Waving a transgender pride flag, Diego Vasquez stood outside Kaiser Permanente’s Los Angeles hospital at a solidarity march for trans youth, shouting “trans lives matter.” He has received gender-affirming care treatments since age 22 and only regrets not being able to access care earlier.
“If I had this when I was younger, I might have had a better shot at life,” said Vasquez, who is trans. Gender-affirming care “gives (youth) the will to live,” he added.
Vasquez joined a small crowd of protesters gathered on Thursday, Aug. 7, in front of Kaiser’s Los Angeles Medical Center along Sunset Boulevard, condemning the massive health provider’s recent announcement that it will halt gender-affirming surgeries for patients under age 19, due to the threat of federal funding cuts. The pause is effective Aug. 29.
Kaiser Permanente’s move follows similar closures to transgender care services offered at Stanford Medicine and Children’s Hospital Los Angeles, which closed its health clinic for younger transgender patients in July.
Gender-affirming health care, as defined by the World Health Organization, encompasses the social, psychological, or medical care — including age-dependent surgeries, which are being paused for young Kaiser patients, or hormonal treatments — to support a person’s gender identity. Opponents worry this type of care is too young for children who do not know the full consequences of sometimes permanent changes to their bodies. Some opponents, including President Donald Trump, called it “mutilation.”
California law prohibits the denial of services to a person because they are transgender. Though the state has protective health care laws that extend to youth, the threat of federal funding cuts, after an executive order by President Trump to ban gender-affirming care for those under 19 nationwide, has prompted many providers to outright end services for young transgender people.
In the January executive order, the president called science-backed, medically supported gender-affirming care methods “junk science” and “chemical and surgical mutilation,” and said restricting them is a way to protect children. He also signed an order defining the sexes as “male and female.”
“Across the country, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions,” Trump said in the order. “This dangerous trend will be a stain on our nation’s history, and it must end.”
In July, at least eight major hospitals and hospital systems based in states where gender-affirming care is legal announced they were ending or restricting gender-affirming treatment for ages 19 and under. Recently, as part of its funding freeze to UCLA, the Trump administration proposed that the school’s hospital and medical school end gender-affirming services, and in return, funds would be restored, CNN reported.
In late July, California Attorney General Ron Bonta — along with attorney general peers from 15 other states and Washington, D.C. — sued the Trump administration, accusing it of unlawfully intimidating health care providers into stopping gender-affirming care for trans youth.
Earlier in the summer, the Supreme Court upheld a ban on gender-affirming care for minors in Tennessee, which advocates called a setback to transgender rights. At least 25 states have laws similar to Tennessee’s.
Kaiser Permanente, the state’s largest health care provider, roughly covers one in four Californians and 4.9 million patients in Southern California, officials said. The massive health care system includes 16 hospitals, 197 medical offices, and a comprehensive network of providers throughout greater Los Angeles, Orange, Riverside and San Bernardino counties.
A July 31 statement from Kaiser cited ongoing pressures hospitals face regarding health care, since Trump took office in January.
“This has included executive orders instructing federal agencies to take actions to curtail access and restrict funding for gender-affirming care, hospital inquiries by the Centers for Medicare & Medicaid Services, and regulatory changes to coverage and broader federal agency review, including by the Federal Trade Commission,” the statement read.
It noted that the U.S. Department of Justice issued subpoenas to doctors and clinics providing gender-affirming care to transgender minors, as part of ongoing federal investigations.
According to Kaiser, these executive moves have led Kaiser to make the “difficult decision” to pause surgical treatment for those under 19, “after significant deliberation and consultation with internal and external experts, including our physicians,” the statement said.
The pause, starting Aug. 29, will not affect other gender-affirming care at Kaiser.
The major health network provides services to members, including hormone therapy, mental health resources, surgical evaluations and procedures, according to its website. In 2024, Kaiser Permanente hospitals were recognized by the Human Rights Campaign Foundation as a leader in LGBTQ+ health care, earning the highest possible score on its Healthcare Equity Index, a tool evaluating facilities on equitable practices related to LGBTQ+ patients, visitors and employees.
As part of gender-affirming treatments — endorsed by major medical associations — younger patients who haven’t gone through puberty yet usually receive counseling and other options. For some, the next step is puberty-blocking medication, and others receive hormone replacement therapy. Gender-affirming care encompasses a wide range of treatments available to trans, intersex and cisgender people.
Gender-affirming surgeries are rarely offered to those under 18, according to research from the Harvard T.H. Chan School of Public Health, though they have happened and have shown positive, even “life-saving,” outcomes.
Kaiser officials stressed that its health system would “remain a voice and advocate for safe, high-quality, and evidence-based care for transgender patients.” All non-surgical gender affirming care, like hormone replacement therapy and therapy, is still available.
Others hoped this pause by Kaiser could mark the end of all gender-affirming care for minors for good.
Erin Friday, the president of Our Duty-USA — a global organization of parents aiming to protect children from “gender ideology” — posted on X a list of “pediatric gender clinics” that have announced an end to services, encouraging opponents of gender-affirming care to “keep the pressure on… to kill the whole of gender ideology.”
“No one is safe until the media, doctors, therapists, teachers, institutions and the Democrats admit that no one can change sex,” Friday said. “Gender identity is a make-believe ‘BS’ concept with its roots in paraphilia.”
In a blog post, California Family Council Vice President Greg Burt expressed the religious group’s position, writing that it’s “not just our Christian beliefs — but our moral and medical objections to giving sterilizing drugs and mutilating surgeries to children struggling with gender confusion.”
New research from the Williams Institute, a public policy think tank at the UCLA School of Law, shows the impact banning gender-affirming care has had on transgender minors. A lack of access could increase the risk of anxiety, depression and suicide among youth. In addition, many trans youth and families have also traveled out of states where care is banned to access services, and even youth in California are scrambling to find new providers, UCLA researchers said.
“The current administration is putting a lot of stress on youth and families seeking to live better, happier, healthier lives,” said Elana Redfield, the institute’s Federal Policy Director. “The denial of basic humanity that comes with being told by an office as powerful as the President of the United States that your life doesn’t matter, that you will be prevented at all costs from accessing health care that could radically improve your life. We now live in an era of information, where young trans people can see the possibilities, and yet the current administration is putting them further and further out of reach.”
Redfield said Kaiser Permanente has a “large budget,” and ending services for trans people “may still come as a bigger shock, because the organization is likely better equipped to withstand a legal battle.”
She called Trump’s actions to withhold funding a part of his “ideological campaign to end access to gender-affirming care for minors.”
“It is unscientific, it is overly ambitious, and it is cruel. Decades of work went into developing the current treatment protocols for trans youth, and all are supported by science,” Redfield said. “The administration has been attempting to retrofit gender-affirming care into existing laws enforced by federal and state government … on top of cutting off grant funding, arguing that federal agencies can change the terms whenever they want to. Much of this is likely illegal or even unconstitutional, and none of it is based on the real experiences of trans people.”
Williams Institute researchers also said that health care providers, aware that some non-local clients seek gender-affirming care in states that allow it, are noticing an increase in demand. Many are “attempting to provide an essential service to a vulnerable population,” Redfield said.
Most “are brave and committed enough to stand their ground. Most simply want to help people live better, healthier lives,” she added. But they are faced with the logistical problem of “how to weather a long and unpredictable storm with the risk of great casualties and costs, and the providers and the trans youth are paying the price.”
‘When they stop, you keep going’
At an Aug. 7 rally in East Hollywood, around a dozen activists marched from nearby Children’s Hospital L.A. (CHLA) — which already closed its trans youth clinic — to Kaiser L.A.’s medical center, chanting and waving signs by the hospital’s entrance. Care workers, advocates from ProtectTransYouthLA and other groups plan to demonstrate weekly in front of the two hospitals.
Carolina Morris, a protester who attended the rally, said she believes Kaiser’s decision to pause gender-affirming care was solely “because of money.”
Pat Posey, another Thursday protester, believes that by closing its gender affirming care unit, CHLA — once a leader in transgender youth care — paved the way for other institutions to follow suit.
“CHLA made this decision to capitulate to extortion and close their clinic,” Posey said. “When they made that move, others followed.”
Growing up in the 80s and 90s, Posey said, was “miserable” as a trans nonbinary person — but kids today “can have a more positive experience” because of the care that hospitals, including Kaiser, offered.
Colin Campbell, another protester, called Kaiser’s pause a way to “erase trans people,” and vowed to be “relentless” by continuing to demonstrate outside the hospitals every week.
“When they stop, you keep going and you keep going,” Campbell said.
But Belissa Cohen, who represents the organization LGB Fight Back — an anti-transgender rights organization that advocates for lesbian, gay and bisexual people — attended the rally celebrating Kaiser’s decision. Afterwards, she said it was “homophobic to tell non-conforming kids that they’re born in the wrong body or the wrong sex.”
Former Costa Mesa resident Jessica Marchesi is a transgender woman who received estrogen hormone replacement therapy and gender-affirming surgeries at Kaiser San Francisco over the last two years. Marchesi said she took advantage of gender-affirming programs at Kaiser, such as gender presentation workshops, group therapy, and vocal feminization care. These inclusive services, Marchesi said, helped her come into her identity as a now 63-year-old.
“I’m outside of the age where I’m affected by (the gender-affirming care pause), but what’s infuriating to me is that if this had been an option for me when I was younger, my life would have been entirely different,” the Bay Area local said. She and other advocates feared that losing access to trans youth care — both at Kaiser and other institutions — and “exclusionary” policies will lead to an increase in suicides in the trans community.
Jesse Budlong has been a patient at Kaiser’s Los Angeles facilities for five years. The 35-year-old said it was “unfair that 18 and 19-year-olds are able to vote, buy a gun, buy cigarettes or join the Army… but can’t receive gender-affirming care, which doesn’t hurt anyone else.”
“I understand the argument that younger children, their brains aren’t fully developed yet, but I certainly believe that teenagers, maybe above the age of 14, should still maintain access to these services,” said Budlong. “I can only imagine what it’s like to be uncomfortable in your body and not be able to fully express yourself.”
Bay Area News Group writer Jia Jung and The Associated Press contributed to this report.