Trump is trying to end gender-affirming care for trans kids. Doctors and nurses are working hard to keep offering it.

Soon after taking office last January, President Donald Trump issued an executive order aimed at ending gender-affirming care for transgender children and teenagers under 19. 

Since then, the administration has launched investigations of several hospitals that provide that care, and in December, the Department of Health and Human Services proposed a new rule that would ban hospitals offering that care from receiving Medicaid and Medicare funding, for anything.

That rule is not in effect yet, and 19 states have sued to block it, but hospitals are spooked; many wouldn’t be able to operate without Medicaid and Medicare funding. Already in recent weeks, a number have stopped offering gender-affirming care to minors, at least for now.

The attacks on transition-related care, at both the state and federal levels, are having a profound effect on transgender kids and their families. They’re also having a profound effect on health care providers. 

In Colorado, two big hospitals that offered gender-affirming care to kids and teenagers, Children’s Hospital and Denver Health, both stopped in early January. Casey Cash, a family nurse practitioner in Fort Collins, was on vacation with her family for the new year when the news broke.

“My phone blew up at 8 a.m., and that's how I found out,” she said. “And I was like, ‘What? What are you talking about? What do you mean? Denver Health, what? Children's, no — what?’”

Cash is not affiliated with either hospital. She and her longtime colleague, Dr. Stacie Johns, just opened a nonprofit primary care practice in November called The Iris Center. Among the services they offer is gender-affirming care, including for kids and teenagers, which is backed by major American medical associations. That can include prescribing puberty blockers or hormones; at their practice, it does not include surgery.

Cash and Johns knew the hospitals might stop offering transition-related care to kids at some point, because they can’t afford to lose Medicare and Medicaid funding, but didn’t think it would happen so soon.

“We thought we had a few more months,” Johns said. “We thought we had at least till April.”

Instead, they only had until Jan. 2, a Friday.

“I think that Monday, we were getting an average of about 20 requests an hour of people calling us,” she said. 

Specifically, parents who were looking for providers for their trans kids. Before, they might’ve gotten that many such calls in a week. 

“We have been really overwhelmed by parents of children under the age of 18 who are no longer feeling safe to get care,” Cash said. 

Cash and Johns’ new practice is not specifically for gender-affirming care, but since they offer it, they’ve been doing a lot of triage in recent days — trying to help as many transgender kids as they can get the care they need. 

“But we are only two people,” Johns said. “And we are primary care. We have a lot of patients that are cisgendered and also need care. So kind of balancing the needs of all of our patients has been challenging.”

It’s also just a challenging time to be a doctor or nurse caring for trans kids in this country. Twenty-seven states have banned transition-related care for minors in the last five years. Some providers in those states have uprooted their families and careers to move to places where they can still practice. And now, even in states where it is still legal to offer that care to kids, a growing number of hospitals are shutting it down — at least temporarily — over investigations and threats from the Trump administration.

“Emotionally, providers are distraught. They care greatly about their patients, they care greatly about these families,” Johns said. “And to have to be forced so abruptly to abandon them — and not to be able to help them with resources or refills and things that they need — is really devastating to a lot of them. And a lot of them have their own fear about what's going to happen to them as providers.”

Fear about whether their employers will continue to support them, fear of losing their jobs, fear of being targeted by the administration. But many are also committed to continuing to support and care for trans kids.

“I've been in medicine for 20 plus years, in ER and on the ambulances, and I have never experienced the joy and the satisfaction as a provider of delivering any other kind of care,” Cash said. “It is amazing to watch the progression of a child who didn't make eye contact finally sit up, smile, push their hair out of their face, tell me about a band that they joined, or whatever. And it is — I get goose bumps. I have goose bumps right now.”

It’s the most rewarding work she’s ever done, and she’s determined to find a way to keep doing it. 

“There are a lot of providers that are desperate to continue this care, and they want to because we know it saves lives,” Cash said. 

In recent weeks, she and Johns have been hearing from other doctors and nurses who work at hospitals or practices where they’re no longer allowed to offer transition-related care to kids, who are considering the possibility of leaving and starting their own practices, or looking for other ways to keep doing this work. 

“Numerous have reached out, saying that they're very interested in trying to help us, and trying to figure out how they could help provide the care as well, outside of where they're currently working,” Johns said. “I do think there are a lot of people that are working hard to try and figure solutions out.”

Parents of trans children reflect

• From March 30, 2022: Parents of transgender children in Texas face a hard choice: stay or go

• From May 8, 2023: A family fled Texas to protect their transgender child. They’re still afraid.