Where Do Trans Kids Go from Here?

On the twenty-eighth of January, Donald Trump signed an executive order titled “Protecting Children from Chemical and Surgical Mutilation.” It declared that the United States will no longer “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” and “will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” The order, which defines a child as anyone under the age of nineteen, may also limit coverage of such care under Medicaid and other federal health-insurance programs. It directs hospitals receiving research or education grants from the government to stop any transition-related treatment programs for minors.

In the week that followed, major hospital systems that receive funds through the federal government began cancelling care in blue-state cities including Seattle, Los Angeles, Denver, and Washington, D.C. In New York City, at least two hospital systems—N.Y.U. Langone Health and Mount Sinai—cancelled surgeries, and some parents were told that they would no longer be prescribing medications to new patients under the age of nineteen. (Neither N.Y.U. Langone nor Mount Sinai has issued a public statement about its policies, or made its doctors available for comment.) Although lawsuits have been filed in response, and two federal judges have temporarily blocked the order, to give the suits time to proceed, not all hospitals that cancelled appointments have rescheduled them, and the fear of losing federal funds seems to be having its intended effect.

After the executive order was published, I spoke with the mother of a trans child who goes to N.Y.U. Langone for gender-affirming care. The possibility of its interruption had sent her into a panic. From the age of four, her daughter, who was assigned male at birth, would hit herself and tell her parents that she wished she had never been born. “It was so bad for so long, I thought my child was being abused by someone,” the mother said. Her daughter was six when, hiding under a table and crying during a family event, she articulated for the first time what was wrong: “In my heart and in my brain I’m a girl.”

“I felt actual relief—and confusion—because I hadn’t experienced anything like this before,” her mother recalled. She herself didn’t know any trans people personally. The decision to allow her daughter to socially transition—to present outwardly as a girl, and to adopt female pronouns—was made under the guidance of doctors. The self-harm and suicidal ideation ceased: “This child went from hiding under the playground and crying all the time to being so happy.”

As her daughter approached adolescence, she followed a standardized protocol of taking puberty blockers, which allow children to pause their development until they decide either to begin taking estrogen or testosterone or to undergo their natal puberty. (The age at which doctors prescribe hormone therapy varies by patient and clinician, but the general rule is sixteen.) “It was not a discussion that we took lightly,” said the mother, who emphasized that her daughter’s gender identity was her own, and that the girl had been present in conversations with doctors about her care. “There are others like her—quietly living their own lives, going through their days as normal kids,” she said.

Her daughter is now fourteen, and a lot of her teachers and peers don’t know that she’s trans. (She and many other parents I spoke to requested anonymity to avoid their kids being outed.) If her access to blockers—or, later, to female hormones—is cut off, as her mother fears, her day-to-day existence will be catastrophically disrupted. “I never thought that my country would want to disappear my child, and would want to essentially deny her existence as a person,” she told me. She worries that the increasingly hostile view of trans people will create “a long and dreadful path” for her daughter. “This is going to rob her of her dignity—of her life.”

During the 2024 Presidential campaign, Trump made an anti-trans stance central to his political platform. Ads mocking trans people ran during the World Series and other major sporting events. According to the advertising-tracking firm AdImpact, the G.O.P.’s total expenditure on broadcast ads maligning trans people—whom studies have found to be less than one per cent of the American population over the age of thirteen—exceeded two hundred million dollars. (Trump’s campaign alone spent some thirty-seven million.) The medical treatment of trans children was a particular focus of fearmongering. During an October campaign stop in the Bronx, Trump asserted that “there are some places your boy leaves the school, comes back a girl, without parental consent.” In Agenda47, his official policy platform, Trump promised to outlaw gender-affirming care for minors nationwide.

Beyond reflecting a campaign promise, Trump’s executive order is the culmination of years of Republican legislative efforts at the state level. In 2021, Arkansas became the first to pass a law banning transition-related treatment for minors; twenty-five more states have since passed their own restrictions on access. The new mandates went against the guidance of medical authorities—including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association, and the American College of Obstetricians and Gynecologists—regarding the efficacy of recommended treatment protocols, which are established by the World Professional Association for Transgender Health, an organization of physicians, mental-health professionals, and surgeons that grew out of an attempt to standardize care in 1979. (Trump’s executive order claims that WPATH “lacks scientific integrity,” calls its protocols “junk science,” and instructs the Secretary of Health and Human Services to produce a review, within ninety days, of “the existing literature on best practices for promoting the health of children who assert gender dysphoria.”) A federal judge struck down the Arkansas ban in 2023, and other suits are wending their way through the courts: in June, the Supreme Court is expected to rule on the constitutionality of state bans in its opinion in United States v. Skrmetti, a lawsuit filed by the A.C.L.U., Lambda Legal, and a few families against the state of Tennessee. The Department of Justice had supported the plaintiffs under Joe Biden, but in early February it sent a letter to the Supreme Court reversing its stance.

As a defensive response to such bans, New York became one of fourteen states to pass so-called safe-haven laws for trans youth. New York’s law, which was signed by Governor Kathy Hochul, in 2023, prohibits local authorities from coöperating with the arrest of medical providers and with out-of-state investigations into families seeking gender-affirming care, among other provisions. The New York State Human Rights Law, which protects New Yorkers from discrimination, also enshrined “gender identity or expression” as a criterion in 2019. Many families with trans children, including one I wrote about in this magazine in 2023, have relocated from states where bans were passed to those where treatment appeared to be more stable. In early February, in the aftermath of the executive order, Letitia James, the New York attorney general, published a letter warning hospitals that withholding services on the basis of gender violates state law.

The denials of care in New York City have therefore come with a sense of betrayal. “Executive orders haven’t changed the law,” a civil-rights attorney named David Brown told families who attended an online workshop about the order which was held by the Campaign for Southern Equality. “They are a statement of policy preference by the President.” The parents of trans children expressed anger that New York hospitals had seemingly acquiesced to the Republican political agenda before they were legally required to do so. One mother told me that Mount Sinai had cancelled a consultation for her son’s top surgery in December, weeks before Trump took office. The family had secured the consultation after months of waiting and a battery of hospital-mandated evaluations by mental-health professionals—only to be informed, the mother explained, “that Mount Sinai would no longer be seeing minors for surgical consults due to the ‘political climate.’ ” A second parent told me that Mount Sinai had also cancelled her son’s top-surgery consultation in December citing the “political climate.” (Mount Sinai declined to comment.)

Several of the parents I spoke to were having trouble eating and sleeping, and more than one broke into tears as we talked. One father told me that his child had expressed that she was a girl since she began picking out clothes for herself, at the age of two and a half, and that as she grew older her choices in clothing, toys, friends, and activities had remained consistent. “In every way that’s socially meaningful about what it means to be a girl nowadays in America, that’s what she’s always done,” he said. A military veteran from the Midwest, he was startled to find himself vilified by the executive order, which cast the care he’d sought for his daughter as “chemical mutilation.” “I’m not exactly a paragon of virtue or anything, but I’m a person who has lived a good and virtuous American life,” he told me. “All of a sudden, I felt like I was pushed outside of all of that, and was criminalized and painted as morally perverse.”