Hospitals Fret Executive Orders Targeting Trans Youth

Federal Funding for Transgender Health Services Targeted, Sparking Widespread Concern

A significant health network in Southern California, St. John’s Community Health, encountered obstacles accessing a $1.67 million CDC grant last week. The funds were specifically designated for transgender health initiatives. The organization, which serves 430,000 individuals annually through its federally qualified health centers, faced this challenge despite an existing injunction against federal departments freezing or terminating funding based on presidential executive orders. The grant money is crucial for covering essential operational costs, including payroll and service provisions.

California Health Center Faces Funding Block for Transgender Programs

Jim Mangia, President and CEO of St. John’s, stated that the remaining balance of $743,706 from the 4-year grant, initiated in June 2022, was removed from their account. This action followed President Trump’s January 28 executive order, titled “Protecting Children From Chemical and Surgical Mutilation.”

Despite this setback, St. John’s has affirmed its commitment to resist these measures and secure funding from alternative sources. The organization manages an annual budget of approximately $230 million, derived from diverse sources, to support its extensive programs and operations across 20 locations in three counties.

“Our stance is clear: we must challenge any attempts to restrict healthcare accessibility for the populations we serve,” Mangia asserted. “We intend to be vocal and undertake all necessary actions, including potential litigation, to safeguard healthcare services for our patients.”

Healthcare Providers Express Concerns Over Funding Cuts and Patient Safety

Providers across numerous non-governmental organizations, similar to St. John’s, are experiencing heightened anxiety. These organizations cater to LGBTQ+, transgender, immigrant, and other medically underserved communities. The apprehension stems from the potential repercussions of losing dedicated funding and the symbolic message conveyed by these funding terminations or suspensions to their patient base.

Rising Fears Among Transgender Patients and Healthcare Staff

Concerns also extend to the increased risk of hate crimes against this vulnerable population, who are acutely aware of their susceptibility to attacks.

Dr. Christopher Veal, a physician at Howard Brown Health in Chicago, one of the nation’s largest LGBTQ+ focused health centers and a leading provider of non-surgical gender-affirming care, noted the pervasive fear within the community since the inauguration. This fear, he explained, is rooted in the apprehension among patients, particularly those who are transgender and undocumented, that seeking care at hospitals or federal clinics could lead to detention and deportation.

Howard Brown Health, which serves 38,000 patients annually from various underserved populations, is currently seeking clarification regarding inconsistent communications from the administration regarding the future of their federal grants, which are integral to their operational budget.

In an official statement, Howard Brown Health reassured its patients that the executive order “has no immediate effect on our operations,” and they will “continue to deliver gender-affirming care to all patients who depend on our services.”

However, Dr. Veal expressed personal unease shared by many colleagues regarding their funding stability under the current administration. He highlighted the administration’s specific targeting of gender-affirming care and transgender individuals, fueled by divisive rhetoric. He fears these actions will persist until these essential services become unsustainable.

Dr. Veal, specializing in suicide prevention, anticipates a rise in suicide attempts due to the chilling effect of these executive orders. He cited instances of Chicago-area programs discontinuing suicide prevention education initiatives due to fear and dwindling financial resources.

Clinicians Voice Alarm Over Impact of Policy Changes on Transgender Care

Direct Patient Impact: Increased Anxiety and Suicidality

Riley Read, PA, a provider at St. John’s transgender health clinic, reported a significant increase in patient anxiety and related complications. According to Read, the new administration’s policies have generated “immense fear and a surge in patients presenting with anxiety-related issues, panic attacks, heightened suicidality and suicidal thoughts, as well as physical symptoms like stomach problems and insomnia.” Some patients are even considering stockpiling medications in anticipation of reduced access to care.

These policy changes are also emotionally taxing for healthcare providers like Read, who described the patient dilemmas as “heartbreaking and very difficult to handle.” He empathizes deeply with patients’ genuine fears, adding, “at the clinician level, it’s heartbreaking and very difficult to handle.”

Read voiced concern that the executive actions might extend beyond transgender patients, potentially affecting other vulnerable groups’ access to healthcare services in the future. He stated, “It doesn’t mean that in 2 weeks, we’re not going to be talking about another group” losing access to care.

If current policies persist, Read suggests healthcare facilities will need to seek alternative funding streams. “We’re all in a bit of a quandary. We’re afraid of retaliation, but it’s our job as clinicians to stand up and take that fear and put it into something practical, and not back down and feel like we’re being bullied [although] we are being bullied.”

Clinic leaders have also reported widespread rumors of hospitals nationwide preparing to suspend gender-affirming surgeries for patients under 19, fearing federal reimbursement losses, a trend that has already begun.

Hospitals and Health Systems Respond to Executive Order on Gender-Affirming Care

Service Suspensions and Pauses at Major Hospitals

Children’s Hospital Los Angeles (CHLA) announced on Tuesday it would halt the initiation of hormone therapy for gender-affirming care for patients under 19, citing the executive order.

CHLA’s statement clarified, “At this time, CHLA is pausing the initiation of hormonal therapies for all gender-affirming care patients under the age of 19 and maintaining the existing pause on gender-affirming surgeries on minors. The physical and mental health, safety, and well-being of all of our patients remains our highest priority.”

Reports indicate NYU Langone Health in New York City cancelled appointments for transgender children scheduled to receive puberty-blocking medication implants this week. The Boston Globe reported that Boston Children’s Hospital has also cancelled appointments for minors, according to a lawsuit.

Children’s National Hospital in Washington, D.C., has reportedly suspended new prescriptions for puberty blockers and hormone therapy while evaluating the situation. Similarly, Virginia Commonwealth University and Children’s Hospital of Richmond have suspended medications and surgeries for gender-affirming care for patients under 19. University of Virginia Health has reportedly suspended all gender-affirming care for pediatric patients, citing concerns about “significant legal risk and substantial financial exposure,” according to an internal memo.

USA Today reported that Denver Health in Colorado and University of Colorado Health have ceased performing gender-affirming surgeries for patients under 19. Lurie Children’s Hospital in Chicago is also reportedly reviewing the executive order’s implications.

Legal Challenges and Political Opposition to Healthcare Restrictions

Lawsuit Filed Against Administration Over Funding Restrictions

On Tuesday, a coalition of plaintiffs, including transgender young adults, family members of transgender youth, and advocacy organizations, lodged a 44-page lawsuit against President Trump, HHS, the National Institutes of Health, and various Trump administration appointees. The lawsuit alleges that the administration’s executive orders unlawfully attempt to dismantle programs by withholding lawfully appropriated federal funds, exceeding their constitutional authority.

The lawsuit contends, “The Executive Orders unconstitutionally usurp congressional authority by withholding lawfully appropriated federal funds from medical institutions, providers and researchers, such as GLMA’s [an LGBTQ+ advocacy organization] health professional members. They violate the rights of thousands of transgender people under nineteen … by depriving them of necessary medical care solely on the basis of their sex and transgender status.”

In response to inquiries about the administration’s orders, a spokesperson for the Endocrine Society referenced an amicus brief filed with the U.S. Supreme Court last September. The brief detailed extensive medical reasons why gender-affirming care is essential for adolescents experiencing gender dysphoria.

National Nurses United, the largest union of registered nurses, issued a statement expressing outrage “by the Trump administration’s rollout of several policies attacking and endangering transgender Americans’ health, safety, and lives.”

State Attorneys General Defend Transgender Healthcare Access

New York Attorney General Letitia James declared that healthcare providers in her state should continue offering gender-affirming care for patients under 19, irrespective of the executive order, asserting that cessation of these services would violate New York’s anti-discrimination laws.

California Attorney General Rob Bonta echoed this stance on Wednesday, cautioning Children’s Hospital Los Angeles that withholding services from transgender patients could constitute a violation of state law.

Gender-Affirming Care Encompasses Broad Range of Medical Services

It is crucial to recognize that gender-affirming care extends beyond surgical procedures. It encompasses a spectrum of medical interventions, including puberty blockers and hormone therapies, as well as vital mental health care, counseling, social support, and assistance with legal document updates. Clinic leaders emphasize that all these essential services are now at risk under the new administration’s policies.

Research and Data Collection Efforts Affected by Policy Changes

Even critical research initiatives are facing setbacks. The Washington Post reported that the Trump administration directed the NIH to halt a large-scale study focused on HIV prevention among transgender youth of color before patient enrollment even commenced.

Last week, the CDC reportedly instructed its scientists to retract any research papers submitted to medical or scientific journals to redact “forbidden terms,” including “transgender,” “pregnant person,” “pregnant people,” “LGBT,” “Transsexual,” “non-binary,” “assigned male at birth,” “assigned female at birth,” and “biologically male.”

Widespread Impact on Transgender Community and Healthcare Landscape

According to a 2022 report from the UCLA School of Law Williams Institute, utilizing data from the U.S. Behavioral Risk Factor Surveillance System and other surveys, approximately 1.6 million transgender individuals over the age of 13 reside in the United States. These policy changes have the potential to affect a significant portion of this population, raising concerns about healthcare access and equity.