Three main medical centers in California, a Democratic-controlled state long known for its trans-friendly politics, recently announced the shutdown of gender-affirming treatment and prescriptions for transgender minors. Many other hospitals in cities and states led by Democrats, such as UChicago Medicine and the University of Pittsburgh Medical Center, have also recently curtailed gender-affirming care services for transgender minors.
In January 2025, President Trump signed Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation,” restricting federal funding and legal protections for gender-affirming care for individuals under age 19. Although federal judges in multiple districts, including in California, have temporarily blocked its enforcement in February, many hospitals are pulling back on gender-affirming medical care for minors due to fears of losing funding, legal uncertainty, and official warnings from the Department of Justice (DOJ). On July 9th, the DOJ announced it had issued over 20 subpoenas to clinics and doctors involved in gender-affirming care to minors.
Debate Over Gender-Affirming Care
Gender treatments for minors, including puberty blockers, hormones, and surgeries, are at the center of intense global debate due to the speculated risk of physiological harm. Some Republican lawmakers in the U.S.have tried to restrict gender-affirming care for transgender youth, citing concerns that such care is overly prevalent or that young children are receiving surgeries. During the 2024 legislative session, the ACLU documented over 79 efforts to limit gender-affirming care for minors.
However, according to a 2025 study published in JAMA Pediatrics, fewer than 0.1 percent of youth received these treatments between 2018 and 2022, suggesting medical practices are very cautious when administering treatment. Additionally, many medical organizations support gender-affirming care as safe, effective, and potentially medically necessary. This is because puberty blockers temporarily pause the development of secondary sex characteristics, such as breast growth and facial hair, giving children time to explore their gender identity and consider the most appropriate options.
On a scientific level, a recent meta-analysis of 20 studies examined the impact of testosterone-based gender-affirming hormone therapy (GAHT) on kidney function in transgender individuals assigned female at birth (AFAB) over the course of 24 months. It found a decrease in eGFR at six and twelve months when using female reference values. However, the authors suggest that this decline likely reflects physiological changes rather than true kidney damage, emphasizing the need for more accurate tools to assess kidney function.
The Society for Evidence-Based Gender Medicine (SEGM) raised concerns about a controversial paper published in the Journal of Sexual Medicine, which concluded individuals who underwent puberty suppression during adolescence did not experience elevated rates of sexual dysfunction by adulthood. SEGM criticized the study for its small sample size and high dropout rate (52 percent overall participation). It also comments that Olson-Kennedy et al. (2025) failed to prove no changes in the mental health of youth treated with PB over 24 months due to a lack of a control group for comparison.
The debate over minors transgender treatments remains highly polarized, shaped by political, legal, and scientific tensions. While current scientific and clinical evidence is not yet strong enough to support either perspective, policy may need to remain broad and noninvasive to protect vulnerable youth.