Last Friday, St. John’s Community Health, a large southern California network of federally qualified health centers serving 430,000 individuals a year, tried to withdraw funds from a $1.67 million CDC grant specifically earmarked for transgender health services.
“We weren’t able to access it,” Jim Mangia, St. John’s president and CEO, told MedPage Today, “even though there was an injunction forbidding federal departments from initiating any funding freezes or terminations based on [the president’s] executive orders.” And even though the money is needed for payroll and service expenses.
The balance remaining in that 4-year grant, which began in June of 2022 — $743,706 — was stripped from their account subsequent to President Trump’s Jan. 28 executive order, “Protecting Children From Chemical and Surgical Mutilation,” he said.
Despite that, St. John’s is committed to fighting back and will find the money elsewhere, he said. It receives some $230 million a year from a variety of sources to maintain its multiple programs and operations in 20 locations across three counties.
“Our perspective is we have to stand up and push back against any attempts to limit healthcare access for the populations we serve,” he said. “We plan to be very vocal … to take whatever actions are necessary to protect healthcare services for our patients,” including filing lawsuits.
Impact on Clinicians
Providers at many non-governmental organizations around the country like St. John’s, which serve LGBTQ+, trans, immigrant, and other medically underserved populations, have been in panic mode. They’re worried not only about what the loss of dedicated funding will mean for their services, but also about the message these terminations or pauses are sending to patients.
They’re also concerned about being targeted with hate crimes, as this population is aware they are vulnerable to attacks.
“Ever since the inauguration there has been fear in the community — an understandable fear — that if they go to any hospital or federal clinic like ours, they will get picked up and deported,” said Christopher Veal, MD, a physician at Chicago-based Howard Brown Health. The facility is one of the largest LGBTQ+ focused health centers in the nation, and a major center for non-surgical gender-affirming care services. Some of the clinic’s patients are both transgender and undocumented, he said.
It’s unclear whether Howard Brown Health, which also treats other underserved populations, will continue to receive federal grants it has been awarded, and which it has budgeted to care for its 38,000 patients a year. It is seeking clarification on seemingly inconsistent messaging from the administration.
In a statement, Howard Brown said the executive order “has no immediate impact on our operations,” which will “continue to provide gender-affirming care to all patients who rely on our services.”
But Veal said personally, he and many of his fellow physicians “are not going to feel comfortable with our funding sources until this administration is out. They have already targeted gender-affirming care and transgender folks specifically, with campaign phrases like ‘Kamala is for them, Trump is for you.’ And they are not going to stop until we can no longer provide these services.”
Veal, who has specialized in suicide prevention starting in medical school, is worried the executive orders will lead to a climate in which suicide attempts are more frequent. He’s heard of Chicago-area programs that have discontinued educational programs on the topic out of fear and because of evaporating funding.
‘We’re Bullied’
Riley Read, PA, who works at a dedicated St. John’s clinic for trans care, told MedPage Today that the new administration’s actions “have caused a huge amount of fear, and an uptick in patients coming in for anxiety-related complications, panic attacks, increased suicidality, and suicidal ideation … stomach problems and insomnia.” Some want to know if they should stock up on their medications.
The policy shifts are also having an impact on providers, including him, often breaking his heart at the dilemmas facing patients. Patients come in with real fears, Read said, “and it’s hard not to feel that with them … but at the clinician level, it’s heartbreaking and very difficult to handle.”
He worries that the executive orders won’t stop with transgender patients. “It doesn’t mean that in 2 weeks, we’re not going to be talking about another group” that will lose access to services.
Read said if the current policies continue, all healthcare facilities will just have to secure other sources of funding. “We’re all in a bit of a quandary. We’re afraid of retaliation, but it’s our job as clinicians to stand up and take that fear and put it into something practical, and not back down and feel like we’re being bullied [although] we are being bullied.”
Rumors abound, several clinic leaders told MedPage Today, that waves of hospitals would be halting any gender-affirming surgeries they had scheduled for any patient under age 19 for fear of losing federal reimbursements. And that has already started.
Health Systems React
On Tuesday, Children’s Hospital Los Angeles announced that it will no longer initiate hormone therapy for gender-affirming care for patients under age 19, given the executive order.
“At this time, CHLA is pausing the initiation of hormonal therapies for all gender-affirming care patients under the age of 19 and maintaining the existing pause on gender-affirming surgeries on minors,” the statement said. “The physical and mental health, safety, and well-being of all of our patients remains our highest priority.”
NYU Langone Health in New York City reportedly cancelled appointments for transgender children scheduled to receive puberty blocking medication implants this week. Boston Children’s also has cancelled appointments scheduled for minors, according to a lawsuit, the Boston Globe reported.
Children’s National Hospital in Washington, D.C. said it has paused prescriptions of puberty blockers and hormone therapy while it evaluates the situation, and Virginia Commonwealth University and Children’s Hospital of Richmond have suspended medications and surgery for gender-affirming care patients under 19. University of Virginia Health has suspended all gender-affirming care for pediatric patients according to this memo, “to protect itself from significant legal risk and substantial financial exposure.”
According to a report in USA Today, Denver Health in Colorado and University of Colorado Health stopped performing gender-affirming surgeries for patients under 19. And in Chicago, Lurie Children’s Hospital said it is reviewing the executive order.
On Tuesday, several plaintiffs including transgender young adults and family members of transgender youth and several organizations filed a 44-page lawsuit against President Trump, HHS, the National Institutes of Health, and several Trump appointees. The complaint accuses his administration of issuing several related executive orders that attempt to shut down programs by withholding federal funds, which the plaintiffs claim they do not have the power to do.
“The Executive Orders unconstitutionally usurp congressional authority by withholding lawfully appropriated federal funds from medical institutions, providers and researchers, such as GLMA’s [an LGBTQ+ advocacy organization] health professional members,” the lawsuit says. “They violate the rights of thousands of transgender people under nineteen … by depriving them of necessary medical care solely on the basis of their sex and transgender status.”
Asked for its reaction to the administration’s orders, a spokeswoman for the Endocrine Society referenced an amicus brief filed in the U.S. Supreme Court last September in which it detailed numerous reasons why treatment is medically necessary for adolescents with gender dysphoria.
National Nurses United, the largest union of registered nurses, said in a statement they are “outraged by the Trump administration’s rollout of several policies attacking and endangering transgender Americans’ health, safety, and lives.”
Meanwhile, New York Attorney General Letitia James said providers in her state should continue offering gender-affirming care for patients under age 19 despite the executive order. If they stopped, she said, they would be violating New York’s anti-discrimination laws.
Likewise, California Attorney General Rob Bonta Wednesday warned Children’s Hospital Los Angeles that if it did withhold services for transgender patients, it could be violating its state law.
Gender-affirming care is not just surgery. It is provided in a variety of medical interventions including puberty blockers and hormone pellets, but it also can include mental health care, counseling, social support, and assistance to update legal documents. All of these services are at risk in this new administration, clinic leaders told MedPage Today.
Even research projects are being halted. According to the Washington Post, the Trump administration ordered the NIH to stop a large-scale study of HIV infection prevention in transgender youth of color even before it could enroll patients.
Last week, the CDC ordered its scientists to pull back any publication of any research paper it submitted to a medical or science journal in order to redact any “forbidden terms” including transgender, pregnant person, pregnant people, LGBT, Transsexual, non-binary, assigned male at birth, assigned female at birth and biologically male.
Transgender individuals over the age of 13 number about 1.6 million in the U.S., according to a 2022 report in from the UCLA School of Law Williams Institute, which used data from the U.S. Behavioral Risk Factor Surveillance System and other surveys.
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