The weaponisation of the womb—where reproductive capacity is treated as the defining feature of womanhood—harms both transgender women and cisgender women who cannot or choose not to bear children, undermining their autonomy and reinforcing rigid reproductive norms within public health discourse. Simultaneously, transgender men, who face distinct reproductive and healthcare challenges, are often excluded from such conversations, underscoring the restrictive nature of dominant reproductive ideals and their failure to accommodate gender diversity. This perspective paper introduces the Empathy-Based Health Equity Framework (EBHEF) as a policy-relevant model for transforming public health systems towards trans-inclusivity. Grounded in the Ethics of Care, the EBHEF critiques exclusionary policies, institutionalised biases, and clinical pathologisation that together enact structural violence against transgender communities. Rather than treating empathy as an individual disposition, this framework embeds it as a structural principle within health policy-making, service planning, and management. To operationalise the EBHEF, the paper applies the CARR model—competence, attentiveness, responsibility, and responsiveness—as the foundational pillars for inclusive public health systems. This paper argues that advancing transgender health equity is not merely a matter of service provision but a systemic imperative. Public health systems at national, regional, and local levels needs to reimagine governance structures and planning processes to ensure that transgender people are not just included but recognised as co-architects of a just and flourishing health system.