Content warning: this story mentions suicide.
Rady Children’s Health, the largest children’s hospital system in California, has stopped providing gender-affirming hormone therapy to patients under 19. The policy change affects two major Southern California hospitals and nearly 1,500 patients and was announced by the system as a response to mounting federal pressure on providers.
Parents and clinicians say the decision was sudden and devastating. A San Diego father identified only as Brett told NPR that his 11-year-old, who came out as a boy and began hormone treatment about 18 months ago, showed dramatic improvement after starting care — becoming more energetic, social and engaged in hobbies. He described clinic staff as “overwhelmingly loving” and said learning that Rady would discontinue hormone therapy felt as if “the whole world kind of dropped out from under me.”
Rady said federal actions, including a referral to the U.S. Department of Health and Human Services Office of Inspector General, created legal and financial risks. Over the past year, the Trump administration has taken steps aimed at limiting access to gender-affirming care for minors, arguing such treatments are harmful. In December, the Centers for Medicare and Medicaid Services proposed rule changes that could, if finalized, reduce federal funding to hospitals that provide gender-affirming hormone treatments or surgeries to minors.
HHS told NPR that gender-affirming care did not meet “professionally recognized standards of health care.” Major medical organizations — including the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association — dispute that view, saying gender-affirming care is evidence-based and important to transgender youths’ mental health. The American Society of Plastic Surgeons recommends delaying gender-related surgeries until at least age 19, and only a small number of transgender minors seek surgery.
Advocates warn proposed funding restrictions pose serious risks. Kellan Baker of the Movement Advancement Project noted that in many states roughly half of hospital funding comes from federal programs like Medicare and Medicaid, meaning funding changes could force hospitals to stop offering services. More than a dozen hospitals across the country have already ended gender-affirming hormone therapy for youth amid similar pressures.
Clinicians and LGBTQ health advocates say private providers may help some families but cannot replace large hospital systems that serve high patient volumes and run research that informs best practices. Alex Sheldon, executive director of GLMA, said clinicians whose institutions stop care have reported terrified patients and families, and recounted parents warning clinicians they would be held responsible if their child died by suicide after losing access to treatment.
Some families are urgently seeking alternatives. Brett said his family has found only one private provider in the county and is unsure whether that clinician can continue care; they are even considering moving abroad. California Attorney General Rob Bonta has sued, seeking a permanent injunction to restore gender-affirming care at Rady, but in the meantime affected families must look elsewhere.
For many families and clinicians, the dispute has become a high-stakes clash between federal policy shifts and medical organizations’ guidelines, with patients’ mental health and access to treatment caught in the middle.