Sustaining gender-affirming care in college health during times of uncertainty

Objectives: We argue that the current landscape requires not only clinical competency but also care systems capable of supporting providers operating within politically and organizationally ambiguous environments. More specifically, we propose a forward-looking framework that emphasizes actionable strategies to strengthen interdisciplinary collaboration, formalize community partnerships, and support sustainability. Background: Gender-affirming care in college health settings is supported by an evidence base demonstrating improvements in mental health, academic persistence, and well-being among transgender and gender diverse students. However, implementation has become constrained by legislative uncertainty, bureaucracy, and burnout. This commentary builds on the 2023 White Paper: Gender Affirming Care in College Health, the American College Health Association's Trans-Inclusive College Health Programs guidelines, and Ilgen and Dhaliwal's (N Engl J Med. 2025;393(16):1624-1632) article, "Educational Strategies to Prepare Trainees for Clinical Uncertainty." Conclusion: Such approaches are necessary to preserve access to affirming care and ensure continuity of services amid structural and policy-related pressures within higher education health systems.