On August 7, 2025, former House Speaker Nancy Pelosi stood at the San Francisco VA Medical Center, her trademark resolve as visible as ever. She was there to tour new research facilities and discuss the threats facing veterans’ services, but the conversation quickly shifted to a topic that’s taken center stage in the American culture wars: national protections for transgender youth. With a transgender pride flag fluttering outside her office back in Washington, Pelosi declared, “We are hoping we can have gender-affirming care for our trans kids. It’s a sad thing for us… I don’t know what effect we can have nationally with what we have going on in the White House and in Congress.” Her words, reported by the Associated Press, echoed the concerns of countless families and healthcare providers across the country.
Pelosi’s remarks come at a time when the landscape for gender-affirming care in the United States is shifting rapidly—and not in the direction many advocates had hoped. A growing wave of state and federal actions has left transgender youth and their families scrambling for care, with hospitals halting services and legal battles mounting. The stakes, as experts and families attest, are nothing short of life and death.
Behind the headlines are stories like that of E, a mother in Montana who still remembers the morning her daughter, then four, quietly announced she was a girl. “Very benign, sitting and brushing teeth early in the morning. They were four years old and said, ‘Oh, I’m not who you thought I was. I’m actually a girl,’” E told NPR. Now, as her daughter approaches puberty, the family’s plan was to begin puberty blockers and eventually hormone replacement therapy at Community Medical Center in Missoula—a plan upended when the hospital closed its gender clinic for minors in June 2025. “To her, it just wasn’t even a thought that it wouldn’t happen,” E said. “So she was like, ‘no, I’m a girl, so when I go through puberty, I’m going through girl puberty.’”
Community Medical cited a “regulatory and legislative environment [that] is changing too fast for them to continue offering gender care.” Hospital officials declined to elaborate, but the context is clear: a Trump administration crackdown that labels gender-affirming care as harmful and has threatened providers with prosecution under laws against genital mutilation, subpoenaed hospitals for patient data, and even prompted the FBI to solicit tips on doctors providing such care.
This federal pressure is not isolated. According to the Human Rights Campaign, as of July 2025, over 40 percent of trans youth aged 13 to 17 live in states where gender-affirming care is banned or severely limited. While some states like California, New York, and Illinois have laws protecting access to this care, federal interference looms large. Even in states where gender-affirming care remains legal, hospitals are pulling back. “This includes in both red and blue states and purple states as well,” Lindsey Dawson of the nonpartisan health policy group KFF told NPR. “There have been reports in California, Colorado, Pennsylvania, Montana now.”
The chilling effect is palpable. Kaiser Permanente, a major healthcare provider, announced it would pause gender-affirming surgeries for patients under 19 starting August 29, 2025. Children’s Hospital Los Angeles closed its Center for Trans Youth Health and Development—the largest of its kind in the country—earlier this summer. Children’s National Hospital in Washington, D.C., has also stopped providing gender-related medical interventions for minors. And in Montana, families like E’s face a seven-hour drive to Seattle Children’s Hospital, if they can afford it. “And it’s just heartbreaking,” E said. “I don’t know if I can afford that trip.”
For many parents, the fear isn’t just about access—it’s about safety and legal risk. Kathryn Brogan, an adolescent psychiatrist in Montana, says parents are increasingly worried. “They wonder, is my kid going to end up on a list that’s going to be used against them in the future; Or will I be, as a parent, held responsible for some sort of abuse allegation in the future?” Brogan said. The Montana Chapter of the American Academy of Pediatrics recommends parents consult with their providers about in-state options, but awareness is limited—E hadn’t heard about local clinics that might still offer care.
Meanwhile, the mental health consequences are dire. “Realistically, an increased risk of suicide, an increased risk of every kind of mental health comorbidity,” Brogan warned. Transgender youth are four times more likely to attempt suicide, a statistic that underscores the urgency of these debates. Liz, an 18-year-old transgender woman in Missoula, was also affected when Community Medical ended care for those under 19. “I feel it’s their job as health care providers, is to stand up to this and to say, ‘this is care that saves lives,’ which they didn’t do,” Liz told NPR. She now plans to drive to Seattle for hormone treatment but worries about long waitlists as more patients are forced to seek care out of state. “They’re going to see even more of an influx of patients. And can they take that many people? How far out does their wait list become?” Liz wondered.
Amid the turmoil, a legal battle is brewing. In July 2025, a coalition of 17 states and Washington, D.C., filed a lawsuit to block the Trump administration’s federal restrictions on gender-affirming care for people under 19. The complaint, which Pelosi referenced during her San Francisco visit, challenges a January executive order that threatens providers with criminal investigations and cuts to federal funding. The order, backed by Attorney General Pam Bondi and Assistant Attorney General Brett Shumate, directs the Department of Justice to prioritize action against doctors and hospitals involved in trans healthcare for minors. Pelosi’s office confirmed that her comments were in reference to this lawsuit, which has become a rallying point for Democrats and advocates nationwide.
Still, the political headwinds are stiff. “Whatever we can do to protect these kids, we’ll keep doing it,” Pelosi vowed, according to the Associated Press. At 85, her legacy as a champion for LGBTQ+ rights is well established—she has spoken openly about losing friends during the HIV/AIDS crisis and has consistently called out anti-LGBTQ+ rhetoric from political opponents. Yet even she acknowledges the uphill battle: “I don’t know what effect we can have nationally with what we have going on in the White House and in Congress.”
For families, providers, and advocates, the fight for trans youth is not just political—it’s deeply personal. As the legal and medical landscape continues to evolve, the question remains: Will the nation’s leaders ensure that transgender kids can get the care they need, wherever they live? For now, the uncertainty persists, and families like E’s are left to navigate a patchwork of laws, hospital policies, and political threats—hoping that, one day, the promise of care will match the reality on the ground.
