Kaiser Permanente, the largest health care provider in California, will halt gender-affirming surgeries for patients under 19 as of August 29.
Kaiser, which covers roughly one in four Californians, follows Stanford Health and Children’s Hospital Los Angeles (CHLA) in pruning back previously available treatments or closing previously existing care programs outright.
California has protective laws around health care that extend to youth from other states seeking services in the “sanctuary” of the Golden State. Yet, the threat of federal funding cuts ingrained in an executive order by President Donald Trump to ban gender-affirming care for those under 19 nationwide have prompted some of the leading institutions in the nation that offer hormone treatments, surgery and mental health resources for young transgender people to stop some procedures.
A statement issued by Kaiser listed the pressures faced by hospitals providing care to transgender kids since January, when Trump took office. These include actions by federal agencies to restrict funding and curtail access to gender-affirming care, hospital inquiries by the Centers for Medicare & Medicaid Service, regulatory changes to coverage and broader oversight by agencies such as the Federal Trade Commission. Most recently, the U.S. Department of Justice issued subpoenas to doctors and clinics providing gender-affirming care as part of its federal investigations.
“As the legal and regulatory environment for gender-affirming care continues to evolve, we must carefully consider the significant risks being created for health systems, clinicians, and patients under the age of 19 seeking this care,” wrote Kaiser, adding that the decision had been a difficult one, made “after significant deliberation and consultation” with internal and external experts as well as physicians in the network.
“We will remain a voice and advocate for safe, high-quality, and evidence-based care for transgender patients,” the statement concluded.
But the network declined to respond to this news organization’s questions about how much federal funding was on the line, how many surgical procedures it provided last year, how many patients will be affected by the decision and what will happen to anyone already in the middle of their physical transition.
Nurses represented by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), an affiliate of National Nurses United (NNU), the country’s largest nursing union, criticized Kaiser’s decision.
“This is preemptively giving in to government overreach in health care,” said Lady Rainsard, a registered nurse in plastic surgery at Kaiser San Francisco. “Gender-affirming care is safe and effective. As nurses, we always follow the precautionary principle, and we always advocate for our patients.”
The union, representing 25,000 nurses in Kaiser’s system, believes that capitulating to what it views as government overreach is a greater risk to patients than continuing to provide gender-affirming health care, regardless of age.
The Trevor Project, a suicide prevention and crisis intervention organization for young people who identify as LGBTQ+, surveyed over 18,000 LGBTQ+ people aged 13-24 nationwide in 2024, including 1,801 respondents from California, 65% of whom identified as transgender, nonbinary or questioning; 39% of this population had seriously considered suicide and 14% of them had made an attempt.
Past research by Kaiser’s own research and evaluation department found transgender and gender-nonconforming kids aged 3-17 to be up to 13 times more likely to have mental health challenges than their counterparts, manifesting in attention deficit disorders in those under 10 and depression in those over 10.
However, some state legislatures, such as in North Dakota, have stated risks of social alienation and policy blocking access to care are a myth, though LGBTQ+ youth there reported similar negative experiences as Californians did to The Trevor Project. The state, as Tennessee recently was, is awaiting ruling on litigation filed by plaintiffs charging that restrictions to gender-affirming care violate the Fourteenth Amendment guaranteeing a constitutional right to equal protection under the law.
State-by-state rollbacks to transgender rights are becoming a trend in the wake of the executive order. And according to the Pew Research Center’s polling results in February, 56% of people across the country supported making gender-affirming care for minors illegal, while 53% opposed insurance coverage for gender transitions for people of any age.
The latest standards published by the World Professional Association for Transgender Care, Standards of Care no longer set forth a minimum age for the “constellation of procedures” that align a person’s physical features with their gender identity but offer complex guidelines for timing based on global clinical examples ranging between a minimum age of 16 through the mid-twenties.
Some Bay Area locales, such as the County of Santa Clara, have begun building alternate funding infrastructures that reduce dependency on the federal government’s support to self-enforce the provision of care held up by state law.
Kaiser said all other gender-affirming care treatment remains unaffected and that care teams are still meeting with regulators clinicians, patients, their families and the community to find a responsible way to move forward forward.
But Sydney Simpson, a registered nurse in interventional radiology at Kaiser San Francisco feels that this is not enough and that Kaiser should have held fast because of the deeper implications of caving in to Trump’s agenda.
“No one should have to fear coming to a hospital. But when corporations preemptively comply with these restrictions, they enable and empower political attacks on health care for vulnerable populations,” she said.