I face many of the same frustrations and hardships that a cisgender woman might, such as being sexually harassed, but often with an additional layer of complexity. Some absolutely refuse to take it seriously when I mention that a patient touched me inappropriately. In one instance, I was touched inappropriately by a patient, reported it, and I was still assigned to that same patient the next day. The patient file had a memo directing that no female nurses be assigned to him, and yet, I was still assigned to that patient, my assailant, the next day. The charge nurse who had read the memo didn’t interpret the fact that I, being a trans woman, would fall under that category, resulting in a situation where I had to take care of someone who dehumanized me.

I wish I could give some constructive advice on how someone like me could keep fulfilling their duty in that sort of situation, day after day. All I can say is that I still come into work with the same mission I always have: To take care of my patient and to make sure that they make it to see the next day. Maybe it’s not the most inspiring mantra, but it helps me make it through a shift.

As for the healthcare system being supportive of me as a trans nurse, I would say it has been supportive in a sense, although individual bias can dampen a lot of that support. Though I’ve had coworkers dismiss my concerns or not take them seriously because I’m trans, I’ve also had many coworkers who were supportive of me and my identity. I’ve even had doctors stand up for me and chastise patients for inappropriate behavior. So in some sense I have support, in another sense I don’t. It really varies from person to person.

What are some injustices you are seeing happen as a healthcare worker?
A hospital’s goal is ultimately to serve the surrounding community and provide the healthcare one needs to live a healthy life. At the bare minimum, even if you can’t afford it, a hospital is legally obligated to provide enough care to stabilize a patient so they don’t die regardless of income, legal status, etc.

I am fortunate that the hospital I work at still provides quality care regardless of the background of the patient. We, as nurses, should make it a priority to provide the same level of care regardless of who someone is. With this in mind, we have provided care for everyone from unhoused individuals, to uninsured undocumented patients, to prisoners with the same expectation of care as everyone else.

This, unfortunately, may vary depending on the individual bias of the nurse caring for the patient; some may have an inherent mistrust of their patients. I’ll give a simple example: A trans woman going to the Emergency Room for intense abdominal pain only to be brushed off as drug seeking behavior. While I wasn’t the nurse in question who failed to acknowledge the patient’s pain, I’ve still heard stories similar to that encounter which boil my blood. Was she being brushed off because the nurse was burnt out or was it because the nurse in question saw a woman in pain, saw what she looked like, and labeled her an addict on the spot?

You’ll find a lot of cases of individual bias affecting our ability to perform our jobs and how we treat our patients.

Systemically, it is difficult to assess what injustices I see as a nurse; often most injustices involve treatments being declined by the patient - treatments that can potentially save lives - because the cost of treatment is too high due to the insurance company turning down coverage. This breaks my heart. It seems that a lot of the barriers to care for expensive therapies such as chemotherapy or immunotherapy tend to be financial. While you have doctors willing to go the extra mile to push insurance companies into approving a treatment, it still hurts to hear those conversations when I’m providing care for a patient who clearly needs that treatment.

I am fortunate that I live in a state that protects individual rights, but I hear nightmare stories of states refusing treatment - for example abortions - because of state laws, resulting in patients being put in danger for things like ectopic or non viable pregnancies. It’s not something I’ve seen as someone in a blue state, but I shudder to think of this becoming the standard nationwide.

Many conservative state lawmakers are currently trying to create legislation banning the use of state and public funds for the coverage of gender-affirming care, including mental health counseling and therapy. What are your thoughts on how this will impact our current mental health crisis?
Our society has done a fine job in stigmatizing mental health. Now let’s go ahead and toss in the stigma of being queer or trans on top of that. Think about the weight it has on an individual to carry on with their day to day lives while not having the tools they need to function at baseline.

What I’m saying is that this will make things worse, way worse.

I always like to explain how gender affirming care is not the be-all-end-all of trans healthcare. It’s a big component sure, but it’s not the magic bullet that’s going to fix everything. What gender affirming care does for me is to take enough weight off my shoulders that I have the energy to work through all of my other problems. This includes seeking therapy, going to the gym, and actually caring about my body because, for the first time, I now feel as if I have a stake in my own well being. Take away gender affirming care, and it’s a slow death. I just can’t go back.

To add to this, there is a stigma that being trans is a mental health issue. Think about the reclassification of Gender Identity Disorder to Gender Dysphoria in 2013 in the DSM-5. Prior to the 2013 reclassification, Gender Identity Disorder was described as a mental illness that was the result of early irreversible interruption of brain development. Consider that definition as opposed to the post-2013 reclassification of Gender Dysphoria, described as the psychological distress over incongruence between sex assigned at birth and gender identity.

Being transgender was seen as a mental illness prior to 2013. And there are people who still believe this. If you listen to the rhetoric from conservatives they view transgender individuals as mentally ill. This was an attitude that went back as far as the 1960’s amongst the medical community here in Baltimore City. Johns Hopkins to be exact. At that time, being trans was viewed as a delusion.

Now imagine if we went back to that attitude. What if the scientific and medical community stopped treating the symptoms of gender dysphoria and went back to reclassifying trans folk as having a mental illness. The impact it would have on trans individuals would be catastrophic. Instead of focusing on the source of distress - working through the dysphoria of being born in the wrong body and helping someone feel like their complete self so they CAN improve their lives - the emphasis again returned to a trans person being seen as as mentally ill individual whose growth was somehow stunted. One is humane, the other, well, I can’t help but feel dehumanized.

The new “Big, Beautiful Bill” had its provision recently passed in the House where they striked the phrase “for minors only” on the issue of banning Medicaid from covering gender-affirming care. Now, if passed, this bill will ban Medicaid from covering gender-affirming care for individuals of all ages. What are your thoughts on this legislation and the change to it? How will this affect the amount of individuals who are able to receive gender-affirming care? How will this affect those who are currently receiving gender-affirming care covered by Medicaid?
The federal government, when it comes to healthcare, sets the standards. What was healthcare like before medicare and medicaid? Everything was fee for service. You chose the hospital, you got charged for your service, and insurance - assuming if you had it - helped pick up the tab. In short, you were charged whatever fee the hospital or physician charged you and you simply had to pay it.

Medicare/Medicaid comes along and then we start seeing limits on what can be charged and fees for services are agreed upon ahead of time, not afterwards. This starts setting standards on what can be charged, how much can be charged, and this in turn cut down (in theory) on waste. Where the government went, private insurance followed. Those standards set by the government led to modern practice.

So, with that logic, what do you think private insurance will do once Medicare stops covering gender affirming care? Will my insurance company pay for the cost of estradiol knowing that Medicare no longer covers it? Honestly, I don’t know but I doubt it.

Now, let’s talk about the trans community, a population that has poorer health outcomes and lower incidence of private health insurance, as well as growing mistrust towards the medical community. In a 2022 nationwide survey conducted by the National Center for Transgender Equality, 28% of respondents disclosed that cost of healthcare was the barrier to not seeing a doctor. That’s 28% of the 92,329 respondents who can't afford to see a doctor. That’s 28% of individuals who didn’t get preventative care, who did not get their vaccines, who just simply couldn’t afford to be healthy. And that’s WITH medicare covering gender affirming care. I’m not sure of the specific rates of trans individuals reliant on Medicare but I do know for a fact that if Medicare drops trans health coverage, that percentage will climb dramatically.

The demographics for the trans community compared to their cisgender counterparts already shows a massive economic disparity and a disproportionately higher rate of morbidity and mortality. In a study of private insurance data from 2011 - 2019, the portion of the cisgender cohort who lived to the age of 80 was 62.4% as opposed to the only 41% of transgender cohort who made it to the same age.

But cut off their access to care and what do you think happens to those numbers over time? It’s taking a population that’s already suffering and making their lives shorter and worse.

What are your thoughts on the UK Supreme Court’s recent ruling on the legal definition of a woman for the specification of their Equality Legislation?
The recent ruling was an absolute travesty without basis in scientific fact and will, with almost certainty, result in a regression of transgender rights, not just for those in the UK, but across the globe; not to mention the erasure of the intersex population. The ruling weighed too heavily on arguments made by TERF and “gender-critical” advocates while all but bypassing, not just scientific finding, but also the lived experiences of trans people.

The UK court wants to draw lines at what they call “basic biology,” but the fact is, the biology isn’t basic — only their understanding of it is. Even a cursory glance into the actual science of biological sex would show that it’s not so simple to draw lines between the male and female sex — and the biggest reason that it’s so difficult is because there really ISN’T a clear line, but rather a fuzzy spectrum in between the two. When the court refers to a person’s biological sex, are they referring to their sex assigned at birth? What if hormonal or genetic variations change how the person develops later on, pushing them to be better categorized as a different sex? Are we speaking about genitals? If so, are we referring to the internal or external genitals? Because they don’t always match. And what if both sets are present? What if they’re later removed? How about chromosomes? Those are also not as cut-and-dry as anti-trans advocates want you to believe, especially given the discovery of the SRY gene. If a person with XX chromosomes also carries the SRY gene, they will develop as a male. So what’s their “biological” sex then?

And make no mistake, being in this fuzzy spectrum area of biological sex isn’t as rare as many people believe. In fact, studies estimate the intersex population to be just a bit under 2% of the total population - about the same percentage as people born with red hair.

And frankly, it feels demeaning to have the entire experience of womanhood be reduced down to “Who’s got a hoo-ha?”

Defining a woman like this hurts everyone; it hurts trans women because we are now seen as men, and it hurts cis women and cis men because it negates their lived experiences down to oversimplified biology. Imagine having your entire essence being dumbed down to just your genitals. Your lived experience, your identity, everything is just homogenized to a set of generalities. Frankly, I am absolutely horrified that women like JK Rowling would shoot themselves in the foot like this.

And on a more personal note as a healthcare provider; biological sex does not take into account social determinants of health. Gender does; that’s literally the reason why that division was established back in 2001. Think about how differently society treated men vs. how women were treated? Even in medicine! Folks didn’t even take into account that women had different symptoms prior to heart attacks than men. How many lives could we have saved? How many women have stories of their health being put to question, being labeled as hysteria, not being taken seriously in the doctor's office, is that because of their chromosomes? Or is it because of the way society treats gender?

While transgender individuals are still protected under the UK’s Equality Act, they are no longer protected by the legislation specific to the gender they identify with. What sort of implications do you think this ruling will end up having?
Oh, the implications are huge and they’re awful. If you’re not providing gender-specific protections to transgender people, then you’re not really providing them protections. For instance, excluding trans women from gender-specific protections would exclude them from labor protections when it comes to hiring and equal pay. It might exclude them from receiving help or protection when applying for government benefits or when seeking shelter and counseling for abuse. Even something as simple as using a bathroom becomes a harrowing decision.

I already see the impact of the ruling in my support groups. Trans folk dread going out, folks worried that they’ll need to detransition just so they can do simple things most folks take for granted. Sure, trans protections are technically still in effect; feel free to express your gender, call yourself whatever you like, get that Gender Recognition Certificate - but it doesn’t mean much if your transitioned gender is treated equally to a gender assigned at birth. The court decision essentially demotes the Gender Recognition Certificate to the same status as a paper Burger King crown.

How can you both legally protect trans women from discrimination while at the same time excluding them from single sex spaces?

Is it even protection at this point?

And let’s delve into the idea of enforcement. We have similar controversies regarding the use of single-sex spaces here in the US as they do in the UK - most notably, the “bathroom issue.” Let’s say that trans women are barred from using women’s bathrooms. How are you going to enforce it? Do you just go by the honor system? Or do you start demanding to see IDs at the door? What happens if a cis woman who is non-gender-conforming or simply has male hormonal traits, like facial hair, tries to use the bathroom? Do you demand she show her genitals to make sure she’s “safe?” Far from being a hypothetical, this same situation has already happened in the US. The fact is, when you diminish the rights of the trans community, you end up diminishing the rights of non-trans people as well.

And on the topic of the interconnectivity of trans right with those of non-trans people, the acceptance of this ruling also marks a distinct backslide toward the philosophies of biological and gender essentialism; philosophies that have long been used to restrict the rights of women, not expand them.

What makes all of this even worse is that the impact of this ruling won’t be limited to the UK. Major court rulings in countries like the UK and US have significant influence globally, for better or for worse. Other countries WILL use this ruling as a basis for their own gender-related legislation, causing a cascading effect of crises for the trans community around the world.

What are your thoughts on parliaments, like Hungary’s, making it illegal for individuals to change their gender altogether?
Let me preface this by saying, I don’t know much about Hungary because, honestly, everything about Viktor Orban disgusts me. But what I can do is put myself in that situation because that may very well be where the US is headed in the near future. Obviously, I oppose such measures. They’re foolish and transphobic, and I’ve discussed many of the reasons why earlier when discussing the UK’s recent rulings.

But on a personal level, if I was told by the government that I couldn’t change my gender, it’s not as if it would change who I am. I am who I am; I always will be who I am. The government can’t change that. If the US made being transgender illegal, it wouldn’t change the fact that I am transgender. You cannot change that simple fact.

And what I do know is even if they make me illegal, I’m still here. They can’t erase me. Even if they close their eyes and refuse to look, I still persist.

What are ways our readers can support the transgender community and advocate for their rights? Could you list a few organizations we should be supporting?
Support your local fighters first. These are your local champions for trans rights and they are some of the most effective advocates. In Maryland, it’s Trans Maryland. There’s also organizations like Baltimore Safe Haven who provide crucial support, like housing and assistance for homeless trans folk. And there’s Freestate Justice, who provide free legal services for members of the LGBTQ community. Find the helpers and give them the resources they need to fight.

On a national level, consider supporting organizations like the Transgender Legal Defense and Education Fund, the Transgender Law Center. Also consider supporting the National Center for Transgender Equality, which did valuable research with their nationwide survey and helped to put the trans experience into hard numbers. And of course, the Trevor Project provides critical counseling and advocacy for not just trans people but across the whole spectrum of the LGBTQ+ community. All of these are fine resources to support.

But quite possibly the most important thing people can do to support the trans community is to get involved themselves by interacting with their local governments and communities. Write to your senators, call them, let them know what you think of the spending bill that passed the house, tell them that you support transgender rights. Hold your elected officials accountable. Show up to pride, make trans friends, use the right pronouns, and provide that safe space for the trans people in your lives.

Lord knows, we need them.

What is some advice you have for someone who may be a part of the transgender community but fears the judgement and discrimination that unfortunately comes with expressing their true self?
There are always going to be people who tell you to be out and proud about your identity, no matter what. But the truth is: Safety comes first. There’s no shame in staying in the closet or on the down low for a while; your safety is the most important thing ALWAYS. You do what you need to do to live and survive. Find your online community, find folks that fulfill you, find ways you can be happy; but there is absolutely no shame in not being out and proud — especially right now. You know who you are inside. You already know in your heart of hearts your true identity. No one can take that away from you.

What do you think the next few years will bring for the transgender and LGBTQ+ community?
It’s going to be a battle, and not a pretty one. We will be fighting tooth and nail to preserve what we have and to resist any further backslide. We’re already exhausted but we’ll have to keep fighting. We have to resist and press forward — there’s simply no other acceptable option.

It’s not looking good.

A lot of the queer community is considering leaving the country. What are your thoughts on this?
Honestly, it’s understandable, and I don’t blame anyone from the queer community who is considering leaving or has already left. This country is revealing itself to be less and less safe for queer people, especially trans people, in the light of this current administration. Personally, I intend to stay and fight for as long as I can, but even I've thought about needing to evacuate the country for my safety. I’ve been asked more than once where my line in the sand is — at what point do I finally flee? And I’ve always said, I’ll stay until they start rounding us up for the camps. Maybe it will happen, maybe it won’t; I don’t know. But in the meantime, I am staying here to fight for the ones who CAN’T leave.

It’s been a rough few years, and we expect at least four more. How have you been staying positive?
Being passionate about a cause is a strong motivator to keep going. I’m working hard for that nurse practitioner degree because I want to be there in the front lines in the fight for trans healthcare. Having a goal to work towards keeps me sane; it keeps me going.

On a social level, I find solace in my found family, my partner whom I love dearly, and those who give my life purpose and whose presence heals me. As a nurse we are taught that the sick can’t give the sick the care they need. You must heal yourself before you can heal others.

What is your motto in life?
F-ck it. It’s not the most professional motto, but, hey, it’s the motto that got me this far. It got me through nursing school, it got me through the board exams, and it’s getting me through bedside nursing.

To learn more about transgender health, please check out the links below:
Of course, I’m a firm believer that knowledge is power so I’m going to give you links to some resources I listed above as well as for some websites where folks can learn about transgender health.

Maryland specific

https://transmaryland.org/

A resource for transgender individuals in Maryland, resources include health related resources to legal resources such as name changes etc.

https://freestate-justice.org/

Advocates for the LGBTQ community here in Maryland, they provide legal services as well

Baltimoresafehaven.org

Resource for transgender housing insecure individuals

Nationwide

Transequality.org

Fantastic resource for trans folk as well as a trans 101 section to learn more about transgender people. There’s also a US Trans Survey that they do which lead to the Health and Wellbeing Report, the latest one released in June of 2025. These reports are cited by academic sources for vital statistics involving the transgender community. A lot of the statistics I’ve mentioned came from reports that this organization has done.

https://translifeline.org/

Trans lifeline, community support for trans people nationwide. Run by trans people for trans people. This one is an obvious choice

Worldwide

WPATH - World professional association for transgender health
- Amazing resource for healthcare professionals, first and foremost WPATH publishes the standards of care manual for transgender individuals. What this manual is a manual that outlines standards for treating transgender individuals. For example, how long must someone be on HRT before gender affirming surgeries, when is it appropriate to provide gender affirming surgeries to transgender youths etc. Contrary to Donald Trump’s claims you can’t just go get gender affirming surgery, there are certain criteria you need to meet and a lot of those criteria are set by the peer reviewed studies in the WPATH manual.

And you can find Sam’s IG here: spoopytransbikeraunt and Facebook here: sam.lee.746463

Sam Lee on the Importance of Transgender Healthcare and Rights