What the closure of CHLA's trans health care center means for trans youth

Children’s Hospital Los Angeles — one of the country’s oldest and largest providers of gender-affirming care for children and young adults — has announced that it will close its Center for Transyouth Health and Development on July 22.

In a letter sent to hospital staff today, the hospital cited “external pressure” — specifically attempts from the Trump administration to block gender-affirming care for youth — in its decision.

Trump began issuing executive orders that aimed to curtail this health care soon after taking office in January.

Why is CHLA making this move?

In its letter to staff, Children’s Hospital Los Angeles acknowledged that it was making this move before many of its peers, which are continuing to offer gender-affirming care.

Hospital leadership called the decision a “painful and difficult decision” and said they had no choice but to comply with the federal government, which has sought to target providers of gender-affirming care.

“Over the past several months, California’s deepening budget crisis, President Trump’s executive orders, proposed federal legislation and rulemaking, and growing economic uncertainty have made the situation even more dire,” the letter reads.

They also said lower Medi-Cal reimbursement rates factored into the hospital’s decision.

The hospital also called its fiscal position “fragile” and said it could only sustain operations for approximately 50 days without federal funding. The hospital said it needed to remain open to serve the “hundreds of thousands of Southern California children, adolescents, and young adults, who are disproportionately low-income and underserved.”

About two-thirds of the hospital’s total inpatient and outpatient revenue came from Medicare and Medi-Cal, totaling $723 million as of 2022.

The hospital said that the Departments of Justice and Health and Human Services, the Centers for Medicare and Medicaid Services, the FBI, and the Federal Trade Commission had all taken positions against health care for trans youth. The positions taken by these agencies go against guidance from many professional medical and pediatric organizations.

Response from local LGBT leaders

After the decision became public, the L.A. LGBT Center issued a statement condemning the move and quickly organized a protest outside the hospital.

“Despite this harrowing news, we are not giving up,” L.A. LGBT Center CEO Joe Hollendoner said in a statement. “We must take action now to demand CHLA keep its gender clinic open to new and current patients in need of gender-affirming care.”

What can current patients do?

In a letter to staff, the hospital said it will help current patients "with patient navigation and seeking to identify potential alternative providers," though it did not specify exactly how. It also said it would explore reassigning employees at its transgender health center to other roles at the hospital "based on needs and available funding."

The hospital also said it chose to shutter the center on July 22 to “give patient families adequate time to plan for moving care to providers less impacted by the legal and financial pressures our health system faces.”

The backstory

In February, amid pressure from the Trump administration regarding gender-affirming care for minors, Children’s Hospital Los Angeles paused the intake of new patients under 19 for gender-affirming surgeries.

At the time, Attorney General Rob Bonta assured Children’s Hospital Los Angeles that it would protect the hospital and other providers of health care for trans youth.

"While the Trump administration attempts to bully and intimidate through its threats to withhold critical federal funding, California remains firm in its commitment to uphold the dignity and rights of all," Bonta said in a statement at the time.

After severe blowback from local health care providers, including weekly protests outside the hospital, the hospital reversed course and once again began offering its full suite of services to all patients.

Guidance from the medical community

The American Academy of Pediatrics has supported gender-affirming care for minors since 2018 and opposes “any laws or regulations that discriminate against transgender and gender-diverse individuals, or that interfere in the doctor-patient relationship.”

The American Medical Association, the Endocrine Society and the American College of Obstetricians and Gynecologists, among others, have also taken similar positions supporting gender-affirming care for adolescents.