When Bug got home from school one winter afternoon in late 2024, his mother was on the couch watching 30 Rock reruns. Bug sat down and announced that he was a boy and would use he/him pronouns.
“OK, cool,” J remembers saying. Bug, then in sixth grade, had earlier come out as nonbinary; this felt like a bigger step. They talked about what he needed to be supported, and he asked to get health care.
J asked NPR to use only her initial and a nickname for her son because the family fears harassment. They had left Austin, Texas, in 2024, resettling in western Massachusetts because J worried about Texas’s increasingly conservative laws — outlawing abortion, dismantling DEI programs, and restricting transgender medical rights. Both children are autistic, and J felt Massachusetts would offer more social services and inclusive laws.
When Bug came out as trans, J turned to Baystate Health in Springfield, the region’s largest system. Baystate offered counseling for gender-nonconforming youth and an endocrinology department experienced in prescribing hormones. Bug, too old for puberty blockers, was eager to start testosterone and had met with doctors in late 2025 preparing to begin treatment.
But the federal political climate complicated care. Days after his January 2025 inauguration, President Trump signed an executive order opposing gender-affirming care for youth. On Dec. 18, 2025, the administration announced an HHS policy barring such care for minors and warned it would investigate hospitals that provided it, claiming the treatments were harmful. Several states, including Massachusetts, sued to block the policy; a judge ruled against the federal policy in March (the administration could appeal).
Despite the legal fight and state laws meant to protect providers — Massachusetts had passed a “shield” law in 2022 and strengthened protections in 2025, and requires commercial insurers to cover gender-affirming care — Baystate abruptly told families in February that it would stop providing gender-affirming medications to minors and would only offer counseling. A letter to families gave no detailed explanation.
“For a while it just felt like the floor had fallen out,” J said. “All the support I thought we had was gone. Maybe this is naive, but I didn’t think that would happen in Massachusetts, and certainly not preemptively.”
Baystate declined an interview but issued a statement saying the decision reflected the risk that the proposed federal policy could lead to the loss of “hundreds of millions of dollars in government reimbursement.” The statement noted that nearly 70% of Baystate’s patients rely on Medicaid and Medicare.
Nationally, dozens of hospitals have preemptively closed youth gender programs after the federal moves — including facilities in blue states such as California, Illinois and New York. The American Academy of Pediatrics, which supports gender-affirming treatment for minors, declined NPR’s interview request; a group representative said pediatricians feared retaliation and would not speak publicly about the closures.
Families are left scrambling. Some parents filed civil rights complaints with the Massachusetts Attorney General after Baystate’s decision. Bug took the news hard. “I felt frustrated that they would do that,” he said. “I bet there’s tons and tons of kids who are like, ‘Okay, I’m going for trans-affirming healthcare. Yay!’ And then we’re like, ‘No, never mind.'”
Another parent, L, whose child had been prescribed puberty blockers and estrogen at Baystate, said the treatment had markedly improved her daughter’s mood and grades. L, who asked for only her initial because she fears harassment, said she is generally conservative about medical intervention and believed surgery was inappropriate for a 13-year-old; but hormone therapy had helped. She was furious Baystate pulled treatment and said the hospital should have taken a “wait and see” approach to the federal threat. At the time she spoke to NPR, L had not told her daughter that Baystate had ended care, fearing it would trigger depression. “It’s a scary time to be 14 and trans right now,” L said.
In western Massachusetts there are alternatives, at least for now. Some families asked primary care physicians to continue prescriptions. Bug’s family was referred to TransHealth, a private specialty clinic in Northampton. TransHealth’s CEO Jo Erwin said the clinic had been preparing for the possibility that hospital programs might close and expects to absorb more than 200 former Baystate patients, plus others who left Boston’s Fenway Health after it also ended hormone therapy for youth.
Erwin said TransHealth can withstand funding threats because of substantial private donations and less dependence on Medicaid and Medicare than most hospitals. “It’s a horrible position to be put in by the federal government,” she said. But she warned that private clinics filling the gap do not erase broader fears across the LGBTQ community. “When you see something like that go down, people get scared that it’s ultimately going to happen to everyone.”
For families like J’s, private clinics offer relief but not certainty. Bug is now excited to start testosterone at TransHealth, but J worries the federal government will find other ways to stop his treatment. “Now we’re dependent on privately funded places and that doesn’t feel like very firm ground to be standing on,” she said. She sometimes wonders whether, instead of stopping in Massachusetts, they should have moved further north to Canada.
The hospital closures have also scared pediatric health providers. According to NPR reporting, the American Academy of Pediatrics’ media representative said the clinicians the group contacted were too frightened of retaliation to speak on record about the closures.
While courts have pushed back against the federal policy, the chilling effect on hospitals that rely heavily on Medicaid and Medicare remains. Hospitals balancing financial risk against patient care have made preemptive choices that alter access for many youths relying on institutional programs. That leaves families to seek other providers, transfer care to primary doctors, or travel to clinics with different funding structures — options that are uneven and uncertain.
This story comes from NPR’s health reporting partnership with New England Public Media and KFF Health News.