Bay Area Clinics Abandon Trans Youth Despite Shield Laws
At least three major providers have ceased to offer surgery for patients under 19. Youth and adults alike fear for the future under Trump.
by Veronica Esposito
Clinics in the Bay Area who provide healthcare to transgender youth have quietly been reducing services. The moves have come even though no federal laws have been passed forbidding the provision of this care, and in spite of shield laws protecting providers of gender-affirming services, Assigned Media has learned that at least three major providers of surgeries to youth have ceased such operations, and providers of puberty blockers and hormone replacement therapy have added barriers and pulled back.
In an email dated June 1 and sent to other providers of care to transgender clients, the Gender Confirmation Center, which opened in 2013 as the project of Dr. Scott Mosser, declared that it would “pause all adolescent care services beginning July 31.” The email indicated that the pause was brought on by “escalating federal actions”. Assigned Media spoke to multiple individuals while reporting on this story who voiced their belief that the abrupt change in practice was a direct consequence of the potential threat of investigations by the Federal Bureau of Investigations, as the Trump Administration has increasingly weaponized the Bureau against perceived enemies. (The Gender Confirmation Center did not respond to multiple requests for comment.)
Jean, a pseudonym for a local provider who asked to remain anonymous due to fear of retaliation from the federal government, told Assigned Media she believes, “What changed was the FBI investigation threat. The FBI can investigate, and it can really ruin your entire practice because you have to spend so much money, it can ruin you, even if you’ve done nothing illegal.”
The abrupt change in tone of the Gender Confirmation Center was a shock to the community of gender-affirming providers in the Bay Area, as the GCC is widely seen as practicing culturally competent, empathetic healthcare in support of the trans community. It was not expected that such an institution would cave under threats from the Trump Administration.
The Gender Confirmation Center is not the only Bay Area organization to make a statement regarding care for trans adolescents. In a statement released earlier this spring, Stanford Medicine, a major provider of gender-affirming services to the region, stated that it would “pause on providing gender-related surgical procedures . . . for LBGTQ+ patients under the age of 19, effective June 2, 2025.” Reports from parents of trans minors seeking gender affirmation surgery have also indicated that Align Surgical Associates, providing gender-affirming surgeries in the Bay Area and Los Angeles, has also stopped accepting new adolescents for surgeries. Sources also report that Stanford Health has stopped issuing implanted puberty blockers for new adolescent clients.
Neither Align Surgical Associates nor Stanford Medicine responded to Assigned Media’s requests for comment.
Maya, the mother of a 15-year-old trans boy in the Bay Area, and her husband, Amir, reported that after working with the Gender Confirmation Center regularly for months to move forward the process of top surgery for her child, the clinic abruptly ceased communication with her toward the end of May. “The lack of transparency was unsettling,” she told Assigned. (Maya and her husband requested anonymity and have been given pseudonyms.)
Shocked and dismayed at suddenly losing her child’s surgery, Maya called four more providers in the Bay Area, yet was not able to find any taking new trans minors for surgery. She then called another handful of providers in Southern California, as well as around ten places in Canada, none of whom were willing to give her son the needed surgery. She finally located a clinic in Washington that agreed to take on her son but now lives in fear that the rug will be pulled out again. “Every time my phone rings my heart just stops, because I fear that they’re going to call me and say I can’t get surgery,” she said.
Maya and Amir’s son came out as trangender during the COVID pandemic in 2020, when he was 10 years old, and he has been on puberty blockers for the past four years. The family has been discussing surgery for about a year and is in full agreement that it is the right choice for them.
“This is a decision that should be between parents, their child, and healthcare providers,” said Maya, “this is not a decision that the government should be involved in. I’m a medical provider, and I just don’t think this should be involved in it. It’s so traumatic for our son to be binding and not be able to breathe. This top surgery is absolutely necessary, and it will be devastating for him if he doesn’t get it.”
Beyond introducing great stress into the lives of Maya, Amir, and their son, the family’s attempts to find a surgical option have left them with a feeling of precarity, and a sense of being failed by institutions that the family once trusted. These feelings will likely remain long after any potential surgery happens. “Previously, there was no uncertainty about it, it was just a necessary step in the process of transition,” said Amir. “That was the mental model until six weeks ago. Now in my mind, and probably [my son’s] mind as well, between now and the actual surgery, there is complete uncertainty as to if it will happen.”
A Changing Environment for Gender-Affirming Care
The cutbacks in surgical services are the latest in an already deteriorating environment for adolescent gender-affirming healthcare in the Bay Area. According to Iain Jasko, an associate marriage and family therapist working in private practice, even before services were curtailed at the GCC, barriers to entry had increased. He shared stories of needing as many as five separate letters to proceed with care (currently WPATH guidelines specify just one letter as necessary), and requiring extra strong advocacy and commitment to push through bureaucracy. “It seems like there was much less red tape before the Trump admin,” Jasko told me.
Beyond stories of lost access to necessary surgeries and increased bureaucracy, therapists specializing in the care of trans youth shared an overall glum picture of increased panic and anxiety on the part of trans youth and their families. In some cases, they even noted the return of self-harm and suicidal behaviors, which they indicated are directly due to the threat of losing access to affirming healthcare.
Sarah Burdge, a licensed psychologist specializing in gender therapy, described parents she works with feverishly working to figure out next steps in the event that their trans child cannot access surgeries or hormonal therapy. According to Burdge and other therapists we spoke with, many parents have already begun investigating options that include receiving healthcare via foreign nations, including Canada, Mexico, and Germany. Additionally, Bay Area doctors have quietly begun suggesting that their young patients should switch from injections to implantable hormone blockers in the case that access is cut off. But, as Burdge noted, not everyone has the resources to take such steps for their child. “Many families have access to the means to do this on their kids’ behalf, but obviously not all kids are that lucky. So many parents are currently highly anxious or borderline panicking.”
Clinicians widely voiced the belief that turmoil over access to medical care is depriving adolescents of normal, developmentally appropriate childhoods. As with Maya and Amir’s son, such adolescents have patiently waited for years while they and their families have worked through their own fears about transition, and then while navigating the process of seeking medical care. To have all that work now potentially undermined is devastating. “I have clients where it’s like, ‘I’ve been patient, I’ve been patient, and now that I’m finally ready to start, we have this new concern,’” Burdge said. “It brings on depressive symptoms, feelings of hopelessness, frustration.”
Jasko believes a person’s transition should be a period of self-discovery and joy. Now, he says, the possibility for that kind of a transition is being sharply curtailed by threats around medical care and wider forms of oppression. “This should be such a joyous process for people, especially youth,” Jasko said. “You can take your time and walk through and figure out what you do and don’t want. People are maybe being forced into a place where they’re making decisions that they’re not ready to make. It just reinforces this narrative that we’re pressuring people.”
Threats to Transition More Broadly
Beyond directly denying trans people needed medical care, cutbacks in service are also making many trans people question their decision to even move forward with transitions. According to Jasko, many of his clients are now questioning if it’s worth it to begin a transition and then be forced into a position down the line where gender-affirming care will be taken away. “One of the main concerns I hear is, can I move forward with care knowing it might be ripped from me? Is it worth it if it’s going to be short-lived? This is a big theme in my work, primarily with my emerging adult clients who are early in transition, or are out and contemplating medical transition. It’s almost like, would I feel better never knowing what my authentic self is, versus being myself and getting it ripped away from me?”
Providers also shared stories of adult clients rushing through surgeries—planning as many as three in one year—out of fears that they will not be able to access them down the line. “It’s concerning how fast my adult clients are having their surgeries,” said Jean, the provider who asked to remain anonymous. “People are doing like 3 surgeries in a year. It’s often helpful for people to take time between surgeries, to integrate their new bodies and experience the reduction in dysphoria. Adults have usually taken time, sometimes 2 to 3 years to have their surgeries. It’s very unusual to have so many surgeries in one year, and it’s unclear what the effect will be.”
Potential threats from the the One Big Beautiful Bill Act, which if signed into law in its current form would strip funding for gender-affirming care from Medicare and Medicaid programs, are also being felt among Bay Area trans people of all ages.
Lisa Melton, who is known for having initiated the Safari web browser project at Apple, transitioned later in life—after navigating ups and downs with her overall health, she is now, at 68 years of age, on the verge of having bottom surgery in November. What should be a period of victory for Melton has instead become an excruciating test of her nerves as she waits to see if gender-affirming care will be stripped from Medicare as part of the the One Big Beautiful Bill Act. “As if dysphoria and dysmorphia weren’t bad enough, now you’ve got this stupid existential dread,” she told Assigned in an interview.
Melton noted that she is in the fortunate position of being able to pay out of pocket, if necessary, but that it would cost her in the range of $60-75,000, money she would have to strip from her retirement fund. “The thing is, I can afford that, it’s not pleasant but I have the savings for that,” she said. “I’m one of the lucky ones, everyone else I’ve talked to on Medicare or Medicaid, they’re just screwed.”
It’s also possible that her medical provider, UCSF, may cease providing gender-affirming care before she can have surgery. According to Melton, this warning was issued by her surgeon, who worries that even the adult program may eventually be threatened. “There’s a damn good chance that UCSF is going to get something held over their head,” she said. “My surgeon said, I’m just going to keep going until the hammer comes down.”
Other providers shared stories of panic among clients on Medi-Cal who are afraid of losing access to HRT if the One Big Beautiful Bill Act is passed in its current form. “I have seen clients on Medi-Cal [California’s Medicaid program] who were terrified the moment the reconciliation bill came out,” one provider told me. “They’re asking me, will I be able to get my hormones?”
Providers also warned of potentially difficult years to come. Jean voiced the belief that the impacts of increased gender dysphoria to the community will be felt more and more strongly as the years of the Trump Administration wear on. “I think we’re going to see a lot more effects of gender dysphoria over time. It still feels early.” She shared that virtually all of her clients are currently under-dosing as a way of stockpiling hormones and voiced concern at what impacts to gender dysphoria that might have on a longer time-scale.
Jean has worked with the trans community since the 1990s, and after witnessing a wide expansion of access to medical treatment roughly during the period 2005 - 2020, now believes the world of trans medicine to be moving backwards. “It feels like we’re taking a major step back. I think everybody’s holding their breath and wondering if this prescription will be the last one they get covered. We’re all on pins and needles waiting to see the next step the Trump administration will take.”
Veronica Esposito (she/her) is a writer and therapist based in the Bay Area. She writes regularly for The Guardian, Xtra Magazine, and KQED, the NPR member station for Northern California, on the arts, mental health, and LGBTQ+ issues.