On August 7, 2025, former House Speaker Nancy Pelosi made headlines with a firm declaration: she is working "at the national level" to protect access to gender-affirming care for transgender youth, even as a wave of restrictive policies and legal battles sweeps across the United States. Her comments, delivered during a tour of the San Francisco VA Medical Center, underscore a growing national divide over the rights of transgender minors and the future of gender-affirming healthcare.
Pelosi’s remarks came at a moment of heightened tension. According to Fox News, she told reporters, “That is something I’m working for at the national level, and 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.” She described the situation as “really sad,” emphasizing her personal support by noting that a transgender-pride flag hangs outside her office, as it does for several of her Democratic colleagues.
Her visit to the VA Medical Center was initially focused on reviewing health-system upgrades and research initiatives, as well as drawing attention to what she described as the threat of House Republicans slashing core veterans’ services. But the conversation quickly pivoted to the national debate over gender-affirming care for minors, a subject that has become a lightning rod for political and cultural conflict.
Earlier this month, officials from more than a dozen Democratic-led states—including California, Delaware, Pennsylvania, New Jersey, Maryland, and others—filed a lawsuit in the U.S. District Court for the District of Massachusetts. Their goal: to block the Trump administration’s efforts to restrict access to sex change procedures and treatments for individuals under 19. The lawsuit specifically challenges President Donald Trump’s January 28 executive order, which bars government support for such operations and treatments. It also targets memos from Attorney General Pam Bondi and Assistant Attorney General Brett Shumate, which direct federal prosecutors to prioritize investigations and potential criminal charges against doctors, hospitals, and pharmaceutical companies providing gender-affirming care to minors.
According to The Post Millennial, Pelosi’s office confirmed that her public support for gender-affirming care was in direct reference to this lawsuit. The complaint filed by the coalition of states accuses the administration of threatening providers with “baseless criminal charges” and overreaching federal authority. The states argue that threatening hospitals with civil and criminal prosecution for providing transgender youth with care has no grounding in federal law and violates the 10th Amendment, which reserves the regulation of medicine as a core state power.
Delaware Attorney General Kathy Jennings, a key plaintiff in the suit, was outspoken in her criticism. As reported by Spotlight Delaware, Jennings called the Trump administration’s policies “despicable, dangerous, and illegal,” adding, “These stunts make kids into political props and do nothing to help Americans.” She also challenged the administration’s use of terms like “chemical and surgical mutilation” to describe gender-affirming care, calling it “offensive and inaccurate.”
The Trump administration, for its part, has doubled down. A spokesperson from the Department of Justice told Spotlight Delaware that the agency would use “every legal and law enforcement tool available to protect innocent children from being mutilated under the guise of ‘care.’” Attorney General Pam Bondi’s April memo instructed the DOJ to investigate any medical providers accused of misleading the public about the long-term side effects of gender-affirming treatments. Since then, the DOJ has issued more than 20 subpoenas to providers, and criminal investigations have reportedly been launched into children’s hospitals in California, Colorado, and Massachusetts.
The federal crackdown has had immediate, tangible effects on healthcare providers and patients. In July, Kaiser Permanente—one of the nation’s largest health systems—announced it would pause sex change surgeries for patients under 19, effective August 29, 2025. Children’s Hospital Los Angeles shuttered its Center for Trans Youth Health and Development, one of the country’s largest clinics serving transgender young people. Children’s National Hospital in Washington, DC, also announced it would no longer provide gender transition-related medical interventions to minors. Nemours Children’s Hospital in Delaware stopped accepting new patients for gender-affirming care in late July, citing “evolving communications and actions from federal agencies directed at healthcare providers related to gender-affirming care.”
According to Spotlight Delaware, Nemours had been the only known facility in Delaware to administer puberty blockers and hormone therapy to transgender youth since 2018. The hospital’s decision came just after Delaware Governor Matt Meyer declared his state a “sanctuary” for gender-affirming care, enacting protections for patients and doctors from prosecution and safeguarding patient data. The Nemours Foundation, which operates facilities across several states, reported more than $800 million in Medicaid and federal grants in 2023—nearly half its $2 billion revenue—highlighting the financial vulnerability of hospitals reliant on federal funds.
The Centers for Medicare & Medicaid Services and Health and Human Services Secretary Robert Kennedy Jr. have further tightened the screws, giving hospitals 30 days to submit data and policies on gender-affirming care and instructing them to disregard treatment standards from the World Professional Association for Transgender Health (WPATH). Trump health officials are reportedly considering policies that would limit hospitals’ participation in Medicare and Medicaid if they continue to perform sex-altering procedures for minors.
These federal actions have rippled across the country. More than 15 hospital systems—including the University of Pittsburgh Medical Center, Penn Medicine, Virtua Health, Kaiser Permanente, and Children’s National Hospital—have scaled back or ended access to gender-affirming care for youth. Meanwhile, the Supreme Court recently upheld states’ rights to ban the practice of medical sex changes for minors, further emboldening state-level restrictions. Nonetheless, states named in the lawsuit—among them California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Washington DC, and Wisconsin—continue to allow such procedures, setting up a patchwork of access that varies dramatically by geography.
Pelosi acknowledged the uphill battle ahead, noting the entrenched opposition from many Republicans on Capitol Hill. “I don’t know what effect we can have nationally with what we have going on in the White House and in Congress,” she admitted. Still, her commitment to the cause was clear, echoed by the visible support of the transgender-pride flag outside her office and those of her Democratic colleagues.
As the legal and political fight rages on, the fate of gender-affirming care for transgender youth remains uncertain. For now, the conflict over these deeply personal and contentious issues continues to play out in courtrooms, hospital boardrooms, and the halls of Congress, shaping the lives of families and children across America.
