In a sweeping escalation of the national debate over transgender rights and healthcare, the Trump administration’s recent crackdown on gender-affirming care for youth has ignited a fierce legal and medical standoff across the United States. The controversy, which has drawn in some of the country’s largest children’s hospitals and triggered a high-profile lawsuit from California and a coalition of states, is reshaping the landscape of care for transgender and nonbinary minors—and leaving thousands of families and medical professionals in a climate of uncertainty and fear.
The flashpoint came in January 2025, when the Trump administration issued an executive order declaring it U.S. policy not to “fund, sponsor, promote, assist, or support” gender transition for anyone under 19 years old. The order, as reported by CalMatters, threatens to pull federal funding from medical institutions that provide such care—an unprecedented federal intervention that has rippled through hospitals, clinics, and state governments nationwide.
On August 22, California Attorney General Rob Bonta, joined by 14 other states and the District of Columbia, filed a lawsuit in the U.S. District Court for the District of Massachusetts to challenge the executive order. The lawsuit contends that the policy violates the Constitution and undermines state laws requiring equal access to medical treatment. “The result is an atmosphere of fear and intimidation experienced by transgender individuals, their families and caregivers, and the medical professionals who seek only to provide necessary, lawful care to their patients,” the attorneys general wrote in their complaint.
But the legal battle is only part of the story. The administration’s crackdown has had immediate, tangible effects on the ground. According to CalMatters, major medical providers in California and beyond have scaled back or suspended gender-affirming services for minors. Children’s Hospital Los Angeles, for instance, closed its gender-affirming care center in July 2025, forcing about 3,000 patients under 21 to seek care elsewhere. Stanford Medicine paused surgical procedures for people under 19, and Kaiser Permanente announced it would halt gender-affirming surgeries for minors starting August 29, though hormone therapies would remain available.
Similar disruptions have unfolded in Pennsylvania, where the Children’s Hospital of Philadelphia (CHOP)—one of the largest providers of gender-affirming care for transgender and nonbinary children in the country—finds itself at the center of a high-stakes legal and federal investigation conflict. As reported by Axios, the U.S. Department of Justice issued a sweeping subpoena to CHOP in June 2025, demanding extensive records related to transition care for patients under 19 since 2020. The request covers therapy, hormone treatments, surgeries, and even sensitive patient data such as birthdates, Social Security numbers, and addresses.
CHOP is pushing back, fighting in court to limit the scope of the subpoena and keep it under seal to protect patient privacy and trust. In its court filings, the hospital has argued that complying with the DOJ’s demands would only heighten patients’ fears of being targeted and could undermine the crucial bond between doctors and their young patients. CHOP declined to comment further to Axios, but the institution’s legal filings underscore the stakes: at risk, they argue, are not just individual privacy rights but the integrity of medical care itself.
The federal actions have not been limited to subpoenas. Following the executive order, the Justice Department, under U.S. Attorney General Pamela Bondi, directed employees to investigate doctors, hospitals, and pharmaceutical companies providing gender-affirming care. In a July statement, Bondi announced that her department had issued more than 20 subpoenas as it investigates “healthcare fraud, false statements and more.” DOJ spokesperson Natalie Baldassarre stated, “As Attorney General Bondi has made clear, this Department of Justice will use every legal and law enforcement tool available to protect innocent children from being mutilated under the guise of ‘care.’”
For many families and healthcare providers, the atmosphere has grown palpably tense. The actions have “created an atmosphere of fear for transgender individuals, their families and health providers, who say they’re providing medically necessary care and haven’t violated any laws,” Axios reported. The chilling effect is evident: other hospitals in Pennsylvania, including Penn Medicine, Nemours Children’s Hospital, and the University of Pittsburgh Medical Center, have scaled back gender-affirming care for children this year in response to the federal crackdown.
Gender-affirming care, as defined by medical experts and supported by research cited in CalMatters, includes hormone therapy, puberty blockers, and surgical procedures. Studies have shown that such care can have a profoundly positive impact on the mental health of transgender youth, reducing symptoms of depression and anxiety and improving overall well-being. Forcing young people to wait until they are 19 or older to start care, the California lawsuit argues, allows symptoms of gender dysphoria to worsen and may lead to more severe mental health challenges.
Yet, the Trump administration maintains that its actions are necessary to protect minors from what it describes as irreversible and harmful procedures. The administration’s position is echoed in a series of related executive orders, including one that recognizes only two biological sexes, another that prohibits transgender girls and women from participating in women’s sports, and a third that threatens to cut federal funds for schools supporting transgender youth.
The legal arguments are complex. The coalition of state attorneys general contends that the federal directives put providers in an impossible position, forcing them to choose between complying with federal policy and adhering to state anti-discrimination and age-of-majority laws. In California, for instance, it is illegal to deny care based on gender identity or expression. At the same time, many medical providers rely heavily on federal funding, whether through research grants or reimbursements from public payer programs like Medi-Cal. The threat of losing this funding, according to Bonta, has already forced several providers to suspend services, even as state officials have tried to reassure them that they are both protected and required to provide gender-affirming care under state law.
“The shutdown came despite efforts my office took over recent months to assure [Children’s Hospital Los Angeles] that they were protected and required to provide gender-affirming care,” Bonta said at a press conference, reflecting the frustration of state officials facing federal resistance.
As the legal battle plays out, the practical consequences are immediate and deeply personal. For thousands of transgender and nonbinary youth and their families, the uncertainty over access to care is more than a political issue—it’s a matter of health, identity, and dignity. For medical professionals, the risk of prosecution or loss of funding is forcing wrenching decisions about how, and whether, to continue providing care they believe is both ethical and essential.
The clash between federal policy and state protections for transgender youth is likely to intensify in the months ahead, with court rulings poised to set precedents that could shape the future of gender-affirming care in America. For now, families, doctors, and advocates are left navigating a landscape marked by legal battles, institutional closures, and a profound sense of uncertainty about what comes next.
