On the twenty-eighth of January, Donald Trump signed an executive order titled “Protecting Children from Chemical and Surgical Mutilation.” It declared that the United States will no longer “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” and “will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” The order, which defines a child as anyone under the age of nineteen, may also limit coverage of such care under Medicaid and other federal health-insurance programs. It directs hospitals receiving research or education grants from the government to stop any transition-related treatment programs for minors.
In the week that followed, major hospital systems that receive funds through the federal government began cancelling care in blue-state cities including Seattle, Los Angeles, Denver, and Washington, D.C. In New York City, at least two hospital systems—N.Y.U. Langone Health and Mount Sinai—cancelled surgeries, and some parents were told that they would no longer be prescribing medications to new patients under the age of nineteen. (Neither N.Y.U. Langone nor Mount Sinai has issued a public statement about its policies, or made its doctors available for comment.) Although lawsuits have been filed in response, and two federal judges have temporarily blocked the order, to give the suits time to proceed, not all hospitals that cancelled appointments have rescheduled them, and the fear of losing federal funds seems to be having its intended effect.
After the executive order was published, I spoke with the mother of a trans child who goes to N.Y.U. Langone for gender-affirming care. The possibility of its interruption had sent her into a panic. From the age of four, her daughter, who was assigned male at birth, would hit herself and tell her parents that she wished she had never been born. “It was so bad for so long, I thought my child was being abused by someone,” the mother said. Her daughter was six when, hiding under a table and crying during a family event, she articulated for the first time what was wrong: “In my heart and in my brain I’m a girl.”
“I felt actual relief—and confusion—because I hadn’t experienced anything like this before,” her mother recalled. She herself didn’t know any trans people personally. The decision to allow her daughter to socially transition—to present outwardly as a girl, and to adopt female pronouns—was made under the guidance of doctors. The self-harm and suicidal ideation ceased: “This child went from hiding under the playground and crying all the time to being so happy.”
As her daughter approached adolescence, she followed a standardized protocol of taking puberty blockers, which allow children to pause their development until they decide either to begin taking estrogen or testosterone or to undergo their natal puberty. (The age at which doctors prescribe hormone therapy varies by patient and clinician, but the general rule is sixteen.) “It was not a discussion that we took lightly,” said the mother, who emphasized that her daughter’s gender identity was her own, and that the girl had been present in conversations with doctors about her care. “There are others like her—quietly living their own lives, going through their days as normal kids,” she said.
Her daughter is now fourteen, and a lot of her teachers and peers don’t know that she’s trans. (She and many other parents I spoke to requested anonymity to avoid their kids being outed.) If her access to blockers—or, later, to female hormones—is cut off, as her mother fears, her day-to-day existence will be catastrophically disrupted. “I never thought that my country would want to disappear my child, and would want to essentially deny her existence as a person,” she told me. She worries that the increasingly hostile view of trans people will create “a long and dreadful path” for her daughter. “This is going to rob her of her dignity—of her life.”
During the 2024 Presidential campaign, Trump made an anti-trans stance central to his political platform. Ads mocking trans people ran during the World Series and other major sporting events. According to the advertising-tracking firm AdImpact, the G.O.P.’s total expenditure on broadcast ads maligning trans people—whom studies have found to be less than one per cent of the American population over the age of thirteen—exceeded two hundred million dollars. (Trump’s campaign alone spent some thirty-seven million.) The medical treatment of trans children was a particular focus of fearmongering. During an October campaign stop in the Bronx, Trump asserted that “there are some places your boy leaves the school, comes back a girl, without parental consent.” In Agenda47, his official policy platform, Trump promised to outlaw gender-affirming care for minors nationwide.
Beyond reflecting a campaign promise, Trump’s executive order is the culmination of years of Republican legislative efforts at the state level. In 2021, Arkansas became the first to pass a law banning transition-related treatment for minors; twenty-five more states have since passed their own restrictions on access. The new mandates went against the guidance of medical authorities—including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association, and the American College of Obstetricians and Gynecologists—regarding the efficacy of recommended treatment protocols, which are established by the World Professional Association for Transgender Health, an organization of physicians, mental-health professionals, and surgeons that grew out of an attempt to standardize care in 1979. (Trump’s executive order claims that WPATH “lacks scientific integrity,” calls its protocols “junk science,” and instructs the Secretary of Health and Human Services to produce a review, within ninety days, of “the existing literature on best practices for promoting the health of children who assert gender dysphoria.”) A federal judge struck down the Arkansas ban in 2023, and other suits are wending their way through the courts: in June, the Supreme Court is expected to rule on the constitutionality of state bans in its opinion in United States v. Skrmetti, a lawsuit filed by the A.C.L.U., Lambda Legal, and a few families against the state of Tennessee. The Department of Justice had supported the plaintiffs under Joe Biden, but in early February it sent a letter to the Supreme Court reversing its stance.
As a defensive response to such bans, New York became one of fourteen states to pass so-called safe-haven laws for trans youth. New York’s law, which was signed by Governor Kathy Hochul, in 2023, prohibits local authorities from coöperating with the arrest of medical providers and with out-of-state investigations into families seeking gender-affirming care, among other provisions. The New York State Human Rights Law, which protects New Yorkers from discrimination, also enshrined “gender identity or expression” as a criterion in 2019. Many families with trans children, including one I wrote about in this magazine in 2023, have relocated from states where bans were passed to those where treatment appeared to be more stable. In early February, in the aftermath of the executive order, Letitia James, the New York attorney general, published a letter warning hospitals that withholding services on the basis of gender violates state law.
The denials of care in New York City have therefore come with a sense of betrayal. “Executive orders haven’t changed the law,” a civil-rights attorney named David Brown told families who attended an online workshop about the order which was held by the Campaign for Southern Equality. “They are a statement of policy preference by the President.” The parents of trans children expressed anger that New York hospitals had seemingly acquiesced to the Republican political agenda before they were legally required to do so. One mother told me that Mount Sinai had cancelled a consultation for her son’s top surgery in December, weeks before Trump took office. The family had secured the consultation after months of waiting and a battery of hospital-mandated evaluations by mental-health professionals—only to be informed, the mother explained, “that Mount Sinai would no longer be seeing minors for surgical consults due to the ‘political climate.’ ” A second parent told me that Mount Sinai had also cancelled her son’s top-surgery consultation in December citing the “political climate.” (Mount Sinai declined to comment.)
Several of the parents I spoke to were having trouble eating and sleeping, and more than one broke into tears as we talked. One father told me that his child had expressed that she was a girl since she began picking out clothes for herself, at the age of two and a half, and that as she grew older her choices in clothing, toys, friends, and activities had remained consistent. “In every way that’s socially meaningful about what it means to be a girl nowadays in America, that’s what she’s always done,” he said. A military veteran from the Midwest, he was startled to find himself vilified by the executive order, which cast the care he’d sought for his daughter as “chemical mutilation.” “I’m not exactly a paragon of virtue or anything, but I’m a person who has lived a good and virtuous American life,” he told me. “All of a sudden, I felt like I was pushed outside of all of that, and was criminalized and painted as morally perverse.”
He and his family have started to map out worst-case scenarios. The father has a legal background, and has found himself reading and rereading the language of Trump’s statements, and even going back to the Federalist Papers. He has found solace in reminding himself of historic examples of Americans who found themselves marginalized for their views and didn’t fold.
Many providers have continued to offer care. On February 4th, on Instagram, the New York City Health and Hospitals Corporation posted a picture of smiling young faces with the trans pride flag over them, and the motto “Caring for everyone in NYC.” Callen-Lorde, an L.G.B.T.Q.+ health center in New York, promised no disruptions and reminded visitors to its Web site that “access to medically-necessary transgender healthcare is explicitly protected in New York State.” But the uncertainty and fear sowed by the order has impeded access all the same. Though N.Y.U. Langone has rescheduled some appointments for existing patients, it’s still unclear whether it will accept new ones (N.Y.U. Langone declined to comment). The news site the City reported that the Web page for youth gender care at NewYork-Presbyterian Hospital was temporarily taken down, then restored without the words “transgender” and “gender-diverse children” or any mention of puberty blockers and hormone treatment. (“We are working through this developing situation to comply with applicable state and federal laws and regulations,” a spokesperson for NewYork-Presbyterian told me. ) Most of the guidance received by parents I’ve spoken to has been verbal, and the hospitals seem reluctant to put any claims in writing. Amid this confusion, individual health-care professionals are making their own decisions. A parent named Christen Clifford described how, days after Trump’s directive was published, her sixteen-year-old’s testosterone prescription was not refilled as usual. When it finally went through, the boy was given a single dose. “Our doctor routinely prescribes for three months,” she told me. “Our insurance company routinely says no, only one month. But we have never been given only one week of medication before.” When she pressed, she learned of another unexpected obstacle: the pharmacist, who was wary of being investigated himself.
“The executive order can not only kill off my clinic—it can kill off my institution,” Jeffrey Birnbaum, a doctor who serves L.G.B.T.Q.+ patients in New York, told me. The trans youth he sees are mostly in their late teens and are old enough to receive hormones, which he cannot prescribe to minors without their parents’ permission. He has received calls from a number of families fleeing other hospital systems in the wake of cancelled appointments, and told me that, if care is banned, an underground market will likely emerge. “The type of care that we provide is evidence-based,” he said, when I asked him about the order’s call for new courses of treatment. “This is not any kind of ideology.”
Puberty blockers can be administered two ways—by injection every few months or by an implant that lasts about a year. Insurance companies sometimes classify the implant’s insertion as a surgery, though the procedure is done in-office, using local anesthesia, and is not invasive. The appointments that N.Y.U. Langone cancelled among the families I interviewed were for implants. In what seems to be a typical case, one mother was told by the hospital that, although it wouldn’t be able to move forward with a plan for her daughter to switch from puberty-blocker shots to an implant—a decision made in part to buy her time in case of further restrictions in care—the shots could continue, as the doctor explained it, “for now.”
“That ‘for now’ sent chills down my spine,” the mother told me. “Maybe N.Y.U. just never really believed in this type of care in the first place,” she said.
I spoke with another mother, whose eleven-year-old son currently has an implant. She, too, requested anonymity because he is not out as trans at school. “Most of his life, and certainly within his living memory, he’s been moving through the world as a boy,” she told me. “The idea of going through female puberty for him would be earthshaking.” Like the other parents I spoke to, she stressed that her son, who started seeing a doctor at N.Y.U. Langone at the age of nine to prepare for the onset of puberty in advance, had positive experiences with his doctor and at the hospital. She said that, after her son received his first implant, in April, 2024, “he felt so proud.” That summer was the first time he swam without a shirt on. “He had a feeling of freedom in his body that was new.”
To continue his treatment, he will need a new implant in the spring or early summer. “I’m glad my kid isn’t on T”—testosterone—“already,” his mother told me. Although the judicial stays have calmed the discourse, she said that the initial response to the executive order was one of emergency. “Kids that are older and already on hormones, they’re stockpiling, they’re talking about going to Mexico and buying it over the counter, they’re talking about getting needles from sympathetic veterinarians, they’re looking for menopausal women like me to donate their estrogen patches. It’s just so bad, the level of desperation.” A few days after we spoke, their doctor told her, in a reversal, that her child would be able to receive his implant as planned. When I asked her whether the hospital’s change of heart gave her a sense of respite, she responded, “It does not, until they reopen doors to new patients under nineteen and offer equal care to all of them.”
On a recent Saturday afternoon, several thousand people gathered in Union Square, in the biting cold, for a rally in support of trans youth. A nine-year-old trans girl named Eli told the crowd that her family had moved to the city from Florida, “because it was unsafe there. Now I am unsafe again because Trump is President, but New York promised to protect me.” Calliope, a junior at Stuyvesant High School, had already faced discrimination close to home, including a parent-led effort in her district to limit the participation of trans girls in sports. “It’s been really disheartening to worry about losing the right to use the bathroom and to not be bullied and to just be who I am in one of the most accepting cities in the world—and now we have to worry about losing all of those rights nationwide,” she said. A fourteen-year-old girl named Niro roasted Trump, “the man who can’t use bronzer or contour correctly,” then said that trans kids “deserve kindness and support, just like everyone else.”
Willow, the trans girl whose move from Tennessee to Virginia I wrote about in 2023, is now seventeen. After Trump signed the executive order, a long-planned routine-care appointment for Willow at the Children’s Hospital of Richmond at Virginia Commonwealth University was cancelled. (V.C.U. said that it was abiding by a directive from the state’s attorney general to comply with Trump’s order.) “If the executive order stands, that means Willow has two more years as a minor,” her mother, Kristen Chapman, told me. “I don’t think she can survive two years without medicine.” Initially named as a plaintiff in a PFLAG lawsuit challenging the order, Chapman stepped back after deciding the exposure would be too stressful for the family. But she said that she would not consider moving again. “There’s nowhere to go in this country that’s safe. I think that’s a fallacy that blue-state people have,” she said. “Having lived in deeply red states my whole life, they tried out all of their worst tricks on our states first,” she continued. “Now they’re taking it everywhere.” ♦
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