I was invited to speak tonight as a member of the greater Attleboro community, in my new role as the Executive Director for the Attleboro Area Interfaith Collaborative. As an openly trans and queer individual, working with houses of worship and community organizations across Attleboro, Mansfield, Foxboro, North Attleboro, and Norton, I have been thinking about how religious and spiritual communities intersect with this historical moment of both repression and visibility for LGBTQ people in 2025.
I come to you today at a moment of significant challenges to the medical and legal rights of trans people in the United States. Before I begin, I would like to say that some of the information I will share is sobering and may be distressing especially if you or someone you love is trans or queer, so please take care of yourself while listening.
In January 2025, someone I know tried to get their passport updated. They wished to change their name, photo, and gender mark on their passport to reflect their gender identity as an adult. When they went to the passport office, the person working looked at them and sighed, and said, “We’ll see what we can do.” They did not receive their passport back for several days, receiving no communication about where their passport was, or what the status of the update was. They began to fear that their passport had been confiscated entirely. Finally, they got their passport back - an updated photo, an updated name, but the old gender marker remained. “At least you have a passport,” someone remarked, as though that rectified the situation.
In January 2025, our current president signed an executive order seeking to “redefine gender at the federal level, erase recognition of trans people in government communications, and block federal dollars from being used to “promote gender ideology.”’
Sweeping bans have been introduced preventing trans youth - children and teenagers - from accessing gender-affirming medical care. This health care includes gender-affirming surgery, as well as hormone replacement therapy. Human Rights Watch announced that 25 states “have enacted sweeping bans targeting this best-practice medical care, replacing gradual, evidence-based treatments with blunt and politically driven restrictions.” Even states where medical care for trans youth is legal have chosen to voluntarily stop or suspend services, including in New York, California, and Washington DC.
The House recently passed a bill that would prohibit Medicaid from covering any transgender health care for both adults and children. More than 300,000 trans people would immediately lose their coverage should this bill be signed into law. Coupled with this potential ban is a further provision, in which the Affordable Care Act is no longer required to cover gender-affirming care for adults as an “essential health benefit.” This means that insurance companies that sell plans on the market could voluntarily opt to drop their trans-related coverage. This seems like a real possibility, considering the precedent set by hospitals and providers in several states already.
The consequences of the increasing prohibitions on trans health care are significant. They are financial, medical, social, familial, and professional.
A 2024 study found that suicide attempt rates among transgender youth increased by as much as 72% in the first year after the adoption of state-level anti-transgender laws. In a 2023 study, more than 40% of transgender adults have attempted suicide, and over 70% have thought about it. Families in states where Medicaid coverage is excluded for transgender youth report facing high costs, with some quoted up to $26,000 every three months for necessary medications. Families in some states without coverage are fleeing to others, sometimes multiple times, as the price of gender-affirming treatments forcing them to choose between the health and well-being of their children, and the financial stability of their families. Since 2022, clinics, hospitals, and care providers have received increasing harassment, threats, online abuse, and even bomb and arson threats for offering gender-affirming care.
Like many of you, I read the news as soon as I wake up. Yet, I still find the summary of information I just shared to be devastating. I myself was on Medicaid for almost a year, where I received access to gender-affirming care. I was unemployed, looking for work, and certainly could not have afforded to pay out of pocket for care.
So why is trans medical care a Jewish issue? There are many ways to answer this question. Throughout the history of medicine, Jewish peoples have a deep involvement in the cultivation and practice of medicine, from the intellectual exchange between medieval Jews, Christians, and Muslims; to the development of Jewish medical ethics through the 20th century; to medical innovation funded by foundations and individuals guided by Jewish values. In the development of inclusive, LGBTQ-affirming Jewish communities, we are living in a moment in Jewish civilization, in which there is increasing leadership and recognition of trans rabbis, spiritual leaders, and Jewish educators; in which organizations like Keshet, SVARA, Eshel, and more educate and create resources for LGBTQ Jews; and in which new rituals, halacha, and liturgy are being written to affirm the spirituality and lived reality of trans Jews.
When I think about this question, I center it on the Jewish value of pikuach nefesh: preserving life. This is a principle in halaka, Jewish law, that the preservation of life overrides almost every other law in Judaism - which, if you know anything about halacha, includes many, many laws. This concept primarily derives from Leviticus 18:5, which reads:
Ush-martem et chu-kotai v’et mishpatai asher yaase otam haadam vachai bahem ani Adonai.
וּשְׁמַרְתֶּ֤ם אֶת־חֻקֹּתַי֙ וְאֶת־מִשְׁפָּטַ֔י אֲשֶׁ֨ר יַעֲשֶׂ֥ה אֹתָ֛ם הָאָדָ֖ם וָחַ֣י בָּהֶ֑ם אֲנִ֖י יְהֹוָֽה׃ {ס}
“You shall keep My laws and My rules, by the pursuit of which human beings shall live: I am יהוה.”
The Rambam interprets this source, saying [quote] “one shall live by them — but not die by them. This teaches that danger to life overrides the Sabbath laws and [all] the commandments.” In other words, the preservation of life is more important than any Jewish law. This is the reasoning behind breaking the laws of Sabbath to rush someone to the hospital; the positive commandment to eat on Yom Kippur if your life would be in danger; and the rationale behind organ donation.
We refer to this as pikuach nefesh. But what does pikuach nefesh mean, exactly?
Rabbi Benay Lappe writes that “nefesh” means life, or breath, but “pikuach” does not actually mean saving. The root is Peh-Kuf-Chet, which means “open,” or “to be aware.” So while Pikuach nefesh is often interpreted as saving a life; it can also refer to opening one’s awareness to the sanctity of life, taking steps to preserve life, protect life, care about life, and opening to one’s own radical possibilities of being alive.
But what is life?
Although I have studied the intersection of religion and politics for the past three years at Harvard, I still find it confusing when people and governments claim that they save lives through war and bombs. I don’t just mean wars on the ground near, or far from here. I also mean wars on books; wars on children; wars on health coverage; and wars on food banks. When I say bombs, I think not just of explosive devices, but also of the bomb in your email inbox, when you read the news, and feel like there’s a small explosion in your heart. The explosive impact of an executive order, a news article, or not knowing who - or what - sources to trust. It makes me wonder: whose lives are we saving through war and bombs?
And what is life? My partner is a biologist. They say that one of the most interesting things about studying biology is the opportunity to interrogate questions of what Life truly is. What does it mean to be alive at a molecular level? Who gets to define who - or what - is alive?
For those of us who identify as LGBTQ, many of us know that there can be several versions of being alive. If you had the experience of “coming out of the closet,” you may be familiar with a few different versions.
There is a buried life, in which you know things about yourself that have not reached the surface, like roots that have not yet sprouted for spring.
There is a heavy life in which you may know things about yourself - that you are gay, or trans, or just know you are different - but you have not told anyone, and it feels like you walk weighed down by a secret backpack.
There is a tender, blooming life in which your best friend knows that you want to go by a new name; or your mom knows you have a crush on someone of the same gender, and it is such a relief that someone, somewhere, knows.
There is a blossoming, glowing life, in which you march at Pride adorned in glitter, and wear the clothes you want, and feel free-er than you ever have.
There is a loving, rooted life in which you are accepted by communities who are different from you, where you find words and clothes that fit, and where you are open, yet grounded, in who you could become.
This trajectory of life is not something accessible, or even desired, by all queer and trans people. But one of the values of having access to gender-affirming medical care is the possibility of living many different lives in order to discover the one that suits you best.
When I came out as trans, my brother said, “Won’t that make your life harder?”
I will not lie - it did make my life harder. It made me sad, depressed, and angry at times. But it also opened up space for new kinds of wonder, joy, miracles, spirituality, relationship, and personal transformation. Some things were lost, and some things were gained. But it is living with complexity, nuance, and dynamic possibility that is part of becoming an adult, and living a full and rich life. When I struggled most with being trans, I called it my personal midbar, wilderness. Like the Israelite people, I wandered, got lost, made mistakes, and learned a lot along the way.
When I think about the stripping of access to trans medical care, we are denying the possibility of a full, rich life to trans people - especially trans youth. There is the increased possibility of life ending, whether through suicide, self-harm, or lack of access to hormones or surgeries. But there is also the denial of a fully-realized spiritual, emotional, and relational life.
In Qabbalah, the soul is divided into two levels: the nefesh and the neshamah. The nefesh is considered “the soul of the body,” the life force that animates all living beings. This is the nefesh of pikuach nefesh. Without the nefesh, one cannot access the neshama - the next level of the soul. The neshama is the spiritual, divine part of the soul. It is from the neshama that we develop a deep understanding of ourselves, do good in the world, and connect with G!d and our communities. When I think of pikuach nefesh, I think not just of saving life in the body, but opening to what life can be in the soul. If our bodies are safe, nourished, and cared for, able to access medicines, medical care, and affirming doctors and medical providers, then we are able to fulfill the potential of who we can be, how we can make our lives good and fulfilling, and develop a purpose beyond self-preservation.
As Jewish people, it is imperative upon us to protect life; to preserve life at all costs; to fight for the medical and financial needs of trans adults and youth; and to inspire others to continue our ancient tradition and the values that uphold it. It is incumbent upon us uphold the full depth of pikuach nefesh, so that all people can access their deepest potential.
I would like to conclude with a brief excerpt from an interpretation of Asher Yatsar, written by trans rabbi Elliot Kukla:
“Blessed are You,
Source of all life and form,
who implanted within us the ability
to shape and reshape ourselves—
molding,
changing,
transitioning,
and adorning our bodies—
so that the fullness of our many genders,
the abundance of our desires,
and the diversity of our souls can be revealed.”
Questions for discussion:
Imagine a moment in which everyone is able to access their fullest selves, their neshama and nefesh. What would that world look like?
How do you see pikuach nefesh being applied to other issues in our world today? Are there issues to which you think it shouldn’t be applied, or the application is too broad?
Many professions have a code of ethics they abide by - including medical professionals. Does your profession have a code of ethics? How does that inform the work you do? Do you see intersections between those principles and Jewish ethics and laws?
What is impactful about the Jewish people having a code of ethics / laws they are responsible to uphold?
Is there anything you’ve had to overcome in order to access your neshama - your fullest existence in life? Is there a moment in which your Nefesh - your life force - has felt cared for such that you were able to access your neshama - your higher purpose, spiritual self, or connected with G!d?
Given June 13, 2025, at Agudas Achim Synagogue in Attleboro, MA.