Trans Care Clinics, Complying in Advance, Leave Patients Unsure of What’s Next

“Many were simply told that services would no longer be available, with little to no guidance on what to do next.”

Debster88 // CHLA // Wikimedia Commons

Editor's Note: Most sources in this article have been granted anonymity.. This is due to increasingly violent attacks against trans-affirming parents, activists, patients and health care providers.

Last week, the Children’s Hospital of Los Angeles’ (CHLA)—which houses one of the largest and oldest gender-affirming care programs for youth—announced it was closing its gender clinic doors, citing pressure from the federal government.

It is among the latest gender care facility to cease or restrict its care amidst the Trumpian anti-trans wave, which resulted in a series of executive orders signed at the beginning of his second term. Subsequently, the Centers for Medicare and Medicaid Services sent a May 28 letter to hospitals across the country pushing a pseudoscientific report on trans-affirming health care, penned by an anonymous panel of government “experts.” It demanded that, within 30 days, gender-affirming care providers have to fork over detailed financial records pertaining to the care of trans patients. It also directed providers to create new treatment guidelines replacing globally-renowned best practices with the recommendations of Trump’s highly propagandized report.

A recent statement by the World Professional Association for Transgender Health (WPATH) denounced this report in the strongest terms, arguing that while ongoing research is still vital, Trump’s report is both dangerous and wrong.

“Policies affecting transgender health must be informed by recognized experts and guided by clinical evidence, not ideology,” it said.

Nonetheless, new closures and restrictions may be imminent in the aftermath of Wednesday’s Skrmetti decision, in which SCOTUS greenlit anti-trans health care bans for youth.

Care Restrictions from Coast to Coast

Following the May 28 letter, Erin in the Morning received reports from across the country of further health care restrictions for youth beyond CHLA. One nurse said that Stanford Health quietly ceased offering new puberty blocker implants or gender-affirming surgeries to trans patients under 19. (Stanford will continue to offer replacement implants, the source said, and that new patients may still be offered other kinds of hormone therapies.) Meanwhile, the University of Pittsburgh Medical Center (UPMC), which had previously stopped accepting new patients under 19 years old, has now begun cancelling many appointments for youth altogether, one clinician in Pennsylvania said. In addition, Penn Medicine announced publicly that it would no longer perform gender-affirming surgical procedures for trans minors.

Most recently, Montana media reported that Missoula’s Community Medical Center (CMC) will stop providing “gender-affirming care” for those under the age of 18.

None of these medical institutions responded to requests for comment.

Parents, clinicians, community advocates and trans people impacted by these restrictions report that the fallout has been saturated with confusion and panic. Patients are finding out about their loss of care through the news. Doctors are reticent to so much as offer a referral, lest they be targeted by federal prosecutors.

“I could get killed for doing this.”

For some parents, such as Diana—a California parent of a 14-year-old transgender boy—getting gender-affirming care for her son has been life-changing, but also Sisiphysian.

She says her child’s top surgery changed his life. “The joy that we all experienced with him going through this was extraordinary,” she told Erin in the Morning. “It has made him a new person.”

It also required a level of privilege—Diana devoted herself to countless hours of health advocacy navigated endlessly frustrating and complex bureaucracies. “When you’re talking about families where people don’t speak English, where they don’t have insurance, what is this supposed to mean for them?” she said.

But the road to her son’s transition was also paved with terror. She recalls being asked to sign a form at the eleventh hour that would waive her son’s privacy rights, should the federal government inquire about her son’s medical records in regards to gender-affirming care. She remembers a surgeon saying over and over, “I could be killed for doing this.” And she recalls a heated phone call with a senior hospital administrator, where she begged officials to fight for her son’s care legally.

“I was like, ‘So, what are you doing to show families that you think that this care is worthwhile?’” she told Erin in the Morning. The answer he gave, as Diana remembers it: “On trans visibility day, we will hang the trans pride flag in front of our hospital.”

The Real Cost of Trans Care—And Trans Care Bans

Dr. Tyler Titus, Vice President Erie City Council in Pennsylvania and a practicing Licensed Professional Counselor, treats trans youth who often receive care through UPMC, one of the facilities that has reportedly begun withdrawing care after the May 28 letter.

Titus saw saw an “immediate spike” in suicidal ideation and emergency care sessions among their trans patients, who may now be suddenly and forcibly detransitioned if they cannot find another provider.

“Many were simply told that services would no longer be available, with little to no guidance on what to do next,” Titus said.

Like many care restrictions across the country, Titus said UPMC’s new policy did not only affect minors.

“As both a therapist and an advocate, I’ve sat with young people, legally adults at 18, who are navigating the crushing weight of a system that tells them they are old enough to be compelled into military service, but not old enough to make decisions about their own bodies,” Titus said. “The contradiction between being deemed ‘old enough’ to sacrifice your life for your country and ‘too young’ to advocate for your truth is not just hypocrisy, it’s cruelty.”

A Double Standard

“Gender-affirming care” has become a buzzword for trans issues, but in actuality, it encompasses many long-standing, evidence-based medical interventions for a variety of health issues—from puberty blockers, to hormone replacement therapy, to surgical procedures, to behavioral health care (like psychotherapy).

Such interventions may be used to treat children of all genders and sexes, although only trans or presumed-trans people have been explicitly targeted by the government. (Of course, gential mutilation remains a perfectly legal and standard practice for intersex babies.) But the gender panic dragnet impacts anyone seeking these modes of care, regardless of the reason.

For example, breast reductions—aka “top surgeries”—are commonly associated with trans men, but the majority of these procedures are actually used on patients assigned male at birth to treat gynecomastia, an excess of breast tissue. And hormone therapies are overwhelmingly used for cancer patients, postmenopausal women and men with erectile dysfunction (ED).

“I think for the most part, providers will continue to do exactly what they're supposed to do, and deliver the care indicated for whatever condition they're treating a patient,” said Abby, a health care provider at a major hospital on the East Coast, which is still providing gender-affirming care—at least for now.

At the same time, she said, “I think there will be a not insignificant number of people either whose access is challenged, or whose providers are afraid to recommend legitimate first line treatments,” she told Erin in the Morning.

“We are seeing a situation where there is heavy anti-transgender sentiment that is causing providers to adopt a defensive crouch," said Alex Rate, legal director of the ACLU of Montana, to Montana Public Radio, in light of the Missoula’s clinic’s pause on care.

Abby compared it to stories emerging from red states, where anti-abortion laws have created a medical chilling effect; complex pregnancies are turning fatal or near-fatal as doctors back away from life-saving medical interventions that could be perceived as an unlawful abortion.

“I think the landscape has become so chaotic that no one knows what exactly they're allowed to actually do, so providers who do this work are fearful all the time,” she said. “It really is a total reprisal of the abortion playbook.”

“Pushing Back”

In theory, trans-affirming care is protected by many states’ laws, in spite of President Donald Trump’s anti-trans EOs and anti-trans directives from federal agencies.

In some states with strong trans protections, officials can put pressure on gender clinics to keep their doors open, as Attorney General Leticia James did in New York.

Despite California laws’ robust trans protections, Governor Gavin Newsrom does not seem inclined to act on them. He has taken a right turn on LGBT issues, sympathizing with the violent and anti-trans politics of Charlie Kirk on his podcast, “This is Gavin Newsom,” as well as cutting critical funding for LGBT services in the state. One parent of a trans kid said plainly, “Gavin Newsom has abandoned us.”

Some who spoke to Erin in the Morning saw the care stoppages or restrictions as a needless compliance in advance—and say hospitals should be doing more, including taking the administration to court over its potentially unlawful enforcement of its anti-trans policies.

Dannie Ceseña, Director of the California LGBTQ Health and Human Services Network, said there are options to fight back, but ceded that gender-affirming care providers are in a tough spot.

“Hospital systems are coming from a place of fear of losing federal funding,” Ceseña told Erin in the Morning. This is especially potent for the CHLA, which relies heavily on federal funds and serves a high population on state welfare. In an email leaked to the LA Times, executives lamented that “hundreds of thousands” of other children could lose their care without federal funds.

“I think what it comes down to is that Children's Hospital of LA and the Board of Directors are too afraid to push back on the Trump Administration, too afraid to file a lawsuit in collaboration with California and other states and institutions that are pushing back,” Ceseña said. “They are just caving because they want to protect their bottom line.”

But Ceseña and others who spoke to Erin in the Morning for this piece emphasized that appeasement will never be a viable solution. The threats to bodily autonomy and access to quality health care won’t stop at trans youth, or trans people, period. And while many institutions are turning their backs on trans patients, others across the country are finding unique ways to continue to serve their communities.

Some can pivot to private funds (such as philanthropic donations), as well as state-backed or county-backed grants. Other institutions reversed course after communities mobilized, protested, and phone zapped medical institutions and local legislators. Other trans health advocates have built coalitions with the reproductive health movement and broader health care initiatives—such as in Washington, where legislation to increase hormone therapy access for everyone, just trans people, gained bipartisan support and passed.