Dr. Kade Goepferd watched the Trump administration's moves on Thursday to ban gender-affirming care for transgender youth with "a mix of sadness and frustration."
Goepferd, who is the founder of Children's Minnesota Gender Health Program, says that for the medical community, nothing has changed about the evidence supporting gender-affirming care that could justify the government's actions.
"There's a massive propaganda and disinformation campaign that is selectively targeting this small population of already vulnerable kids and their families," Goepferd says.
"Men are men"
Federal health officials said many times at Thursday's announcement that their actions were driven by science and evidence, not politics or ideology. They frequently praised a report published by the Department of Health and Human Services in November. It concluded that clinicians who provide medical care to help youth transition have failed their patients and emphasized the benefits of psychotherapy as an alternative.
At times, health officials cast doubt on the idea that a person could be transgender at all.
"Men are men. Men can never become women. Women are women. Women can never become men," said Acting CDC Director Jim O'Neill. He added that "the blurring of the lines between sexes" represented a "hatred for nature as God designed it."
Health Secretary Robert F. Kennedy Jr. said doctors and medical groups had "peddled the lie" that these treatments could be good for children, and that those youth were "conditioned to believe that sex can be changed."
Doctor groups disagree
The American Academy of Pediatrics, the medical group that represents 67,000 pediatricians across the country, pushed back forcefully on those characterizations.
"These policies and proposals misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families," said AAP President Dr. Susan J. Kressly in a statement. "These rules help no one, do nothing to address health care costs, and unfairly stigmatize a population of young people."
AAP's official position on this medical care is that it is safe and effective for the young people who need it. That view is shared by the American Medical Association, the Endocrine Society, among other medical organizations.
In a statement Thursday, the American Psychological Association wrote: "APA is deeply concerned about recent federal actions that not only challenge the scientific understanding of gender identity but also potentially jeopardize the human rights, psychological health, and well-being of transgender and nonbinary individuals."
The most significant proposal released by HHS would withhold all Medicare and Medicaid funding from hospitals — a big portion of their budgets — if they provided gender-affirming care to those under age 18.
The Children's Hospital Association said that rule — if finalized — would set a dangerous precedent. "Today's proposed conditions make it possible for all kinds of specialized health care treatments to be withheld based on government-mandated rules," wrote CEO Matthew Cook. "Millions of families could lose access to the care they need."
After a 60-day comment period, the rules could be finalized and then take effect.
Attorneys general in New York and California have said they will fight these rules and protect the rights of trans people to get care in their states. The ACLU has vowed to sue, and more legal challenges are expected.
"I don't want to be lost"
According to a CDC survey, about 3% of teenagers aged 13-17 identify as transgender, approximately 700,000 people. A poll from health research organization KFF found that less than a third of transgender people took medication related to their identity and 16% had had surgery.
For young people, medical options most commonly include puberty blockers and hormones. Surgery is very rare for minors. "This is health care that evolves over time, is individualized, tailored to a patient's needs, often after years of relationship with a trusted health care team," says Goepferd.
NPR spoke to a transgender 15-year old in California this week about the moves Trump administration officials were making to restrict care. "They think what I'm feeling is a phase and that my family should just wait it out and that it's better I'm unhappy and never receive care," he says. NPR agreed not to name him because of fears for his safety.
He says it can be difficult for those who are not transgender to understand that experience, but that, as far as he can tell, these health officials "are not interested in understanding trans people."
He describes the long and deliberate process he made with his parents and doctors before he began taking testosterone. "The decision to not start gender-affirming care is often just as permanent as a decision to start it," he says. "Not starting [hormone therapy], for some people, it feels like ruining our body, because there are certain changes we can never have."
Now, after six months on testosterone, he feels like he's on the right path, and is worried about the prospect of losing access to his medication if HHS's efforts to shut down care nationally succeed. "It feels like someone's throwing me into the bush just off the path I'm on, and that's kind of terrifying," he says. "I don't want to be lost. I want to keep going where I'm going."
"Deep moral distress"
More than half of states already ban gender-affirming care for young people after a frenzy of laws passed since 2021 in Republican-led states. This week, Republicans in the House led efforts to pass two federal bills that would restrict access to care, including one that could put doctors who provide the care in prison for up to ten years. It's unclear if the bills will be voted on in the Senate.
Although nothing has officially changed in states where the care is still legal, these efforts to enact national restrictions have doctors and health systems in those states bracing for the possibility that their clinics will have to close down.
"There's a deep moral distress when you know that there is care that you can provide to young people that will measurably improve their health and the quality of their life, and you're being restricted from doing that," Goepferd of Children's Minnesota says. "And there's a moral distress in feeling like — as a hospital or a health care system — you have to restrict care that you're providing to one population to remain financially viable to provide health care for other kids."
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