Trans Teens Face Healthcare Crisis as Clinics Close Amidst Political Pressure

By the time the Children’s Hospital closed its doors to trans patients, Sage had already stopped taking testosterone. A nonbinary high school student, they originally received treatment for the rapid onset of puberty. The changes their body experienced felt frightening and sudden. They developed PMOS, a relatively common hormonal disorder that can lead to hair growth and irregular periods. The pandemic didn’t help. Too much time to focus on scrutinizing the person in the mirror while doomscrolling. Their doctor first prescribed puberty blockers to help with their PMOS symptoms — not explicitly for trans-related reasons — and eventually recommended they take testosterone to help with hormonal imbalances. Figuring out their gender came later. “Overall, my story was just I decided to attempt suicide and then that’s the only way that my parents took me seriously,” Sage says. “Which is sadly the case with a lot of trans people. They have to go to an extreme to be recognized.”

Kids are hardly supposed to be seen or heard in our society, especially trans ones. At a protest I attended last year, trans kids’ voices were centered in all their corny, beautiful, galaxy-brain words. In most spaces, however, it is the adults who get the last word. Why do we insist on hearing more from the parents and legislators than the actual children whose lives are at stake? Stories that aim to whip up panic about an alleged boom in trans kids gaining medical resources often only interview people with no firsthand knowledge of transness, infantilizing kids as naive or unreliable narrators. Sage’s story is just one in a chorus; many trans kids are struggling to have their voices heard. Few newspaper or magazine features have given space to the words and lived experiences of trans kids living under the Trump administration. “I had a lot of trans friends online or people that I used to know who were trans and did not make it,” Sage says. This troubled and difficult relationship to transition is often the kind of story people associate with coming out.

Now 17, Sage ended up getting care through the Children’s Hospital Los Angeles, which specialized in the relationship between gender, hormonal imbalances, and mental health. This care appealed to Sage as they sorted through their identity and their PMOS symptoms. Eventually, they decided to stop taking testosterone. Navigating care at the hospital was relatively easy. Their life opened up. They met a trans girl named Brooklyn in their high school marching band and the two started dating. Brooklyn’s coming out was less intense than Sage’s: She told her family she wanted to start taking estrogen after she began to experience dysphoria. Her parents understood, and Brooklyn got on hormones soon after.

“We’re teenagers, for God’s sake”

For many children in liberal cities, things were going relatively well. At least until last summer, when the Trump administration began to threaten the funding of hospitals that provided trans healthcare for kids. Around this time, Sage logged into a therapy session with a psychiatrist only to be told that the hospital would no longer be treating patients like them. There was no attempt to provide continuity of care and no suggestion of where else to turn. Kaiser Permanente, one of the largest providers of healthcare for trans people in California, paused providing surgical pediatric trans care. (In a statement, Kaiser Permanente spokesperson Hilary Costa said, “after significant deliberation and consultation with internal and external experts, we made the difficult decision to suspend surgical gender-affirming care for patients under the age of 19 in our hospitals and surgical centers.”) Since then, finding someone else who can navigate hormones and mental health has been a nightmare. Some parents, like Sage’s, are supportive. Others, less so. Without proper medical care, some kids have been forced to temporarily detransition — at least physically — until turning 18, 19, or 21, depending on the state’s current rules.

Sage couldn’t even continue seeing their doctor for PMOS-related care. Brooklyn also had to look elsewhere for care. Sage even knew a doctor who lost their job after the Children’s Hospital shuttered its pediatric trans care unit. (The Children’s Hospital did not respond to a request for comment.) The hospital cited potential funding issues, worried if it kept its gender clinic open it’d lose federal funding for its other services. Others may find hormone replacement therapy (HRT, as it is known, referring to testosterone and estrogen) through less official sources. Neither is a foolproof option.

Some kids like Sage and Brooklyn worry about the rapid rise of anti-trans sentiment. Not even in North Hollywood, where both members of the T4T couple reside, are they safe from teasing and victimization. “It just looks different than most people would describe,” Sage says. Some people even record themselves bullying trans teens and post it online. Others are harder on trans people who don’t pass than those who do. “I’ve had adult parents come up to me or my friends saying, ‘Oh, you’re trans, but you don’t look the part.’ Adults commenting on children’s bodies because they don’t look like the gender they’re trying to portray,” Sage groans.

As their own mental health frays, trans people may even end up bullying each other. Some trans kids use derogatory terms like trooning or pooning to refer to trans kids who don’t pass or meet strict beauty standards. It’s a symptom of self-loathing and internalized transphobia, Sage and Brooklyn tell me. This is a generation that’s had both more access to trans culture and more national scrutiny than ever before. That’s a lot to handle, something that Sage worries can create a hostile environment for all involved. “Sometimes it feels like everyone’s against each other,” they say. “I think a lot of it too is that transphobia is such a loud voice in discourse today that inevitably so many people are going to eventually hear it — even in the most accepting of places — and start to empathize with it,” Brooklyn adds.

Sage worries that few people are thinking about the effect HRT has on mental health. Not just as a way of keeping suicidal ideation at bay, but also in terms of balancing hormone levels during the volatile teen years. Going off HRT can be disastrous — even more so at such a vulnerable time. “We’re teenagers, for God’s sake,” Sage says exasperatedly. Adolescents shouldn’t have to stage die-ins or go on radio shows to demand their rights. Sage wants doctors to give trans people autonomy because they deserve it, not just out of pity.

Children can and do know the cost of their desires. It is adults who try to simplify the jagged contours of adolescence. “It is bitter for the young to see what awful innocence adults grow into, that terrible vulnerability that must be sheltered from the rodent mire of childhood,” the novelist Katherine Dunn once wrote. Kids understand the joys and risks of transition, perhaps as well as anyone. For children, the ability to get care has always been fickle. Not every parent is supportive. Some of the adults I talked to split custody with co-parents who weren’t as accepting.

The world of childhood is not simply a safe space, even if it should be. It is a time of suffering, limitations, and walking around in the suburbs or city streets blasting emo songs and bubblegum pop in order to process big feelings. The fantasy of innocence serves only those who seek to restrict the rights of queer youth. For the rest of us, we prefer kids to thrive on their own terms rather than become accessories to their parents. In recent years, major features that speak to real trans people have slowed to a trickle — and I’ve hardly seen any outlets speak with trans kids. (Speaking out in support of trans care for youth may even be penalized soon by the FTC for “consumer fraud.”) In such a hostile climate, hearing from teenagers themselves felt like an important story that no one wanted to tell. After I put out the call to talk with trans youth, I met Sage and so many others. They’re a terrified, witty, angry, and resilient bunch who want to speak for themselves.

Instead of focusing solely on pitying trans people or writing depressing news stories, trans kids like Sage wish people wrote more about the positive side of the equation — community events and clothing swaps. Of course, Sage knows there aren’t as many clicks in those kinds of banal, optimistic stories. For them, laughter is a big part of survival. So is making plans for the future in spite of the horrors. They’re thinking of becoming a journalist.

Across the US, trans clinics treating children for gender dysphoria are closing. Alongside the Children’s Hospital Los Angeles, UChicago Medicine in the Midwest and NYU Langone in New York all abruptly stopped treating kids even before being ordered to do so by the Trump administration. They are hardly the only hospitals to stop providing transition-related care for those under 18. Therapists have left clients in the lurch, doctors have stopped working in pediatrics, and parents have been left to pick up the pieces. Documentaries like 2025’s Just Kids chronicled a country on the brink — parents terrified of being labeled abusive by the state struggling to finance moves to more liberal states, only to now face the same obstacles at a national level. What are the options left for trans kids and their parents? HRT and surgery for trans youth have become practically outlawed. Across the country, trans kids have demanded a voice in response to these dire developments — at protests, in op-eds, online, and in person. They are far more scrappy, resourceful, intelligent, cynical, and determined than they’re given credit for by the mainstream media.

Trans teenagers are often skilled at advocating for their own care. In Los Angeles, Sage participated in protests after the Children’s Hospital closed. They were frustrated by the institution bowing down to pressure by the federal government to pull funding. In New York, I was at a rally for trans youth last February, shortly after NYU Langone first threatened to suspend care for children. I listened as women like Alaina Daniels and Rabbi Abby Stein spoke and ushered trans kids up the steps at Union Square to share their stories. The most powerful moment was when a trans kid belted “Defying Gravity” a cappella. It was not a song I had ever expected to be moved by.

“Every time I turn on social media or I hear someone talking about the news, it’s just another batshit insane thing”

Donald Trump built a platform on mocking trans people and saying Kamala Harris would give trans surgeries out like candy to incarcerated immigrants. Now in power, Trump is forcibly detransitioning inmates throughout the prison system. He routinely makes exaggerated claims about trans children like “there are some places your boy leaves the school, comes back a girl, without parental consent.” The reality is that even obtaining puberty blockers usually requires multiple meetings with doctors and therapists. In response to such rhetoric, one father of a trans teenager tells me, “If you trust doctors to take care of you when you’re sick, trust the doctors at a gender clinic.”

When a child comes out as trans, they typically meet with a psychiatrist multiple times in order to receive a diagnosis of gender dysphoria and “prove” they understand the gravity of taking hormones or going on puberty blockers. For children who have yet to go through puberty, blockers may be prescribed by a doctor. Typically, these medications pause puberty through the administration of regular shots or an implant that gets replaced every year. The effects are typically temporary and reversible — if someone stops taking the medication, their puberty resumes. Blockers are a very low-stakes first step that most practitioners require trans kids try out before they move on with their transition.

By contrast, hormone replacement therapy is usually given to those who have already been on blockers or are older and further along in the puberty process. HRT has some effects that may be irreversible, like hair growth for those taking testosterone or breast growth for those taking estrogen. Typically, testosterone is a shot, while estrogen can be injected or taken in a pill form. Most trans kids do not get surgery, though some transmasculine people may get top surgery (a kind of mastectomy to remove breast tissue).

Still, many have attempted to sensationalize trans medicine by fabricating reports in an attempt to fearmonger concerns about safety and the specter of detransition. But regret is rare. Certainly, some parents worry about the mental health of their kids both before and after transition. But for trans kids, this is lifesaving medicine. Suicidal ideation is a real risk for those who do not receive adequate care. The parents I spoke to were primarily the kinds of parents who advocate for their kids, but some parents do express fear before ultimately coming around and supporting their children’s transition. Certainly, it’s a big life step for anyone to take in a world consumed by transphobia. The stress alone can be a lot to handle even for families that end up being extremely empathetic. Most of the kids I spoke with ended up seeing doctors initially for mental health reasons. By the time the kids came out, their parents knew the stakes were high. Multiple high-stakes murders and suicides have occurred in the past few months alone, including the stabbing of Juniper Blessing at the University of Washington.

For a few years, the liberal rhetoric around trans care was that it would become a states’ rights issue. Kansas has invalidated the driver’s licenses of those who change their sex on their ID. Many mainstream news outlets have hardly covered these dire developments, though independent reporters like Erin Reed have been providing in-depth updates. In Texas, the parents of trans kids may be investigated for child abuse (though during the course of reporting this article, I didn’t talk to or hear about anyone who has faced such charges). A Williams Institute survey from 2024 found that nearly half of trans respondents had moved or were considering moving to more accepting states.

However, after NYU Langone and Mount Sinai told parents they would stop treating pediatric trans patients in February, left-leaning outlets like The Nation called on Mayor Zohran Mamdani to do something. How could it happen here? families seemed to wonder. How could these hospitals comply with Trump’s anti-trans policies before they even became law? The answer, of course, is based on economics, not morality. Trump has stated he will suspend federal funding for healthcare systems that treat trans minors. Still, the fight isn’t over. The ACLU has launched endless lawsuits, and in response to NYU Langone’s recent moves, the New York Attorney Gene