States sue Trump over gender-affirming care for youth

Seventeen Democratic officials accused President Donald Trump's administration of unlawfully intimidating health care providers into stopping gender-affirming care for transgender youth in a lawsuit filed Friday. The complaint comes after a month in which at least eight major hospitals and hospital systems — all in states where the care is allowed under state law — announced they were stopping or restricting the care. The latest announcement came Thursday from UI Health in Chicago. Trump's administration announced in July that it was sending subpoenas to providers and focusing on investigating them for fraud. It later boasted in a news release that hospitals are halting treatments. The Democratic officials say Trump's policies are an attempt to impose a nationwide ban on the treatment for people under 19 — and that's unlawful because there's no federal statute that bans providing the care to minors. The suit was filed by attorneys general from 15 states and the District of Columbia, plus the governor of Pennsylvania, in U.S. District Court in Boston. "The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children," New York Attorney General Letitia James said in a statement. Trump and others who oppose the care say that it makes permanent changes that people who receive it could come to regret — and maintain that it's being driven by questionable science. Since 2021, 28 states with Republican-controlled legislatures have adopted policies to ban or restrict gender-affirming care for minors. In June, the U.S. Supreme Court ruled that states have a right to enforce those laws. For families with transgender children, the state laws and medical center policy changes have sparked urgent scrambles for treatment. The medical centers are responding to political and legal pressure The Center for Transyouth Health and Development at Children's Hospital Los Angeles, the biggest public provider of gender-affirming care for children in teens in the U.S., closed in July. At least seven other major hospitals and health systems have made similar announcements, including Children's National in Washington D.C., UChicago Medicine and Yale New Haven Health. Kaiser Permanente, which operates in California and several other states, said it would pause gender-affirming surgeries for those under 19 as of the end of August, but would continue hormone therapy. Connecticut Children's Medical Center cited "an increasingly complex and evolving landscape" for winding down care. Other hospitals, including Penn State, had already made similar decisions since Trump returned to office in January. Alex Sheldon, executive director of GLMA, an organization that advocates for health care equity for LGBTQ+ people, said the health systems have pulled back the services for legal reasons, not medical ones. "Not once has a hospital said they are ending care because it is not medically sound," Sheldon said. Trump's administration has targeted the care in multiple ways Trump devoted a lot of attention to transgender people in his campaign last year as part of a growing pushback from conservatives as transgender people have gained visibility and acceptance on some fronts. Trump criticized gender-affirming care, transgender women in women's sports, and transgender women's use of women's facilities such as restrooms. On his inauguration day in January, Trump signed an executive order defining the sexes as only male and female for government purposes, setting the tone for a cascade of actions that affect transgender people. About a week later, Trump called to stop using federal money, including from Medicaid, for gender-affirming care for those under 19. About half of U.S. adults approve of Trump's handling of transgender issues, an AP-NORC poll found. But the American Medical Association says that gender is on a spectrum, and the group opposes policies that restrict access to gender-affirming health care. Gender-affirming care includes a range of medical and mental health services to support a person's gender identity, including when it's different from the sex they were assigned at birth. It includes counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes, as well as surgery, which is rare for minors. In March, a judge paused enforcement of the ban on government spending for care. The court ruling didn't stop other federal government action In April, Attorney General Pam Bondi directed government investigators to focus on providers who continue to offer gender-affirming care for transgender youth. "Under my leadership, the Department of Justice will bring these practices to an end," she wrote. In May, the Department of Health and Human Services issued a report discouraging medical interventions for transgender youth and instead focusing solely on talk therapy. The report questions adolescents' capacity to consent to life-changing treatments that could result in future infertility. The administration has not said who wrote the report, which has been deeply criticized by LGBTQ+ advocates. In June, a Justice Department memo called for prioritizing civil investigations of those who provide the treatment. In July, Justice Department announced it had sent more than 20 subpoenas to doctors and clinics involved in gender-affirming care for youth, saying they were part of investigations of health care fraud, false statements and other possible wrongdoing. And in a statement last week, the White House celebrated decisions to end gender-affirming care, which it called a "barbaric, pseudoscientific practice" Families worry about accessing care Kristen Salvatore's 15-year-old child started hormone therapy late last year at Penn State Health. Salvatore said in an interview with The Associated Press before the lawsuit was announced that it was a major factor in reduced signs of anxiety and depression. Last month, the family received official notice from the health system that it would no longer offer the hormones for patients under 19 after July 31, though talk therapy can continue. Salvatore has been struggling to find a place that's not hours away from their Mechanicsburg, Pennsylvania, home that would provide the hormones and accept Medicaid coverage. "I'm walking around blind with no guidance, and whatever breadcrumbs I was given are to a dead-end alleyway," she said. The family has enough testosterone stockpiled to last until January. But if they can't find a new provider by then, Salvatore's child could risk detransitioning, she said.