Within hours of the start of his second administration, on January 20, 2025, President Donald Trump signed an executive order proclaiming that the country would now recognize only two sexes, male and female, essentially rejecting transgender identity, and directing all federal agencies to use the term “sex” and not “gender” in applicable federal policies and documents.1 The declaration came a month before the results of a new Gallup poll showing that 1.3% of Americans identify as transgender, which is up from 0.6% in 2020 and higher than other large surveys have found in recent years. In addition, the polling results showed that nearly 1 in 10 adults identifies as lesbian, gay, bisexual, transgender, or queer (LGBTQ), nearly triple the number since Gallup began polling the question in 2012 and up by two-thirds since 2020.2
Since the executive order was signed, researchers studying LGBTQ health have had their federal grants terminated, and government programs that promote diversity, equity, and inclusion (DEI) have also abruptly ended. According to an analysis of federal data by The New York Times, of the 669 grants that the National Institutes of Health (NIH) had cancelled in whole or in part as of early May, at least 323 related to LGBTQ health. The grants totaled more than $800 million.3 The upheaval caused by the cancellation of federal funding in health equity and diversity research intended to improve the lives and health of LGBTQ individuals—who often face greater risk factors for developing cancer and worse outcomes than those in the general population4—as well as other underrepresented individuals, is being felt across the country.
In late January, Mandi Pratt-Chapman, PhD, Associate Center Director for Community Outreach and Engagement, and Associate Professor of Medicine at George Washington Cancer Center, was among those researchers who received notification that her large-scale, NIH-funded study had been terminated. The study, “Sexual Orientation and Gender Identity Data Collection in Community Oncology Practice,” was examining effective ways to collect data in cancer care settings on the sexual orientation and gender identity of patients to help assess and reduce disparities in care; it was one-third through completion when the grant was pulled.
“With the NIH funding terminated, I’m most worried about LGBTQ patients living in rural areas, because that is where these individuals often feel isolated and reticent to access health care.”— Mandi Pratt-Chapman, PhD
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Dr. Pratt-Chapman’s research was also partially funded by ASCO to identify the key difference-making factors that distinguish ASCO members’ institutions that collect sexual orientation and gender identity data from those that do not. The results of that part of the study found that three factors consistently distinguished sites routinely collecting sexual orientation and gender identity data from institutions that did not. They included leadership support in collecting this information, electronic health record structure to incorporate sexual orientation and gender identity data, and clinicians consistently asking patients about their pronoun preference.5,6 A qualitative explanatory analysis of the study is expected soon.
The ASCO Post recently talked with Dr. Pratt-Chapman about the loss of her NIH grant, the status of her research data, and the impact the elimination of DEI programs and funding is already having on LGBTQ+ patients with cancer.
Determining How LGBTQ+ Patient Data Are Collected in Oncology Practices
Please talk about how you learned your NIH grant had been terminated?
Shortly after presenting the data on our study at a national meeting, we received a call from our National Cancer Institute program officer instructing us to stop our study by 5:00 PM that day. We alerted all of our recruited sites that we could not proceed with collecting data and confirmed to our program officer via e-mail that we had complied with the request. Other than that e-mail documenting the verbal exchange, I never received a written notice cancelling our grant.
If we had been allowed to proceed with our study, we would have had cancer centers in 33 states represented, which is substantial. I was so excited because we were learning about the geographic variances in how sexual orientation and gender identity data are collected, with the goal of informing interventions that could improve cancer care for LGBTQ patients. The part of the study funded by ASCO represents 17 states; those data have been analyzed and accepted for publication and will be released soon.
With the NIH funding terminated, I’m most worried about LGBTQ patients living in rural areas, because that is where these individuals often feel isolated and reticent to access health care. We wanted to expand our data set to understand what is happening for these patients. Having to stop this research is a huge loss to that understanding and to our efforts to alleviate health disparities in sexual and gender minority patients.
What happens to the data you collected from your NIH grant?
I have been told by NIH that we could analyze the data funded by the grant but couldn’t collect any more data, and I’m honestly not clear on what exactly is permitted. Given the rapid changes to what is being ordered day to day, we have paused the research and have analyzed only the ASCO-funded data for now.
Understanding How Cancer and Its Treatment Affect LGBTQ+ Patients
Please talk about the importance of this kind of research and how cancer potentially impacts LGBTQ+ patients differently from heterosexual patients with cancer.
LGBTQ+ patients, regardless of whether they are affected by cancer or another life-threatening disease, often have negative health-care experiences because of factors such as discrimination, stigma, lack of cultural competency among health-care providers, and insufficient training on the health issues affecting this community. In addition, we don’t do a good job in our cancer screening guidelines of accounting for differences in body composition, anatomy, and hormonal exposure in this population and the ways in which these differences may correlate with cancer risk to better guide cancer screening.
We also don’t know how cancer treatment may impact LGBTQ+ patients differently from heterosexual patients. For example, we know that cancer therapies sometimes have dissimilar effectiveness in cisgender men and women, but we don’t know how treatment effectiveness in LGBTQ+ patients, especially transgender individuals undergoing gender-affirming hormone therapy, might vary. This is why it is so important to continue research focusing on LGBTQ+ health, especially regarding cancer care.
Recognizing That Biological Sex Is Not Binary
The executive order signed by President Trump narrowly defines the sexes as male and female as determined by one’s anatomy at birth. How does limiting the definition to these two categories impact research on how cancer and other diseases affect LGBTQ+ individuals?
There are assumptions that human sex rests on a biological binary based on an individual’s chromosomes, but “biologic sex” is not that simple. There are variations in chromosomes and sex characteristics, often referred to as differences in sex development or intersex traits. To say that there are only two sexes and that all people have 100% typical female traits or 100% typical male traits and there is no variation in chromosomal arrangements, inherent variations in gene-expression patterns, and hormone levels in individuals is scientifically incorrect.
It is estimated that up to 1.7% of the global population has an intersex trait and that about 0.5% of people have clinically identifiable sexual or reproductive variations.7 Gender is separate from sex, and saying there is no such thing as gender and it’s an ideology is just not true. If you have biological traits that include both male and female typical traits, but you’ve lived your life as a woman and identify as a woman, you’re a woman, and that identity may be separate from what your chromosomal signature might be. When we ignore these differences and accept only the “mythical norm,” a concept coined by writer Audre Lorde, usually defined as someone who is White, thin, male, young, heterosexual, Christian, and financially secure, it leads to the marginalization of those who don’t fit this definition. By centering care only on this mythical norm, we provide suboptimal care for the vast majority of people in the world.
Losing Ground in Research in LGBTQ+ Patients With Cancer
Patients with cancer who identify as sexual and gender minority often report less satisfaction with the care they receive, and they are more likely to experience discrimination in health-care settings than non–sexual and gender minority individuals.8 How might limiting research to only male and female patients exacerbate dissatisfaction with the cancer care sexual and gender minority patients receive? And how might the ban on trans health research programs reduce providers’ knowledge about how to care for this patient population?
I’ve conducted several health-care professional surveys asking about clinician level of confidence and knowledge regarding treating sexual and gender minority patients with cancer, and the results show that generally clinicians report greater comfort and confidence in caring for gay and lesbian patients rather than transgender or intersex patients. When asked about treating trans and intersex individuals, a high rate of clinicians reported feeling unqualified to treat these patients, because they hadn’t received training in medical school. It’s not a question of not wanting to treat these patients; it’s concern by some clinicians that they may not be effective because they lack the training.
Terminating cancer research in LGBTQ+ patients will further limit our understanding of how to determine the most effective, evidence-based therapies to deliver appropriate tailored cancer care to these patients. We have already lost precious time in this important research. Through intimidation and all the chaos of the elimination of federal DEI programs and funding, whether the termination of these programs and grants is permanent or not, a large amount of damage has already been done in the increasing lack of trust among historically excluded patients. These bans are a huge hit for scientific research and for the patients we serve.
DISCLOSURE: Dr. Pratt-Chapman reported no conflicts of interest.
REFERENCES
1. The White House: Defending women from gender ideology extremism and restoring bilogical truth to the federal government. January 20, 2025. Available at www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/. Accessed May 19, 2025.
2. Miller CC, Paris F: Nearly one in 10 U.S. adults identifies as LGBTQ, survey finds. The New York Times, February 20, 2025. Available at www.nytimes.com/2025/02/20/upshot/lgbtq-survey-results.html. Accessed May 19, 2025.
3. Mueller B: Trump administration slashes research into LGBTQ health. The New York Times, May 4, 2025. Available at www.nytimes.com/2025/05/04/health/trump-administration-slashes-research-into-lgbtq-health.html. Accessed May 19, 2025.
4. Maingi S, Schabath MB, Dewald I, et al: Disparities uncovered: LGBTQ+ patients report on their cancer care journey. 2024 ASCO Annual Meeting. Abstract 1516. Presented May 29, 2024.
5. Pratt-Chapman ML, Mullins MA, Miech EJ, et al: Key difference-making conditions distinguishing ASCO members’ institutions that collect sexual orientation and gender identity (SOGI) data from those that do not. 2023 ASCO Annual Meeting. Abstract e18554. Publication only.
6. Pratt-Chapman ML, Miech EJ, Mullins MA, et al: Difference-makers for collecting sexual orientation and gender identity data in oncology settings. Cancer Med 14:e70727, 2025.
7. Medina C, Mahowald L: Key issues facing people with intersex traits. The Center for American Progress, October 26, 2021. Available at www.americanprogress.org/article/key-issues-facing-people-intersex-traits/. Accessed May 19, 2025.
8. Winstead E: LGBTQ+ voices: Listening to sexual and gender minority people affected by cancer. National Cancer Institute, May 1, 2024. Available at www.cancer.gov/news-events/cancer-currents-blog/2024/cancer-disparities-lgbtq-plus-people. Accessed May 19, 2025.
