When Bug came home from school one winter afternoon in late 2024, he told his mother, J, that he was a boy and would use he/him pronouns. J, who asked that NPR use only her initial and a nickname for her son because the family fears harassment, replied, “OK, cool.” Bug, then in sixth grade and previously nonbinary, said he wanted medical support as well.
The family had moved from Austin, Texas, to western Massachusetts in 2024 out of concern about Texas’s increasingly conservative laws on abortion, DEI programs and transgender medical care. Both of J’s children are autistic, and she said she believed Massachusetts would offer more inclusive services and stronger legal protections.
J turned to Baystate Health in Springfield, the region’s largest system. Baystate offered counseling for gender-nonconforming youth and an endocrinology team that prescribed hormones. Bug, too old for puberty blockers, had been preparing to start testosterone after meeting with clinicians in late 2025.
But national politics intervened. Days after his January 2025 inauguration, President Trump signed an executive order opposing gender-affirming care for minors. On Dec. 18, 2025, the administration issued an HHS policy barring such care for people under 18 and warned it would investigate hospitals that provided it. Several states, including Massachusetts, sued to block the policy; a judge ruled against the federal policy in March, though the administration could appeal.
Despite state protections — Massachusetts passed a “shield” law in 2022 and strengthened it in 2025 and requires many insurers to cover gender-affirming care — Baystate abruptly told families in February it would stop providing gender-affirming medications to minors and limit services to counseling. The hospital sent a letter to families offering 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 move was driven by the risk the proposed federal policy posed to government reimbursement, noting that nearly 70% of Baystate’s patients rely on Medicaid and Medicare.
Across the country, dozens of hospitals have preemptively closed youth gender programs after the federal actions, including institutions in traditionally Democratic 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 representative said clinicians feared retaliation and would not speak publicly about the closures.
Families were left scrambling. Some filed civil rights complaints with the Massachusetts attorney general after Baystate’s decision. Bug said he was frustrated: “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, identified only as L, said her daughter had been prescribed puberty blockers and estrogen at Baystate and that the treatment had significantly improved her mood and school performance. L, who also asked for only her initial out of fear of harassment, described herself as cautious about medical intervention and opposed to surgery for a 13-year-old, but said hormone therapy had made a real difference. She was angry that Baystate ended care and said the hospital should have taken a “wait and see” approach to federal threats. At the time she spoke with reporters, L had not told her daughter about the change, fearing it could trigger depression. “It’s a scary time to be 14 and trans right now,” she said.
In western Massachusetts some alternatives have appeared. A number of families have 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 prepared for the possibility that hospital programs might close and expects to absorb more than 200 former Baystate patients, as well as youths who left Boston’s Fenway Health after it also ended hormone therapy for minors.
Erwin said TransHealth is better insulated from funding threats because of private donations and a smaller dependence on Medicaid and Medicare than many hospitals. “It’s a horrible position to be put in by the federal government,” she said. Still, she warned that private clinics stepping in do not eliminate broader fears within 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 provide some relief but not long-term certainty. Bug is now scheduled to start testosterone at TransHealth, but J worries the federal government could find other ways to disrupt 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, adding that she sometimes wonders whether they should have moved farther north to Canada.
The closures have also alarmed pediatric health providers. NPR reporting found clinicians were reluctant to speak publicly because of fear of retaliation. Even as courts have pushed back against the federal policy, hospitals that rely heavily on Medicaid and Medicare continue to weigh financial risk against patient care, and many have preemptively curtailed services.
That leaves families to find alternatives: transfer care to primary doctors, seek private clinics with different funding models, or travel for care. Those options are uneven, often costly, and uncertain — a reality that advocates say will leave many transgender youth and their families in limbo while legal and political battles continue.