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, citing escalating actions by the Trump administration that pressured medical providers nationwide. The move affects two major Southern California hospitals and nearly 1,500 patients.
Parents and clinicians say the change has been sudden and devastating for many families. 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 a year and a half ago, improved dramatically after starting care — becoming more energetic, social and engaged in hobbies. He described the clinic staff as “overwhelmingly loving.” When Rady informed families they would discontinue hormone therapy, Brett said it felt as if “the whole world kind of dropped out from under me.”
Rady said its decision was driven by mounting federal pressure, including a referral to the U.S. Department of Health and Human Services Office of Inspector General for investigation. Over the past year, the Trump administration has taken multiple steps aimed at limiting access to gender-affirming care for minors, arguing the treatments are harmful. In December, the Centers for Medicare and Medicaid Services proposed rule changes that, if finalized, could reduce federal funding to hospitals that provide gender-affirming hormone treatments or surgeries to minors.
The U.S. Department of Health and Human Services 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 characterization, stating that such care is evidence-based and important for transgender youth mental health. The American Society of Plastic Surgeons recommends delaying gender-related surgeries until at least age 19; only a small number of transgender minors seek surgery.
Advocates warn that the proposed funding restrictions pose serious risks. Kellan Baker of the Movement Advancement Project noted that roughly half of hospital funding in many states comes from federal programs like Medicare and Medicaid, meaning funding changes could force hospitals to stop offering services. More than a dozen hospitals around the country have ended gender-affirming hormone therapy for youth in the last year amid similar pressures.
Clinicians and LGBTQ health advocates say private providers may help some families but cannot replace large hospital systems that handle greater patient volumes and conduct research that informs best practices. Alex Sheldon, executive director of the LGBTQ medical association GLMA, said providers whose institutions stop care have reported terrified patients and families. He recounted instances in which clinicians were blamed by parents, who warned that if their child died by suicide because they lost access to treatment, the clinicians would be held responsible.
Some families are scrambling to find alternatives. Brett said his family has identified only one private provider in the county and is uncertain whether that clinician can treat his son; they are even considering moving abroad to secure care. California Attorney General Rob Bonta has filed a lawsuit seeking a permanent injunction to restore gender-affirming care at Rady Children’s Hospital, but in the meantime affected families must look elsewhere.
For many families and clinicians, the dispute over care has become a high-stakes conflict between federal policy shifts and medical organizations’ guidelines, with patients’ mental health and access to treatment caught in the middle.