California's largest children's hospital system ends gender-affirming care as a state lawsuit looms

Children’s Hospital of Orange County and Rady Children’s Hospital in San Diego ended their gender affirming hormone therapy on Friday to people under 19, pending a legal challenge from Attorney General Rob Bonta.

The closure leaves hundreds of patients in limbo at Rady Children’s Health, the largest pediatric hospital system in California.

Growing restrictions and fewer options

When San Diego father Brett heard about the Rady Children’s Health closure, he was shocked.

“The whole world kind of dropped out from under me,” he said.

Brett had been preparing for this after a spate of closures and restrictions last year among California providers and nationwide. But he said he wasn’t ready for the feelings of anger and abandonment that soon followed.

Brett’s son started getting hormone treatment at Rady Children’s Hospital San Diego about a year and a half ago. Brett says they were happy with their endocrinologist, who was “overwhelmingly loving” — and he was also comforted by her assurances that they could go off of the hormone treatments if needed.

He said his family had no plans to cease hormone treatments, since they've helped his son come into his identity and massively improved his mental health. But he doesn’t know where he’ll get his son’s testosterone now.

The legal challenge ahead

Bonta filed suit on behalf of the state seeking a permanent injunction citing that the hospital broke its contract when it guaranteed the health care system would maintain the same level of gender-affirming care through 2034.

Though the lawsuit is a narrow one that only applies to Rady Children Health, it was still celebrated by LGBTQ groups and organizers in Orange County.

A CHOC spokesperson told LAist at the time that it would address Bonta’s concerns “through the legal process.”

Bonta filed the suit in the state Superior Court of San Diego County. The court has yet to issue a ruling on Bonta’s request for an injunction.

Providers in California and nationwide feel fear

Experts have said this follows actions from the Trump administration to restrict gender-affirming care through a variety of enforcement mechanisms. The most recent action threatened to pull Medicare and Medicaid funding to hospitals that provide gender-affirming hormones and surgeries to minors.

“People go into pediatrics or adolescent medicine because they care about kids, not because they want to have some giant fight with the federal government about an existential question of whether their hospital or their clinic can stay open,” said Kellan Baker, senior advisor for health policy at the think tank Movement Advancement Project.

Baker pointed to statistics that hospitals nationwide receive about 50% of their funding from Medicare and Medicaid. At some, such as Children’s Hospital Los Angeles, that percentage is even higher.

Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ+ Equality, is also worried about whether the federal government will use these same policies to restrict funding for areas like vaccine and cancer research.

“ This is like forcing a firefighter not to use water because the government doesn't like who lives in the burning house,” they said. “Those flames will spread and everyone will get burned.”

The Trump administration weighs in

The U.S. Department of Health and Human Services said in a statement that gender affirming care did “not meet professionally recognized standards of health care.”

The American Academy of Pediatrics, the Endocrine Society and the American Psychological Association have all opposed that view, saying that this care is evidence-based and necessary for trans mental health.

Families forced to make other plans

Other providers, including telehealth providers, can step in to fill the gap, though some families say they aren’t a replacement for in-person services.

“ We'll do everything in our power to protect providers from this large scale efforts of criminalization of care that remains legal,” said Sheldon, who says they’ve been in touch with hundreds of medical providers in California and across the country.

For his part, Brett understands the position his doctors are in and doesn’t blame them for the hospital’s decisions. But his family is now considering moving abroad.

It’ll be a hard pill for Brett to swallow, since he can trace his ancestry back to a signer of the Declaration of Independence.

“There's a feeling of having to flee this country,” he said. “ And that means leaving the country that we were all born in, that we all love, that we believed would protect every citizen.”