Blair’s mom had been cautious when she first brought her 6-year-old to the LGBTQ clinic at Cleveland’s MetroHealth hospital, “trying to figure out why he felt different inside,” as she puts it. She didn’t want to rush her child into treatment. So she was grateful to find the clinicians there took a slow and careful approach to Blair’s health care. Over the years they provided open-ended counseling, monitored his hormone levels and bone development, and only progressed with puberty blockers when it was clear that transitioning was making him happier and more confident. “That was my barometer for doing the right thing,” she tells me.

Today, at 16, Blair (a pseudonym to preserve his privacy) has been going to the clinic for a decade, and, by his mom’s account, thriving. Even when Ohio banned transgender medical treatments for minors in 2024, he could stay on his medication thanks to a grandfather clause in the law. But a few months ago, his mom got a message from MetroHealth alerting the family to a new threat.

The rule would deliver an ultimatum to hospitals: Stop providing the treatments to trans kids, or else get kicked out of the federal Medicaid and Medicare programs.

On December 18, 2025, Health and Human Services Secretary Robert F. Kennedy Jr. issued a declaration that rebranded transgender medical care as “sex-rejecting procedures” and claimed, erroneously, that the treatments “fail to meet professional recognized standards of health care” when given to minor patients. That same day, his agency proposed a pair of regulations that would curtail access nationwide. The first would forbid federal insurance programs that cover kids in low-income families from paying for puberty blockers, hormone therapy, and the surgery used in rare cases to treat gender dysphoria. The other would deliver an ultimatum to hospitals: Stop providing the treatments to trans kids, or else get kicked out of the federal Medicaid and Medicare programs.

The rules were designed to be a “nuclear weapon” against trans youth health care, a former Trump domestic policy assistant explained at a recent event. Medicaid and Medicare reimbursements cover nearly half of all hospital-care spending. “Hospitals just are not in a position to say, ‘You know what? It’s really important to us that we continue to provide this care, and we’re going to forego payments from the federal government,’” says Lindsey Dawson, director of LGBTQ program at the health policy research firm KFF. The rules are not yet final, but they’ve already sent shockwaves through the health care system. Since the start of the year, at least nine hospital systems stopped providing puberty blockers and hormone therapy—including Lurie Children’s Hospital in Chicago and Rady Children’s Health in San Diego, according to a STAT News analysis.

For a teenager struggling with gender dysphoria, a break in treatment could mean their body proceeds with the puberty of their birth sex, with potentially severe mental-health consequences. Blair’s mom worried not just about her son losing his medication, but also the counseling, regular blood tests, and side effect monitoring he received from his team at the MetroHealth clinic. So, after taking some time to think, she wrote a comment on Regulations.gov, beseeching the government to stay out of her family’s personal business.

“I have learned that my original vision of what my child’s life would look like is very different from reality—and yet, this version is just as beautiful, if not more so,” she wrote. “That is why I find it so hard to understand why the government would try to interfere in such personal and medically complex matters.”

She’s not the only parent pleading with HHS not to cut off their child’s treatment. “Every decision I have made as a parent is to keep my kid healthy and safe,” wrote one of the 30,000-some public commenters on the proposed regulation. “In an emerging culture where parents’ choice is so important to school and child development policies, why is my choice to consult with my child’s medical team and make informed decisions being taken away and infringed on?”

The answer is bound up in a Trump Era political crusade against transgender people, one that has the backing of a small cadre of academics and clinicians who disagree with the position held by virtually all leading US medical groups that gender-affirming treatments are medically necessary for some kids. In its latest attempt to wipe trans health care off the map, the administration drew on a report authored by these opponents—none of whom have direct experience providing hormone treatments to trans children, and some of whom have a background in anti-trans activism.

Right-wingers began drafting the earliest bans........

© Mother Jones