Across the United States, the landscape for gender-affirming medical care is shifting rapidly, with legal battles, federal interventions, and hospital policy changes generating uncertainty for transgender patients and their families. In recent weeks, hospitals in Pennsylvania and Ohio have curtailed or ended certain gender-affirming services, while a high-profile court case in North Carolina underscores the national debate over insurance coverage for transgender health care. These developments come amid a political and legal environment that is, by turns, fiercely polarized and deeply personal for those affected.
In June 2025, the University of Pittsburgh Medical Center (UPMC) and Children’s Hospital of Philadelphia (CHOP) were served with subpoenas from the U.S. Department of Justice (DOJ), demanding detailed medical records and personal information about transgender youth who received gender-affirming care. According to the Pennsylvania Capital-Star, the subpoenas requested everything from billing records and consent forms to information on the use of puberty blockers and hormones, as well as doctors’ notes, adverse event reports, and patient identifiers such as social security numbers and home addresses for minors. The breadth of these requests sent shockwaves through the families of transgender patients and the medical community alike.
The response was swift. On September 22, 2025, the Public Interest Law Center in Philadelphia, along with the law firm Ballard Spahr, filed motions to quash the subpoenas on behalf of four UPMC patients and five CHOP patients and their families. Legal Director Mimi McKenzie of the Public Interest Law Center argued that the Trump administration’s rhetoric—describing gender-affirming care as “mutilation” and “child abuse”—had sown fear among families. “Parents and patients are extremely worried about having their identities disclosed to the Department of Justice and the broader world in this political and social climate,” McKenzie said, as reported by the Pennsylvania Capital-Star.
The DOJ’s actions follow executive orders and memos from President Donald Trump’s administration, which reversed federal policies recognizing transgender people and directed Attorney General Pam Bondi to investigate what the administration called “deception of consumers, fraud, and violations of the Food, Drug, and Cosmetic Act” by providers of gender-affirming care. The orders referred to such care as “chemical and surgical mutilation.” According to the DOJ, their intent is to investigate providers for potential violations of federal law regarding the off-label use of hormones and puberty blockers, as well as possible violations of the False Claims Act for submitting claims to federal health care programs for “non-covered services related to radical gender experimentation.”
McKenzie and her colleagues argue that the DOJ’s requests are both overly broad and politically motivated, lacking a compelling reason to invade the privacy of patients. “If the Constitution means anything, it means the federal government can’t rifle through your child’s medical records in order to intimidate you,” McKenzie said. The filings also point to a recent decision by a federal judge in Massachusetts, who quashed a similar subpoena to Boston Children’s Hospital, finding it improperly interfered with the right to gender-affirming care.
The consequences of this federal scrutiny are already being felt. UPMC has ceased certain gender-affirming care, specifically restricting puberty blockers and hormone therapy for individuals under the age of 19, citing DOJ memos, directives, and subpoenas. “These actions have made it abundantly clear that our clinicians can no longer provide certain types of gender-affirming care without risk of criminal prosecution,” a UPMC spokesperson said in a statement, as reported by the Pennsylvania Capital-Star. The hospital continues to offer behavioral health support and other care “within the bounds of the law.” CHOP, meanwhile, continues to provide gender-affirming care through its Gender and Sexuality Development Program, though it has been fighting the subpoena since July and accuses the DOJ of targeting vulnerable patients.
Elsewhere, the impact of state-level legislation is also being felt acutely. Starting September 26, 2025, Nationwide Children’s Hospital in Ohio stopped providing gender-affirming prescriptions such as hormones and puberty blockers, according to Axios. The hospital’s decision, announced earlier in the month, was made “in order to proactively plan and support our providers and patients in a rapidly changing regulatory environment.” Patients can still access behavioral health services and other healthcare, but gender-affirming prescriptions have ended for all, including those over 18. The move comes despite an Ohio law allowing children already receiving gender-affirming care to continue if their doctor deems stopping it medically harmful. Nationwide Children’s Hospital, however, chose to end all such prescriptions, a decision that drew praise from Rep. Gary Click, the primary sponsor of the 2024 ban, for “going above and beyond the requirements.”
Not everyone is pleased. TransOhio, an advocacy group, called the hospital’s actions “non-legally mandated discrimination.” Executive Director Dara Adkison told Axios that while they were “not surprised,” they were “furious” at the decision and urged affected families to seek support. Adkison emphasized, “No kid anywhere deserves to be stigmatized and/or targeted, and trans youth are just kids.” The legal battle over Ohio’s ban continues, with the state Supreme Court currently hearing challenges to the law. An estimated 3% of Ohio youth identify as transgender, underscoring the significant impact of these policy shifts.
The courts remain a key battleground in the fight over access to gender-affirming care. In North Carolina, the 4th U.S. Circuit Court of Appeals issued an order on September 23, 2025, returning the lawsuit challenging the state health plan’s restrictions on coverage for transgender patients to the federal trial court. The case, Kadel v. Folwell, has already seen dramatic twists: in 2022, U.S. District Judge Loretta Biggs ordered the state health plan to cover transition-related services, a decision upheld by the 4th Circuit in 2024. But the U.S. Supreme Court vacated that ruling in June 2025, instructing the lower court to reconsider in light of the high court’s decision in United States v. Skrmetti, which upheld Tennessee’s ban on puberty blockers and hormone therapy for transgender teens.
The North Carolina State Treasurer’s office, which oversees the health plan, has indicated it expects to reinstate the exclusion on transition-related medical care once the legal process concludes. The exclusion, which dates back to the 1990s (with a brief exception in 2016), is just one of several in the plan, which also bars coverage for treatments like cosmetic surgery and experimental therapies. Supporters of the exclusion argue it is necessary to ensure affordable, high-quality care for all plan members, while opponents contend it singles out transgender patients for unequal treatment and can have devastating mental health consequences.
As these legal and policy battles play out, the stakes remain high for transgender individuals and their families. Major U.S. medical organizations, including the American Academy of Pediatrics, continue to support gender-affirming care as safe and potentially lifesaving, but the patchwork of state laws and federal interventions has left many patients in limbo. While some states and institutions are moving to restrict or end access, others are fighting back in court, arguing for the right to privacy and medically necessary treatment. With ongoing lawsuits, shifting hospital policies, and divided public opinion, the future of gender-affirming care in America remains deeply uncertain.
