What to do
Work out which side of 17 March 2025 you are on
This is the whole question. VHA Notice 2025-01(1) allows cross-sex hormone therapy only for veterans already receiving it from the VA as of that date, or who received it as part of and upon separation from military service. Everything else stopped. If you were already receiving it, you are inside a written exception — say so in those words.
Get the decision and the reason in writing
Ask for the specific basis. A denial resting on the March 2025 notice is a different conversation from one resting on clinical judgement, and you cannot tell which you have until someone writes it down.
Start with the patient advocate at your facility
Every VA medical centre has one, and they are the fastest route to a decision being looked at again. This is not an insurance appeal and treating it like one wastes the first move.
Keep the care that is not affected
The notice explicitly preserves comprehensive health care including preventive and mental health care for veterans with gender dysphoria. That care is not discretionary and not something you should stop asking for. Nothing in the policy makes a gender dysphoria diagnosis a reason to receive less of anything else.
If you are outside the exceptions, plan for care elsewhere
Hormone therapy the VA will not start can often be obtained through community providers, a marketplace plan, or a state programme. That is a worse answer than the VA providing it, and it is better than months spent appealing a written policy that says no.
What the March 2025 notice actually says
VHA Notice 2025-01(1), dated 17 March 2025, rescinded VHA Directive 1341(4) — Providing Health Care for Transgender and Intersex Veterans, in force since May 2018 — citing Executive Order 14168.
Its operative paragraph allows cross-sex hormone therapy only where the veteran is already receiving that care from the VA as of the date of the notice, or where the care was provided as part of and upon separation from military service. Veterans outside those two categories are, in the notice's words, not eligible for cross-sex hormone therapy through VA health care.
Paragraph 6 is one sentence: the VA does not provide any other medical or any surgical therapy for gender dysphoria. Paragraph 5 preserves the rest — comprehensive health care including preventive and mental health care continues.
The notice is scheduled for recertification on or before the last working day of March 2030, and says it remains national VHA policy until recertified or rescinded. We read it directly from va.gov on 13 August 2026, which shows it is still published; it is not proof that no later notice has amended it.
The regulation underneath it
38 CFR 17.38 lists what the VA medical benefits package covers and what it excludes. Paragraph (c)(4) excludes, in two words, gender alterations. That exclusion sits alongside cosmetic surgery and unapproved investigational treatment, and it long predates 2025.
So the surgical exclusion is regulatory and the March 2025 notice is policy layered on top of it, narrowing hormone therapy that the directive had previously provided. They are two different instruments, and a decision citing one is not answerable by an argument aimed at the other.
What we have not verified
Whether VHA Notice 2025-01(1) has been amended or superseded since March 2025. We confirmed it is still published; we did not find a later notice, and not finding one is not the same as there not being one.
The VA's own appeal routes and their timelines. Higher-level review, supplemental claims and the Board of Veterans' Appeals are real machinery with real deadlines, and they belong to VA benefits law rather than insurance law. We have not read them, so this page does not give you a number.
The status of litigation. A challenge was filed in 2025 in the Court of Appeals for Veterans Claims. We have not verified where it now stands, and you should not plan around an outcome.
Common questions
- I was already getting hormones from the VA. Does this stop them?
- The notice's first exception is for veterans already receiving that care from the VA as of 17 March 2025. If that is you, you are inside a written exception rather than asking for a favour, and it is worth quoting the notice by name in any conversation about it.
- Is the VA the same as TRICARE?
- No. TRICARE covers serving members, retirees and military families and runs on 32 CFR 199 with its own appeal ladder. The VA is a separate system for veterans, provides care directly, and is governed by 38 CFR. If you have both, they are two separate questions.
- Does a gender dysphoria diagnosis affect my other VA care?
- It should not. The notice says veterans with a diagnosis or history of gender dysphoria continue to receive comprehensive health care including preventive and mental health care. If other care is being withheld or delayed on that basis, that is worth raising with the patient advocate specifically.
- Can I appeal the policy itself?
- Not usefully. A written national policy is not overturned by an individual appeal — the argument that gets somewhere is that the policy as written does not apply to your facts, most often because you fall inside one of the two exceptions.
Where to go next
Sources for the legal points on this page
- The VA stopped starting new gender-affirming care in March 2025
Federal — Veterans Health Administration · effective in force since 2025-03-17
VHA Notice 2025-01(1), 17 March 2025, Rescission of VHA Directive 1341(4); 38 CFR 17.38(c)(4) excludes "gender alterations" from the VA medical benefits package
Status: settled · source-checked 2026-08-13 · primary source verified: 2026-08-13
- Executive Order 14187 defines a "child" as under 19 and targets TRICARE and FEHB
Federal — executive order binding on DoD (TRICARE) and OPM (FEHB, PSHB) · effective signed 2025-01-28
EO 14187, 90 FR 8771 (3 Feb 2025), FR Doc 2025-02194 — sec. 2(a) definition of child, sec. 6 TRICARE, sec. 7 FEHB and PSHB
Status: settled · source-checked 2026-08-13 · primary source verified: 2026-08-13
Also on this page, without a citation yet
- VA's own appeal routes and their deadlines — higher-level review, supplemental claim, Board of Veterans' Appeals. Real machinery with real timelines that we have not read.
- Whether VHA Notice 2025-01(1) has been amended since March 2025.
- The current status of litigation challenging the policy.
- Whether and how community care referrals are affected.
These are specific and checkable and we have not yet checked them against a primary source. Treat them as a starting point rather than as settled, and do not put them in an appeal without confirming them.