In CA, Access to Top Surgery is Vanishing. One Surgeon Calls it a “Tactical Retreat.”
As Kaiser Permanente acts to halt access to gender-affirming surgery for minors and young adults, many providers fear for the well-being of patients. Others are defending the decision.
by Veronica Esposito
Last Wednesday, nonprofit healthcare juggernaut Kaiser Permanente announced that it will halt surgical gender-affirming care for trans people aged 19 or under on August 29. It will continue to provide puberty suppression and hormone replacement therapy, unlike at Yale New Haven Health, the focus of another Assigned Media investigation, which ended all youth care.
The decision by Kaiser, which operates 40 hospitals and 614 medical facilities across eight states, means that, after August 29, there will be no options remaining for trans youth to receive gender-affirming surgery in the Bay Area, and possibly anywhere in California.
“I just can’t imagine what these parents who came here for safety are feeling when their corporate healthcare provider is capitulating and playing politics,” said Syd Simpson, a nurse liaison for Kaiser. “I know kids who moved here from Texas and Florida for access to these services. They’ve gone from no access to what I feel like is false hope.”
In a statement issued to press outlets, Kaiser cited the intense focus on gender-affirming care by the Trump administration, as well as executive orders targeting providers, as rationales for its decision. Notably, the medical provider made mention of the threat of subpoenas and the weaponization of the federal government against providers. “Most recently, the U.S. Department of Justice issued subpoenas to doctors and clinics providing gender-affirming care to transgender youth, as part of ongoing federal investigations,” the statement read. It remains unknown whether Kaiser was among those who received subpoenas.
The list of providers throughout California that no longer perform gender-affirming surgeries on trans youth and young adults include Stanford Medicine, which ceased services on June 2, and Children’s Hospital Los Angeles, which closed its Center for Transyouth Health and Development completely on July 22, ending 30 years of service to trans youth and leaving over 3,000 patients without medical care. Major Bay Area providers of gender-affirming surgeries Align Surgical and the Gender Confirmation Center also recently shut their doors to trans youth.
Whereas Children’s Hospital Los Angeles receives over two-thirds of its funding from the Federal government, Kaiser is much less exposed to revocation of Federal dollars. Simpson argued that the nonprofit had sufficient resources to weather a Federal attack, claiming that 2024 was Kaiser’s “most profitable year ever.” Although Assigned was unable to verify Simpson’s claim, data from Fierce Healthcare shows a $14.9 billion jump in Kaiser’s revenue from 2023 to 2024, an increase of 14.8%, vastly outpacing rival healthcare agencies.
According to Simpson, the announcement immediately sent shockwaves through the ranks of Kaiser patients and providers. “There are absolutely kids on surgery lists who are finding out they’re not on surgery lists,” they said, adding that the announcement augments an embattled atmosphere that Kaiser’s affirming care providers have felt since the Trump Administration began its war on trans people. “People in the gender-affirming care clinic are being intimidated. They’re scared for their jobs and terrified for their patients. They disagree with this decision.”
Not all providers see the decision in the same way, however. A leading gender surgeon who wished to remain anonymous argued that the decision to cut off care was more akin to a “tactical retreat” and that providers are eager to continue serving youth patients.
“Surgeons are not delicate people. They’re fine being raked across the coals,” this surgeon told Assigned Media, “Our whole lives, every day, is deep, deep risk that can go sideways. We need to be ready, we need to have thick skin for that. [Cutting back youth services] is not a cowering, it’s a tactical defensiveness because you see that you have a well-resourced opponent.”
This surgeon reasoned that Kaiser was making an institutional choice to not divert focus from the larger body of patients. “They have a moral responsibility to the greater body of all the people they treat,” he said. “If there are resource-intensive attacks coming, how will that affect the greater responsibility of healthcare?”
The number of trans minors who access surgery is vanishingly small, making them easy targets for politicians looking to play games of divide and conquer with institutions such as Kaiser—a Reuters investigation of such surgeries found fewer than 300 per year in the entire U.S. for the years 2019 through 2021.
California is one of 14 states to have enacted shield laws explicitly protecting gender-affirming care from Federal bullying. In a statement made to KQED, California state Senator Scott Weiner indicated that he would put pressure on California Attorney General Rob Bonta to enforce these laws, which would effectively put institutions like Kaiser and Stanford Medicine in between two opposing forces. “I don’t want the state to have to fight with Kaiser or with Stanford or with any of our great health systems, but we have to enforce the law,” Weiner said. “California should be a safe place for trans people and LGBTQ people generally, and this is not what should be happening.”
The decision by Kaiser and other medical providers to make age 19 the cutoff means that many young adults will be denied the opportunity to have a gender-affirming surgery before beginning college. Trans youth often opt for a surgery prior to college, at age 17 or 18, in order to reduce the possibility of nonconsensual outing, increase safety, avoid disruptions to the college years, and get a fresh start. “Lord knows, you don’t want to do a major surgery once you’ve been in college for a year,” said Simpson. “You get to become your full self, then start over brand new in college, like a rebirth.”
One fact often lost in the conversations around youth surgery is that the majority of gender-affirming surgeries are performed on cisgender males. According to research by Dannie Dai and colleagues, surgeries for cisgender males greatly outnumber those for trans males. Kaiser and other medical providers will continue to perform these surgeries.
With the battle to retain surgery access lost for now, Simpson’s focus is turning to supporting children and their families who have been impacted. “If you’re going to do this, then what are you doing on the back end to support these families who are going to need more help?” they asked. “Because now you’ve devastated them, and thrown their kid into crisis.”
Simpson has asked Kaiser what it will do to adequately resource those who are mourning the loss of dearly needed surgeries, but the answer has been extremely discouraging. “No response so far,” they said. “No response.”
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.