trans youth

When Children’s Hospital Los Angeles first told thousands of patients it was shuttering its pediatric gender clinic last month, Jesse Thorn was distraught but confident he could quickly find a new local care team for his kids.

But by the time the Center for Transyouth Health and Development officially closed its doors on Tuesday, the father of three was making plans to flee the country.

“They’re targeting whoever they can,” Thorn said. “[I’m afraid] the police will show up at my door because I took my child to see their doctor.”

Until this week, Children’s was among the largest and oldest pediatric gender clinics in the United States — and one of few providing puberty blockers, hormones and surgical procedures for trans youth on public insurance.

The closure of the renowned program signals a wider unraveling in the availability of care across the country, experts said. That includes in former safe havens such as California, New York and Illinois, where state laws protecting trans-specific healthcare are crumbling under mounting legal pressure and bureaucratic arm-twisting by the Trump administration.

In the last week, University of Chicago Medicine and Children’s National in D.C. announced they will end or dramatically scale back services for trans youth, following similar moves by Stanford Medicine, University of Pittsburgh Medical Center and Children’s Hospital of Orange County.

“There’s a rapid collapse of the provision of this care in blue states,” said Alejandra Caraballo, a civil rights attorney and legal instructor at Harvard. “By end of 2025, most care will effectively be banned.”

Some parents in L.A. say they fear the Department of Justice will use private medical data subpoenaed from California’s largest pediatric safety-net hospital to take their children away from them.

“It’s absolutely terrifying,” said Maxine, the mother of a Children’s Hospital patient, who declined to give her last name for fear of attacks on her son.

“I’m very afraid that the DOJ and this acting Attorney General are going to come after parents and use the female genital mutilation law … to prosecute parents and separate me from my child,” she said.

On July 9, Atty. Gen. Pam Bondi announced the Department of Justice was subpoenaing patient medical records from more than 20 doctors and clinics, the latest in a cavalcade of legal and technical maneuvers against providers who care for trans youth.

“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,” Bondi said in a news release announcing the move.

Children’s would not say whether it had been subpoenaed or if it had turned over records responsive to the government’s demand.

The Justice Department was already investigating pediatric specialists for a litany of alleged crimes, from deceptive trade practices to billing fraud. Federal health agencies have vowed to withhold funding from institutions that continue to provide affirming care.

“These threats are no longer theoretical,” Children’s Hospital executives wrote to staff in an internal email announcing the closure June 12. “[They are] threatening our ability to serve the hundreds of thousands of patients who depend on CHLA for lifesaving care.”

Advocates say gender-affirming care is also lifesaving. They point to statistics — contested by the federal government and some experts — showing high rates of suicide among trans youth.

In June, the decision to shutter the clinic was widely condemned. Advocates said Children’s Hospital L.A. had “thrown trans kids under the bus” in disregard of state law.

Few are saying that now.

“You could see kids with leukemia being cut off their chemo therapy unless these hospitals stop provide care to trans people,” Caraballo said. “If one of the biggest children’s hospitals in the country couldn’t shoulder that burden, I don’t see many others being able to do so.”

Others agreed.

“No matter what California or any other state has done to say, ‘We want to protect these kids,’ unless they can write checks that equal the amount of money that’s being lost, [programs close],” said Dara E. Purvis, a law professor at Temple University.

So far, the Trump administration has painted parents as victims of “radical gender ideology.”

Some experts warned that as the government tightens the screws on doctors and hospitals, trans teens and their families are likely to seek hormones outside the medical system, including through gray market channels.

“We’ve seen this with abortion,” Caraballo said. “People are going to go about getting it whichever way they can.”

There are fears that families could face prosecution for continuing to seek medications, similar to charges being filed against mothers who have secured abortion pills for their teenagers.

“We’re working with Congress on existing criminal laws related to female genital mutilation to more robustly protect children,” Justice Department Chief of Staff Chad Mizelle said during a Federal Trade Commission workshop entitled “The Dangers of ‘Gender-Affirming Care’ for Minors.”

“We are using all of the tools at the Department of Justice to address this issue,” Mizelle said.

For now, dozens of hospitals across California still provide gender-affirming care, including hormone therapy and surgical procedures.

But the list changes almost day to day.

“Even programs that may have been operating a month ago are not operating now,” said Terra Russell-Slavin, chief impact officer at the Los Angeles LGBT Center. “There’s a lot of concern about even being public about offering care because those agencies become targets.”

With the medical care their children rely on under threat and few promised protections from the state, some families are unsure what the coming months will bring.

For one Orange County father, who asked not to be named for fear of retaliation against his trans son, plans for future travel are suddenly in jeopardy.

He said only about half of his son’s identity documents match his gender, and they’ve been warned not to try to change others.

“He won’t be able to leave the country because he can’t get a matching passport,” the father said.

For Maxine, the L.A. mom, balancing the banal with the existential is a daily strain.

“My kid is just living their life. They want to go to concerts, they want to go shopping for back to school — they don’t know any of this is happening,” the mother said. “You have to experience this intense fear while maintaining a normal household for everybody else.”

Children’s Hospital Los Angeles is the preeminent center for pediatric medicine in Southern California. For three decades, it’s also been one of the world’s leading destinations for trans care for minors. Don’t take my word for it: CHLA boasts about its record of providing “high-quality, evidence-based, medically essential care for transgender and gender-diverse youth, young adults, and their families.”

Earlier this month, it abruptly ended all that, telling its staff in a meeting that the Center for Transyouth Health and Development would be shutting down. (My daughter was, until this announcement, a patient at the center.)

Did some new medical breakthrough, some unexpected research drive the decision to cut off care for roughly 2,500 patients with no warning? No. It came, the hospital said, after “a thorough legal and financial assessment of the increasingly severe impacts of recent administrative actions and proposed policies.”

In other words, the hospital caved. In advance.

CHLA made the move a week before the Supreme Court’s 6-3 decision in the United States vs. Skrmetti, which upheld a Tennessee law that bans most gender-affirming care for minors. More than 20 states have passed similar laws that prevent trans minors from accessing many different forms of medical care. The decision essentially shields those laws from future legal challenges.

But the Supreme Court ruling had nothing to do with CHLA’s decision. There is no such law in California.

Why, then, without any court order or law, did the center suddenly close, leaving so many young patients in need of doctors, medications and procedures? You can probably guess the answer.

Pressure from the Trump administration threatened the hospital with severe repercussions if it continued to serve these patients. One form of pressure arrived in a May 28 letter from the Centers for Medicare and Medicaid Services, signed by its administrator, the former TV host Dr. Mehmet Oz. He announced that his agency would seek financial records on a range of gender-affirming care procedures from several dozen hospitals.

Being faced with the choice of discontinuing care for an entire class of patients or battling the administration over access to financial records is not a dilemma any doctor wants to face. To be clear, this is not a debate over medical science or proper care for trans youth. CHLA followed the science — until it didn’t. This is a debate over ideology about who is deserving of medical care.

In the past few months, we have seen powerful law firms, large corporations and universities forced to contend with difficult bargains. Settle with an administration that has singled you out? Or take the battle to court?

In February, when Children’s Hospital announced that it would stop taking on new patients in its Transyouth Center, California Atty. Gen. Rob Bonta sternly reminded them that they had a legal obligation to continue to provide this care. The hospital quickly reversed course.

That’s why the recent choice of the CHLA board marks a huge shift that could potentially affect care for not just trans youth patients but so many others as well.

Because what the board of CHLA did was, in fact, a choice. Moreover, CHLA’s choice went against its own medical advice about the urgent need for such care. On its website, the hospital claims it was “immensely proud of this legacy of caring for young people on the path to achieving their authentic selves.”

When confronted with threats, the board chose to sacrifice the care of one group of patients in the hope that it could continue to care for others. Perhaps the board concluded that it was following a crude, utilitarian logic: denying the medical needs of some would allow it to provide for many more.

That’s not how I see it. In caving to blackmail, they have endorsed the administration’s bigotry. They have demonstrated that trans youth are expendable. The board has made it clear that this group of patients is not as deserving of care as others. When CHLA faced actual pressure, its own record of providing “high-quality, evidence-based, medically essential care” simply became too inconvenient.

This time, it was trans youth. Who will it be next time? Disabled children? Children born outside the U.S.? CHLA agreed to play the game rather than call it out for what it is.

As a journalist, I occasionally grant anonymity to a source. It’s not an action I take lightly. The decision means that if pressured, even when threatened with contempt of court, I will not reveal their identity. Thankfully, it’s never come to that for me, although other journalists have gone to jail to protect sources. If I were to break that pledge once, I could never in good conscience grant it again.

I now wonder how doctors at CHLA can ever look their young patients in the eye again and promise that, no matter what, they will fight for their care.

Gabriel Kahn is a professor of professional practice at the USC Annenberg School for Communication and Journalism.