Trump Banned Gender-Affirming Care for Teens. Now, These Families Are in Chaos

Yahoo

20-02-2025

Gender expression can come in many forms, but for a kid I'll call Sarah, it first came in the form of a pair of owl pajamas. They were soft cotton, with wide-eyed owls cavorting on a pink background, and at 18 months old, Sarah would wriggle her way out of her 'boy' clothes and into the pajamas as soon as she got home from preschool, toddling back into the living room pleased as punch with herself. 'She was so, so determined,' says Sarah's parent Ingrid (who has asked in this article to go by her middle name). 'Like, 'No, this is actually what I want.''
At age two, Sarah came across a rack of dresses hanging outside a store and tried to put one on right there on the sidewalk ('You look beautiful,' an older woman said in passing, to Ingrid's relief). At three, according to Ingrid, Sarah began to 'socially transition herself,' asking to grow her hair out, gravitating in the aisles of Target toward sparkly dresses in hues of Pepto-Bismol pink and to anything having to do with unicorns. In kindergarten, Sarah said she wanted to change her pronouns. In first grade, she said she wanted to change her name. Somewhere along the way, her parents went to see some specialists to ask for advice on how to handle what was clearly not just a phase: 'We were like, 'Well, this thing seems to be a thing. What do we do to not mess her up?' And they were like, 'Just give her space, make sure she's safe, and let her lead.' And so that's what we've [done].'
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They also began to join listservs for the families of transgender children, tapping into a network of fellow New York City parents who had experience navigating some of the parenting concerns specific to raising a trans child. There were meetups and playdates and support groups. There was also information about medical providers and timelines. It was understood that not every trans child would want or require medical care — especially when it comes to a generation of children that, more than previous generations, understand gender to be both a spectrum and a construct. But it was also understood that trans kids were significantly more likely than their cisgender peers to die by suicide. A national 2022 study conducted by the Trevor Project, a nonprofit organization dedicated to LGBTQ+ youth suicide prevention, found that more than half of transgender and nonbinary youth seriously considered suicide in that year alone. Another study, published this past September in the journal Nature Human Behavior, linked those rates not to something inherent in trans identity but instead to trans acceptance in the broader culture: In states that passed anti-trans legislation, including bans on gender-affirming care, suicide attempts by transgender teenagers could increase by as much as 72 percent in the years after the ban went into effect. It stood to reason that for children who experience gender dysphoria, or distress over the disconnect between their biological sex and their gender identity, even offering them possibility of not having to grow into an unwelcome body could buttress their mental health.
Sarah's parents had noticed that each step she took in transitioning seemed to calm her, to make her more 'settled,' as Ingrid puts it. As Sarah approached the age of puberty, they began to carefully broach the subject of what she could expect. 'I mean, who wants to talk about puberty with their parents?' asks Ingrid. 'We were just like, 'You're going to enter this thing called puberty pretty soon. Right now, your puberty will have you end up in a boy body, but there's these different options. If you want to, we can pause it until you figure out if you want a girl body or a boy body.'' Sarah was adamant that she already knew: She was not a boy; she did not want to end up in a boy body. Her parents booked an informational appointment with the Transgender Youth Health Program at NYU Langone's children's hospital, one of the world's most well-regarded gender-affirming-care practices at one of the world's premier medical institutions.
That was about a year ago. This past November, after Sarah turned nine, bloodwork came back confirming what her parents already suspected: Her body was 'establishing puberty,' which meant that it was the ideal time to begin puberty-blocker treatment — before irreversible physiological changes had become too apparent but not so early that it would be impossible to determine how the influx of puberty hormones might affect Sarah's gender dysphoria. In her case, the beginning of puberty did nothing to lessen her gender dysphoria; it only threatened to make it worse, which was to be expected. While it is not entirely impossible that gender dysphoria could dissipate at the onset of puberty, the idea that children frequently 'detransition' — or grow out of their gender dysphoria — is a popular anti-trans talking point that the data does not bear out. A 2022 study in Pediatrics found that 94 percent of children who had socially transitioned still identified as transgender five years afterward; a further 3.5 percent identified as nonbinary.
'First, I was totally shocked, and then I was frustrated, and then I was scared, and then I was furious.'
Ingrid, parent of a trans kid
After the bloodwork came back, Sarah's doctors ordered a bone scan to confirm the health of her bones (research suggests that puberty blockers can cause a reduction in bone density, especially if taken for a long time, so their use may not be suggested for children with brittle bones). They ordered a scan of her left hand, to check her growth plates. Ingrid says that a psychiatrist who specializes in gender issues, and who Sarah had been seeing for years, prepared a so-called readiness letter, confirming that Sarah met the qualifications for gender dysphoria: She had distress relating to a gender identity that differed from the sex she had been assigned at birth and that distress had lasted six months or longer — in Sarah's case, it had lasted for years. 'And then they have a seven-page consent that you go over with your kid,' explains Ingrid. 'We went through it line by line with Sarah, made sure she understood it. Kids can only hear so much at a time, so when we had a spare moment — like walking to the bus or whatever — we'd be like, 'Oh, let's look at what questions you have.''
Puberty-blocker medications can be administered via an implant, which lasts one year, or a series of shots. Because of her fear of needles, Sarah opted for the implant, which insurance companies classify as a 'surgical' procedure, though it is not invasive and can be done in-office with local anesthesia. On Jan. 12, Sarah had an appointment in which her doctor walked her through what she could expect: A tiny incision would be made in her upper arm; an implant the size of the tip of a pencil's lead would be inserted, releasing the puberty blocker Supprelin LA; the incision would be closed by a single stitch. The next available appointment was on Friday, Jan. 31. Sarah took it.
On Tuesday, Jan. 28 — after the Trump administration issued an executive order referring to gender-affirming care as 'the chemical and surgical mutilation of children,' ordering the removal of federal funding from institutions that continue to provide gender-affirming care, and directing the Department of Justice to explore whether a federal law against female genital mutilation for minors could be applied to those who provide the care — Ingrid says she reached out to NYU to confirm that Sarah's procedure was still scheduled and would still be covered by insurance. She was assured that, on both counts, it was. Then, at 4:06 p.m. on Wednesday, Jan. 29, she received another call from NYU. 'It was a nurse from pediatric surgery. I thought it was going to be like, 'Oh, don't drink water after midnight,' right?' says Ingrid. 'Instead, it was someone from operations calling to say that because of the executive order, they're quote-unquote pausing all treatment at this time. So, they canceled the appointment.'
WHEN IT COMES TO THE AMOUNT of political attention a subject is given and the number of people those attentions target, it's hard to imagine an issue as profoundly lopsided as gender-affirming care. While it is estimated that roughly one percent of the population is transgender, a 2025 peer-reviewed research analysis conducted by researchers at the Harvard T.H. Chan School of Public Health — which was published in JAMA Pediatrics and which analyzed a database of private insurance claims from 2018 to 2022 that included more than 5 million American adolescents — found that less than 0.1 percent of minors with private insurance receive puberty blockers or hormone treatment for gender dysphoria. Despite what right-wing dog whistles would have one believe, irreversible procedures like top surgery are performed on individuals under the age of 18 in only the rarest of cases. The Harvard study, for instance, found the rate to be 2.1 procedures per 100,000 teens between the ages of 15 and 17 (no surgeries were performed on children younger than 15), meaning that less than 300 of such surgeries are performed each year for a diagnosis of gender dysphoria. (For reference, 23,527 individuals age 19 or younger had surgical cosmetic procedures like nose jobs and breast implants in 2022 alone.)
Puberty blockers — which have been used since the early 1980s to treat kids with early-onset puberty and since the 1990s to treat kids with gender dysphoria — have minor medical risks, like many other medications given to children without fanfare or undo concern. They are essentially a pause button: They will not reverse physical changes that have already taken place, but they can buy a child extra time to explore their gender identity, which, studies have shown, continues to develop even while a child is on them. They are considered reversible because once a child stops receiving them, fertility development is restored and natal puberty resumes as usual (unless the child begins taking gender-affirming hormones, which cannot be prescribed without parental permission); yet there can be permanent, if slight, effects when it comes to bone development, which relies on the release of the hormones. Because of that, children are not supposed to stay on them for more than a few years, and, as in Sarah's case, their bone health is monitored. Some recent studies of puberty blockers have failed to replicate the improvement in mental health that other studies have demonstrated, leading to calls for further longitudinal research. Yet the strength of the data in their favor is such that they continue to be the standard of care supported by the American Academy of Pediatrics, the American Medical Association, and the American Psychological Association, among many other nonpartisan organizations of repute. 'The only statistic that anyone knows for sure — and that matters — is that a scarily high percentage of trans kids who aren't supported fucking kill themselves,' one mom of a trans child tells me pointedly, of weighing the potential pros and cons of gender-affirming care.
Which is why Ingrid went into panic mode the afternoon she received the news that Sarah's appointment had been canceled at NYU: 'First, I was totally shocked, and then I was frustrated, and then I was scared, and then I was furious.' The following morning, she reached out to Mount Sinai, having heard through the parent network that that hospital was still accepting new patients. 'We were like, 'We'll take any appointment you will give us,'' Ingrid explains. They were able to schedule an appointment for that coming Monday. 'Then Friday at 5:30, someone calls me, and I'm like, 'You're calling to cancel the appointment, aren't you?'' Ingrid says. 'And she was like, 'Well, I'm not canceling it, but what I'm telling you is that we are not taking on any new patients to give them any sort of medical or pharmaceutical interventions.'' According to Ingrid, the Mount Sinai representative offered instead to refer Sarah to a psychologist. Ingrid was floored. 'I was like, '[Sarah] doesn't need to see a psychologist. She has a psychologist. She needs actual medical care for a diagnosis.''
Possibly the worst part of all for Ingrid was figuring out how to break the news to Sarah that the procedure she had been anticipating would not, in fact, be happening for the foreseeable future. 'I mean, it was really hard as a parent to figure out what to say, because she's very smart and precocious, but she's also only nine and a half. You don't want to saddle her with all of the hate,' Ingrid says. Unsure what Sarah might hear at school the next day, Ingrid sat on the edge of Sarah's bed and broached the subject cautiously, explaining what was going on in the broadest of strokes and reassuring her that they would do whatever they could to get her the care she needed. Sarah seemed to take the information in stride. But for Ingrid, it was proof that, despite her best efforts, the careful bubble of acceptance she'd created for her child was in the process of being burst. 'She's in a school that's very affirming. We've been able to build a community that's very affirming,' Ingrid says. 'It's like, how do you tell your kid that they can't get needed medical care because people don't think that they should exist — when they're the proof in front of you that this is what they need to thrive and grow?'
ACROSS AMERICA, 674 anti-trans bills were proposed at all levels of government in 2024, the fifth consecutive year that saw a rise in the amount of proposed legislation targeting trans people. Close to 200 of those bills sought to prohibit or outlaw gender-affirming care, and 11 such bills passed, including New Hampshire's HB619 (which not only banned gender-affirming care for minors but also prohibited medical professionals from referring patients who sought such care out of state) and Wyoming's SF0099 (which would revoke the medical license of anyone found to be providing such care). To date, anti-trans health care bills have passed in 26 states.
But 2024 also saw the continuation of a trend: the increasing push to pass anti-trans legislation federally. A record-breaking 87 anti-trans laws were considered at the national level last year, many of which took their cues (and language) from state-level laws that took their cues (and language) from boilerplate provided by right-wing, anti-trans groups like the Society for Evidence-Based Gender Medicine, which, despite its legit-sounding name, is not a recognized medical organization and which the Southern Poverty Law Center has designated an anti-LGBTQ+ hate group and referred to as a 'hub of pseudoscience.' In fact, one piece of evidence that the Society for Evidence-Based Gender Medicine is not in fact 'evidence-based' is its promotion of the idea of 'rapid-onset gender dysphoria,' a debunked theory that trans-ness is a 'social contagion' and can come on unexpectedly in late adolescence (the theory has been debunked, in part, because it was originally derived from a survey of parents recruited from anti-trans websites). That 'rapid-onset gender dysphoria' is name-checked in Trump's executive order is the proof no one really needed that the pseudoscience and lack of scientific rigor that has undergirded state legislation is now to be promoted from the top down.
'Rapid-onset gender dysphoria is not real. That does not exist,' says Sydney Duncan, who is senior counsel for the Washington, D.C.-based Advocates for Trans Equality and who represented amicus clients in United States v. Skrmetti, a case challenging Tennessee's bans on gender-affirming care for minors that is currently before the Supreme Court. 'It is junk science, the absolute definition of junk science, the Pizzagate of science, and it's right there in black and white in this executive order being offered as something that's a basis for bringing this kind of action against the trans community.'
The lack of scientific rigor has nevertheless not stopped the order from having a chilling effect on some hospital administrations in states that have long been safe havens for gender-affirming care. 'Many of these institutions rely on federal funding simply to keep their doors open,' says Alex Sheldon, the executive director of GLMA, an organization of health professionals who advocate for LGBTQ+ equality in the health care field. 'We're talking about, in some cases, hundreds of millions of dollars to individual institutions. We're talking about funding that allows for them to care for all children, not just trans and nonbinary children. It is a scary prospect to close down a gigantic hospital system simply because you provided care to one population — and that is a fear that we can, frankly, understand and empathize with.'
Yet if the executive order has put hospital systems in a terrible bind, the restrictions some of those systems have put in place have forced their physicians into an impossible situation as well, one in which they are forced to choose between obeying the new regulations and abiding by the Hippocratic Oath. 'The providers I've spoken to are experiencing immense moral injury,' continues Sheldon. 'I know providers who have had to cancel appointments, and in doing so, have received messages from those patients and families saying that they will be to blame for the patient's suicide. Just like how we are asking elementary school teachers to be armed guards, we're now asking providers to be legal professionals in a changing legal environment. They do not know how to keep up, and they shouldn't have to.'
'Just having an appointment scheduled for gender-affirming care can be lifesaving for some of these kids.'
Del Sasso, clinical psychologist
There's also the fear — among families and providers alike — that a window that had been getting smaller might be closing entirely. Though Trump's executive order is neither enforceable nor legal — in fact, New York Attorney General Letitia James almost immediately responded with an order for hospitals in the state to resume care or be in violation of anti-discrimination laws — the clear proof that care could be affected or paused even in blue states like New York points to the prospect of a national ban. 'I thought this was a safe space, and I feel stupid for thinking that,' one parent of a New York trans kid tearfully told me, explaining how her child had recently asked if he could get his puberty-blocker implant early, in anticipation of a time when he wouldn't be able to get it at all. On Feb. 4, when lawyers from LGBTQ+ civil rights organization Lambda Legal and the ACLU announced that they were pursuing a legal challenge to the executive order, they shared that one of their plaintiffs was a 17-year-old whose family had moved from Tennessee to Virginia to access gender-affirming care, only to have her appointment in Virginia canceled the day after the order came out. At a certain point, a child simply runs out of time.
'There really isn't room for error,' says Del Sasso, a clinical psychologist who specializes in treating trans children. 'The analogy I've been making is if you said to a family, 'You know, your child's chemotherapy that's keeping their cancer at bay? They'll be able to get it again. We just have to pause and get our ducks in a row.' No one would accept that. That's not a risk that's acceptable.'
It's especially not acceptable for Sasso, who has seen firsthand the devastation that can come from denying or delaying care. 'Just having an appointment scheduled for gender-affirming care can be lifesaving for some of these kids,' they tell me. 'Many of them are barely hanging on, and the thing that's keeping them going is knowing that they're gonna get this care.' In fact, Sasso points out, studies have shown that policies that promote the mental health of trans kids, like having access to gender-affirming care and having gay-straight alliances in schools, can promote the mental health of all kids. 'Having your peers commit suicide is not good for anyone's mental health,' Sasso says plainly. 'Knowing that your peers are frightened, that they may have to talk to Child Protective Services, that they're afraid of being in school and having their teacher forced to misgender [them] — and then the teacher is uncomfortable, the kids are uncomfortable, the child who's experiencing gender dysphoria is uncomfortable — these are awful situations that impact communities. It's really shortsighted to think that it's only affecting that child or their family.'
Until Congress passes a national ban, Duncan has faith that the executive order will not prevail in court (although, she adds, 'One of the problems with these executive orders is that they're so incompetent that it's hard to understand what's [legally] actionable and what's not actionable'). Two federal judges have already blocked the order, and there is some evidence that hospitals that paused care have since resumed some procedures (NYU Langone and Mount Sinai both declined to comment). Yet all concerned parties agree that the very fact of the executive order's existence is damaging enough to the well-being of trans kids and those who love them, that it continues to scapegoat a vulnerable population — and that its existence should concern anyone who fears the erosion of civil liberties under this new administration. 'Fifty percent of Americans out there are dialing into these media organizations and these executive orders and these state policies, and they're seeing over and over and over again vilification of trans existence,' Duncan says. 'That has a cultural consequence.'
That cultural consequence is certainly a concern for Ingrid, who spent much of the week following the executive order calling hospitals up and down the East Coast before she found one that would agree to treat Sarah. (It is a testament to the precarity of the times that she does not want to divulge who the doctor is or where they practice for fear that they will face retribution, though she did share that 'the doctor said she'll stop caring for these kids over her jailed body, which is the energy I need.') 'These executive orders are using the force of our government to discriminate against a tiny minority of kids,' she tells me. 'My kid is left bewildered and wondering what she did to deserve all this hate. I'm left wondering how to protect her.'
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