When Bug came home from school one winter afternoon in late 2024, he told his mother he was a boy and would use he/him pronouns. Bug, who was assigned female at birth and had earlier identified as nonbinary, was in sixth grade. His mother, who asked to be identified only as J and to use her son’s nickname because the family fears harassment, remembers asking what he needed. He asked for health care.
J was relieved: the family had left Austin, Texas, in 2024 and resettled in western Massachusetts, hoping the state’s laws and medical culture would better support their autistic, gender-nonconforming children. Massachusetts had passed protections for gender-affirming and reproductive care, including a 2022 “shield” law and stronger protections in 2025, and the state required commercial insurers to cover gender-affirming services. J expected she could find clinicians to support Bug.
Baystate Health in Springfield, the region’s largest hospital system, initially seemed to fit that need. Its pediatric counseling and endocrinology services had treated gender-diverse youth, and by late 2025 Bug was meeting with doctors and preparing to start testosterone, which he said he was excited about.
But the national political context had been shifting. Within days of President Trump’s January 2025 inauguration, an executive order targeted gender-affirming care for youth. On Dec. 18, 2025, the administration announced a policy that would bar such care for minors and said it would investigate hospitals that provide it, warning of possible consequences to federal reimbursements. Dozens of hospitals around the country — in both conservative and liberal states — began shutting or scaling back youth gender programs. Twenty-seven states, mostly Republican-led, had already passed laws banning gender-affirming care for minors.
Two weeks before Bug’s scheduled start of hormone therapy, Baystate notified families it would stop prescribing gender-affirming medications to minors and would offer only counseling. The notice did not explain the rationale. J says she felt the floor fall out. “Maybe this is naive, but I didn’t think that would happen in Massachusetts, and certainly not preemptively,” she said.
Baystate told families and the media that its decision reflected a risk to “hundreds of millions of dollars in government reimbursement” if it continued offering care after the federal pronouncement. The hospital noted that nearly 70% of its patients rely on Medicaid and Medicare. In March, a judge ruled against the administration’s policy in a lawsuit Massachusetts had joined, though the administration could appeal. Baystate’s decision to stop prescribing for minors has nonetheless stood.
The closure has had immediate effects on young patients and their families. L, the mother of a former Baystate patient who asked to be identified only by her first initial, said her daughter had been severely depressed and suicidal before coming out. Baystate physicians prescribed puberty blockers and estrogen; L said her daughter’s mood and school performance improved. When L received the letter that Baystate would end medical treatment, she was furious and worried about the mental health consequences for her child, who had not yet been told.
For children like Bug, the announcement was crushing. “I felt frustrated that they would do that,” he said. “I bet there’s tons and tons of kids who are like, ‘Okay, I’m going for trans-affirming healthcare. Yay!’ And then we’re like, ‘No, never mind.’”
Nationwide, the chilling effect has been clear. Dozens of hospitals shut youth gender programs preemptively after the federal threat, including institutions in blue states such as California, Illinois and New York. The American Academy of Pediatrics has endorsed gender-affirming treatment for minors, but a media representative said pediatricians the organization contacted were too afraid of retaliation to speak publicly about hospital closures. Several parents filed civil-rights complaints with the Massachusetts attorney general after Baystate’s decision.
Some families scrambled for alternatives. In western Massachusetts, a private specialty clinic called TransHealth in Northampton began preparing to take on more patients. Jo Erwin, TransHealth’s CEO, said the clinic has been staffing up in anticipation of hospitals pausing youth services and expects to absorb more than 200 former Baystate patients, plus dozens who previously left Fenway Health in Boston after that clinic stopped hormone therapy for minors. TransHealth says it can sustain the influx because it relies on large private donations and is less dependent on Medicaid and Medicare than major hospital systems.
But private clinics are not a full solution. They often have limited capacity, may be farther away for many families, and depend on philanthropic support that could fluctuate. “When you see something like that go down,” Erwin said, “people get scared that it’s ultimately going to happen to everyone.” J echoed that uncertainty: she is relieved Bug will start testosterone at the new clinic but worries the federal government could again interfere. “Now we’re dependent on privately funded places and that doesn’t feel like very firm ground to be standing on,” she said.
The closures also leave clinicians and institutions in a fraught position. Hospitals that rely heavily on federal reimbursements say they face untenable financial and legal risk if they continue offering care the federal government says it will penalize. That risk has prompted preemptive responses even in states where courts and elected officials have challenged the administration’s policy.
Families who moved to states they saw as safer often feel blindsided. J said she left Texas partly to protect her children from what she saw as a creeping erosion of rights; after a school shooting in Uvalde, the move felt urgent. She and her husband bought a farmhouse in the Berkshires and enrolled the children in a local private school. In Massachusetts, she expected legal protections and a supportive community. Instead, she found that institutional decisions driven by federal pressure can override state laws meant to shield providers and patients.
For now, some parents have found ways to continue care: primary care doctors have taken over prescriptions in a few cases; private clinics have stretched to accept new patients. But many families face waiting lists, longer travel for appointments, uncertain costs, and the constant fear of another abrupt change. Clinicians and families alike describe a climate of fear that inhibits open discussion and even confers silence on professionals who worry about retaliation.
The experience of families like J’s and L’s illustrates how federal policy, hospital risk calculations, and the uneven funding of health care systems combine to shape access to gender-affirming care, even in states that have enacted protective laws. For transgender youth who had hoped for medical support, the abrupt closures have immediate physical and mental-health implications, and for their parents, the decisions have rekindled doubts about where to live, who to trust, and what protections will actually hold.
This story is part of NPR’s health reporting partnership with New England Public Media and KFF Health News.