"Even in states with legal protections, fear of federal funding withdrawal is forcing healthcare providers to abandon vital gender-affirming care for transgender youth, leaving families scrambling for alternatives."
The landscape of transgender healthcare for minors has become a volatile battleground, where political pressure and the threat of financial repercussions can abruptly halt access to life-saving treatments, even in states actively working to protect such services. This article explores the experiences of families navigating this complex terrain, highlighting the profound impact of these disruptions on young individuals and the broader implications for healthcare access.
In late 2024, a sixth-grader known by the nickname Bug, who was assigned female at birth, shared a significant revelation with his parents: he identified as a boy and would be using he/him pronouns. His mother, identified only as J to protect their family from potential harassment, responded with immediate support, asking, "What do you need to be supported?" Bug’s direct request for healthcare marked the beginning of a journey that would soon illuminate the precarious nature of accessing gender-affirming treatment.
J and her husband had anticipated such a moment, having moved their family from Texas to Massachusetts earlier that year specifically for the state’s more liberal and inclusive political climate. They believed Massachusetts offered a more supportive environment for their children, both of whom have autism, and for Bug’s burgeoning gender identity. However, they soon discovered that even in a state with robust legal protections for gender-affirming care, access could be unexpectedly curtailed.
This challenge is not isolated to Massachusetts. Across the United States, numerous hospitals, in both politically liberal and conservative states, have independently decided to withdraw gender-affirming care for minors. This trend intensified in the initial months of the Trump administration, with at least 20 hospitals ceasing or restricting such services. The driving force behind these decisions appears to be the administration’s threats to withhold federal funding or initiate investigations into fraud and wrongful claims related to gender-affirming treatments. Since then, the availability of these critical services has continued to decline.
Bug and his younger sister were born in Austin, Texas. However, their parents grew increasingly concerned by the state’s legislative actions, including the outlawing of abortion, the dismantling of diversity, equity, and inclusion (DEI) programs, and the curtailment of medical and civil rights for LGBTQ+ individuals. The parents feared that the essential support services their children, particularly Bug and his sister who both have autism, relied upon might be compromised. "I had a fear of being like the frog in the boiling water and not realizing what was happening until it was too late," J recalled, explaining their decision to leave Texas. "I needed to get the kids out of Texas."
Upon Bug’s coming out as transgender, J felt a sense of relief, knowing they had relocated to a state with a legislative "shield" law designed to protect healthcare providers offering gender-affirming care. Massachusetts also mandates that commercial insurance plans, like the one Bug’s family held, cover these services, a requirement in 24 states.
Following Bug’s gender announcement, J’s research led her to Baystate Health, the largest hospital system in western Massachusetts, based in Springfield. This marked the commencement of a months-long process to initiate hormone therapy for Bug. A vibrant and artistic 14-year-old with a passion for horses, cats, and filmmaking, Bug was past the age for puberty blockers but eagerly anticipated starting testosterone. He recognized the physical changes it would bring – a deepening voice, facial hair growth, and increased muscle mass – and expressed, "Every part of it sounds fun."
However, this hopeful trajectory took a sharp turn in February, just two weeks before Bug was scheduled to begin testosterone. Baystate Health announced it would no longer provide gender-affirming medications to minors, offering only counseling services. The letter sent to affected families offered no specific explanation for the abrupt change.
Heather Duggan, a spokesperson for Baystate Health, provided a statement explaining that the decision to discontinue treatment for minors was driven by the potential loss of "hundreds of millions of dollars in government reimbursement" due to the Trump administration’s policies. She noted that "Nearly 70 percent of Baystate Health’s patients rely on Medicaid and Medicare for coverage." For Bug, this meant the eagerly awaited medical intervention was suddenly out of reach. "I felt frustrated that they would do that," Bug stated. He articulated the disappointment felt by many young people: "I bet there’s tons and tons of kids who are like: ‘OK, I’m going for trans-affirming healthcare. Yay!’ And then, like, tons and tons of kids were disappointed and sad and frustrated."
J expressed her shock, admitting, "Maybe this is naive, but I didn’t think that would happen in Massachusetts." Baystate Health’s decision placed it among a growing number of providers hesitant to offer puberty blockers and hormones as the legal and political landscape surrounding these treatments remained in flux. This spring, Massachusetts joined a lawsuit challenging the Department of Health and Human Services’ threats of withholding federal funding from providers offering gender-affirming care to minors. A federal judge had previously ruled such threats unlawful. Further legal actions were underway, with another federal judge in June allowing 16 states, including Massachusetts, to proceed with a lawsuit against the administration concerning its efforts to criminalize gender-affirming care.
The American Academy of Pediatrics, while declining an interview, reiterated in a past statement its stance that decisions regarding gender-affirming care should be made by young patients and their families in consultation with their doctors, emphasizing that such care should be "delivered with compassion, and offered without political interference."
One mother, who asked to be identified only by her first initial, L, shared her experience as a former Baystate patient’s mother. Before her daughter came out as a transgender girl, she had been struggling with severe depression and suicidal ideation. L recounted that after Baystate doctors prescribed puberty blockers and estrogen, her daughter’s mood and academic performance improved significantly. The news of Baystate discontinuing medical treatment left L "furious." She and other parents subsequently filed civil rights complaints with the Massachusetts attorney general. The attorney general’s office did not provide a comment on the matter. "There’s a sense of, ‘How could you?’" L stated. "And there’s also the awareness of the impact just pulling care could have on a youth – from a physical health perspective but also from a mental health perspective."
Both L and J managed to secure alternative care for their children. L’s family found their primary care doctor willing to take over hormone prescriptions. Bug’s family was referred to Transhealth, a private specialty clinic in Northampton, Massachusetts, which reported taking on approximately 50 former Baystate patients. Jo Erwin, CEO of Transhealth, explained that the clinic had been proactively expanding its capacity in anticipation of such disruptions across the state. Transhealth, she noted, is less reliant on Medicaid and Medicare funding due to substantial private donations, allowing it to better withstand funding threats. However, Erwin expressed concern for the broader LGBTQ+ community, stating, "When you see something like that go down, people get scared that it’s ultimately going to happen to everyone."
The legal battles surrounding transgender youth care continue to unfold across the nation. In May, Colorado’s Supreme Court ordered a children’s hospital to resume gender-affirming care for transgender youth, while in Texas, a court settlement compelled a children’s hospital to establish the nation’s first "detransition clinic." The Trump administration has persisted in its efforts to pressure providers, including by seeking the medical records of transgender minors.
Despite the setbacks, Bug was able to begin testosterone therapy at the new clinic in the spring. His mother, J, reported that the treatment is progressing smoothly, and Bug has become adept at self-administering his injections. Nevertheless, J remains apprehensive about potential future federal interference that could disrupt his care again. She has even questioned their decision to move from Texas, at times wondering if seeking care in Canada might have been a more secure option.
This article was produced through a collaboration involving New England Public Media, NPR, and KFF Health News.
