Two hospitals in California that are part of Rady Children’s Health have stopped providing gender-affirming hormone therapy to patients under 19, citing growing federal pressure. The decision affects nearly 1,500 young patients and was communicated to families recently.
Rady Children’s Health, which runs Rady Children’s Hospital in San Diego and another large Southern California pediatric hospital, told families it would discontinue hormone treatments for minors. Parents and providers say the move follows a series of federal actions intended to limit youth access to gender-affirming care.
Those federal actions include a referral to the Department of Health and Human Services Office of Inspector General for investigation and proposed rule changes by the Centers for Medicare and Medicaid Services. Advocates warn the CMS proposals, if adopted, could jeopardize federal funding for hospitals that provide hormone treatments or surgery to minors.
One San Diego father, who asked that his last name not be used, described how his 11-year-old began hormone treatment at Rady about a year and a half ago after coming out as a boy. He said treatment led to rapid improvements in mood, social life and engagement in hobbies, and praised clinic staff as “overwhelmingly loving.” He said the hospital’s announcement left his family stunned: “The whole world kind of dropped out from under me.”
Federal officials have defended their actions. HHS told NPR in an emailed statement that gender-affirming care did not meet “professionally recognized standards of health care.” Major medical organizations disagree: the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association say gender-affirming care for youth is evidence-based and important for mental health. The American Society of Plastic Surgeons has recommended delaying gender-related surgeries until age 19, and only a small number of transgender minors pursue surgical interventions.
Advocates say the proposed CMS rules have broad implications because a large share of many hospitals’ funding—often about half—comes from federal programs such as Medicare and Medicaid. Over the past year, more than a dozen hospitals nationwide have stopped offering gender-affirming hormone therapy to minors, according to advocacy groups.
Providers and families describe fear and uncertainty. Alex Sheldon, executive director of GLMA, an LGBTQ medical association, said clinicians at institutions that end youth care have received desperate messages from patients and families. Sheldon recounted reports of a nurse being told by a parent that if a young person died by suicide because they lacked access to treatment, it would be the nurse’s fault.
Private clinicians may be able to absorb some patients, but they cannot fully replace large pediatric systems that provide high-volume care, research and clinical guidance. In San Diego, the father said his family has found only one private provider in the county and is uncertain whether that practice can treat his son; they have even discussed seeking care abroad.
California Attorney General Rob Bonta has filed a lawsuit seeking a permanent injunction to restore gender-affirming hormone therapy at Rady. Meanwhile, affected families are looking for care elsewhere, pursuing legal remedies and weighing travel options as the dispute unfolds.