Cracks are beginning to appear in the landscape of gender-affirming care for trans and gender-diverse youth in Washington state, as the federal government's efforts to restrict the field have turned more aggressive in recent months.
Since President Donald Trump returned to office, he has intensified his agenda against gender care providers and trans people around the country, leading many hospitals and clinics to face a difficult decision: Continue to treat young patients with health services deemed medically necessary, or actively oppose the federal government and risk funding cuts.
A number of children's hospitals, including in Democratic-controlled states, have chosen to narrow their gender care services or shutter gender clinics altogether. In Washington, largely considered a welcoming and safe place for trans people, the shift has stunned many LGBTQ+ families, who wonder how these changes could happen in a state where this care remains legal.
It feels like I am being dehumanized," one 17-year-old who lives in Puyallup, and who is nonbinary, wrote in a message to The Seattle Times. Their family requested anonymity to protect their child's privacy and safety, as did other parents included in this story.
The Pierce County teen has taken gender-affirming medication — first a puberty blocker, and now a pill that suppresses menstruation — for years, and said it has saved their life.
The puberty blocker "also gave me time to think and learn about myself instead of my body just taking over," they wrote.
Now they fear losing access to their prescription.
So far this year, the Trump administration has issued an executive order to halt federal funds linked to gender-affirming care for people under 19; launched efforts to collect evidence providers are promoting "false or unsupported claims" around gender care; and threatened providers with felony charges for offering certain types of care.
In July, the Justice Department subpoenaed more than 20 doctors and gender clinics to hand over patient information.
Trump has championed these federal actions as part of his promise to recognize "only two genders" in the U.S., as he and other critics of pediatric gender care argue more research around medical interventions is needed.
In the U.S., medical providers who are experts in delivering gender-affirming care say treatments can significantly reduce depression and suicide risk among trans youth. Most major U.S. medical associations, including the American Academy of Pediatrics and the American Medical Association, continue to support gender-affirming care options for gender-diverse minors.
Elected officials in Washington and other states have taken steps to challenge federal moves in an attempt to protect local access to gender-affirming health services — still, some care has been cut back.
Shifting access
As bans on gender-affirming care sweep the country, medical providers have become increasingly hesitant to speak out on the topic — many are worried about experiencing threats, putting their safety in jeopardy or becoming targets of the Trump administration. In Washington, health care institutions that have provided this care for youth either offer vague explanations for the changes in gender-affirming services, or refuse to discuss the subject.
At Seattle Children's, home to one of the state's busiest gender clinics, patients reported in February that the hospital had paused at least some gender-affirming surgeries.
After state Attorney General Nick Brown sued the Trump administration over the executive order that halted federal money — including grants and Medicaid — a judge in Seattle granted an injunction that preserved the funding. Children's appeared to reschedule procedures.
But, a couple of months later, patients said their surgeries had been paused again, The Stranger reported.
Seattle Children's media relations office declined to answer questions regarding the current status of care. As of this month, a few patients confirmed with The Seattle Times that their prescriptions for gender-affirming medication — like hormone therapy and puberty blockers — were renewed over the summer, but Children's will not say if it continues to offer surgeries.
The hospital no longer lists surgeries on its gender clinic website, which used to include details about a variety of services offered.
A Seattle parent of a nonbinary 16-year-old said he and his child's mother experienced some delays earlier this year when trying to schedule their teen's next puberty blocker appointment with Children's. When they asked why, they weren't given a clear reason.
"They perform a lifesaving service to kids in this city and the state," the parent, who is in his 50s, said of Children's. "For that, they're a solid organization. And I do think they're between a rock and a hard place."
At the same time, he said he's lost some trust in the hospital, and he and his child's mom worry about losing access to their child's care in the future.
"We've looked at how we can stockpile and ration their medication, so that even if there's an issue, we have a plan," he said.
Other health care systems in Washington have also shifted their scope of gender-affirming services, pointing to general federal pressure.
In July, Kaiser Permanente, which has clinics and health centers in Washington, announced plans to limit gender-affirming surgeries to patients 19 and over, "after significant deliberation and consultation with internal and external experts including our physicians," the organization said in a statement. The pause went into effect Aug. 29.
"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," the Kaiser Permanente statement said.
The organization continued, "We will remain a voice and advocate for safe, high-quality, and evidence-based care for transgender patients."
Kaiser still offers gender-affirming medication and mental health care to patients under 19, according to spokesperson Linnae Riesen.
And last month, the state's only other hospital-based pediatric gender clinic — at MultiCare Mary Bridge Children's Hospital in Tacoma — cut its waitlist and confirmed that after Sept. 12, it would not start new patients on medical treatment.
Patients can still receive mental health care and counseling at the gender clinic, hospital spokesperson Kalyn Kinomoto wrote in a statement. Treatment also will continue for patients who already receive gender-affirming medication, Kinomoto wrote.
But the roughly 150 families who were on the waitlist will have to find other avenues for gender-affirming health care, Kinomoto said.
Mary Bridge does not provide gender-affirming surgeries, which are rare among youth under 18.
When explaining the decision, Mary Bridge mainly cited "changing federal expectations" and ongoing staffing challenges. The hospital declined to clarify which specific federal changes were behind the decision.
Kinomoto noted more than 60% of all Mary Bridge patients rely on Medicaid, or Apple Health in Washington.
The clinic had struggled with staffing for the past year and hadn't been able to take new patients, which created a waitlist, Kinomoto added. The hospital made these changes to its gender care program to "ensure that we protect our patients, their families and our staff in this uncertain time," she said.
The Polyclinic, another Seattle-area provider families have turned to for gender-affirming care, declined to say if it continues to offer services for youth.
"Unprecedented intrusion"
Other children's hospitals, including in California, New York and Illinois, have similarly stopped or scaled back gender care for minors, due to mounting federal pressure and legal threats. At Children's Hospital Los Angeles, which closed its gender clinic in June, executives wrote to staff that "these threats are no longer theoretical," the Los Angeles Times reported.
The impact of Trump's orders in both red and blue states marks "an unprecedented intrusion into the lives of so many people," said Dr. Scott Leibowitz, a board member of the World Professional Association of Transgender Health, an international expert organization known as WPATH.
Options for care are quickly dwindling for many young people and their families, he said. And providers, including himself, are finding themselves in a "horrible and precarious situation," he said.
Leibowitz has practiced child and adolescent psychiatry for 17 years and worked at three gender clinics on the East Coast and in the Midwest, but left his clinical position last December. "The laws and political intrusion have really come between doctors and their ability to uphold their Hippocratic oath," he said.
As he's watched clinics close, he worries about losing out on long-term research opportunities, which federal agencies and some opponents of pediatric gender care argue already don't exist and should be expanded.
"If there was a true concern for the evidence and longitudinal data, we would be expanding research and funding opportunities to better appreciate the nuances and specifics of the population," Leibowitz said.
State law generally requires parental consent for most medical care for trans minors. Providers in the U.S. do not typically perform any gender-affirming face or bottom surgeries for those under 18, even with parent permission.
In Washington, there are still independent clinicians — not associated with hospital systems — that offer some gender-affirming services to minors, but several families say they had hoped larger health care organizations would do more to stand up for LGBTQ+ children.
"We're just really sad to see … (hospitals) obeying and complying in advance, even though legally, they have the state's jurisdiction and protection behind them," said a Seattle-area parent of two trans kids, one who's 17 and the other who's 12.
"I understand they don't want other things that are getting funded to get canceled," the parent, 41, said. "It's a complicated situation."
State law prohibits discrimination on the basis of sexual orientation or gender identity, including when seeking medical care. The injunction issued by a federal judge in Seattle also remains in place, according to the state attorney general's office.
Still, many families are not quite sure what those legal protections mean for changes among the region's health care systems.
The Seattle father in his 50s said the national discourse around trans kids makes him afraid for his child's safety. He and his child's mom took a long time to research, discuss and mull "difficult decisions" before they felt comfortable moving forward with medical treatment for their 16-year-old, he said. Now, the increasingly political nature around the topic has made navigating options even harder.
"At this point," he said, "we're not even having a conversation around care.
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