Hospitals and gender-affirming care restrictions: What to know

Amid increased federal pressures, more than 20 hospitals and health systems have discontinued transgender care for patients younger than 19.

Here’s what to know:

1. Since 2021, 27 states have enacted laws that prohibit access to puberty blockers, hormone therapy and/or surgeries for trans minors — 17 of which are being challenged in courts, according to KFF.

2. Of hospitals halting care, 12 have announced they will or have discontinued puberty blockers and hormone therapy for trans patients under 19, four hospitals are no longer providing transition-related surgeries, one discontinued its gender-affirming care for teens, and four have temporarily stopped transgender care, NBC News reported Aug. 24. In addition to those, five hospitals have removed webpages dedicated to trans care for minors to comply with state and federal regulations.

3. Supporters of transgender care restrictions for minors say the treatments have not been adequately studied and can have harmful long-term effects on minors who cannot actually consent. However, physicians say puberty blockers and hormone therapy have been provided to minors for decades to treat a number of conditions. Medical groups across the country also support transition-related care for minors.

4. Transgender care is only legal in a few states, including California, Colorado, Oregon, Illinois, Washington, Connecticut and Pennsylvania. These states have seen an influx of out-of-state patients seeking a safe haven. 

5. In January, an executive order from President Donald Trump instructed health insurers to exclude coverage for pediatric transgender surgeries and hormone treatments. Many hospitals and health system executives have pointed to President Trump’s executive order as the reason for ending these healthcare services.

6. In April, CMS told state Medicaid agencies not to cover hormone therapies or gender-affirming surgery for children. In May, the federal agency said it was investigating an unspecified number of hospitals that offer gender-confirming care to children. 

7. In June, the FBI began urging the public to report hospitals, clinics and practitioners offering gender-affirming surgeries for minors.

8. In July, the Federal Trade Commission opened an investigation into whether gender-affirming care providers are violating consumer protection laws. The agency hosted a workshop concerning unfair or deceptive trade practices in gender-affirming care for minors and has opened a portal for consumers to comment. 

9. The investigation comes due to the rate of detransition among transgender adults. A 2015 survey asked 27,715 U.S. transgender adults if they ever detransitioned — 80% said yes, and the majority indicated a temporary detransition. Common reasons were pressure from a parent (36%), difficulty with transitioning (33%), harassment or discrimination (31%) and trouble attaining a job (29%). 

10. In August, the U.S. Office of Personnel Management announced it would end coverage of gender transition-related surgeries and hormone treatments regardless of age under the Federal Employees Health Benefits and Postal Service Health Benefits programs, beginning in 2026. Counseling services for possible or diagnosed gender dysphoria will remain covered when provided by licensed mental health professionals. 

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