Last year, New Hampshire became the first state in New England to ban gender-affirming care for minors. And, in Connecticut, two major hospitals stopped offering some or all gender-affirming care for minors.
In a Feb. 9 letter to parents and guardians, Springfield’s Baystate Health said it would continue to offer mental health counseling for children and adolescents but would stop prescribing gender-affirming hormone medications and puberty-blocking drugs to patients younger than 18. Medication care will be transferred to Transhealth, a local health care organization specializing in gender-affirming care, or to another provider of the patient’s choice.
The letter was signed by Dr. Matthew D. Di Guglielmo, pediatrician in chief at Baystate Health.
“This decision offers patients the specialized expertise and continuity of care they need and deserve and reflects the evolving regulatory landscape that threatens hundreds of millions of dollars in hospital Medicaid and Medicare funding,” Baystate said in a separate statement to the Globe. “Nearly 70 percent of Baystate Health patients rely on Medicaid and Medicare, and preserving access to care for these individuals and all others in our community is a responsibility we take seriously.”
Transhealth, also based in Western Massachusetts, did not immediately respond Tuesday to the Globe’s request for comment.
The recent changes follow a series of proposals by the Trump administration aimed at sharply restricting gender-affirming medical care for minors.
Under the proposals, the federal government would bar hospitals that participate in Medicare and Medicaid from providing gender-affirming care, including hormones, puberty blockers, and surgery, for patients under 18. A separate rule would block federal Medicaid and Children’s Health Insurance Program funding for such treatments for youths 19 and younger.
Because nearly every hospital in the United States relies on federal reimbursement, health policy experts have warned that the changes could amount to a virtual national ban.
Already, Baystate is digging itself out of a financial hole. The health system issued several rounds of layoffs in the last two years, including cutting 117 jobs on Feb. 13, in an effort to find financial stability.
Nationwide, 26 states have banned the use of hormones and puberty blockers for transgender minors, according to advocacy groups tracking such laws after the US Supreme Court upheld Tennessee’s ban last June, reinforcing the legality of such restrictions.
Gender-affirming care for minors — which can include mental health counseling, puberty blockers, hormone therapy, and in rare cases surgery — is considered medically necessary by major professional organizations, including the American Academy of Pediatrics and the Endocrine Society. Those groups say the treatments can reduce gender dysphoria and improve mental health outcomes, including lowering the risk of depression and suicide.
Dr. Robbie Goldstein, the state’s public health commissioner, said gender-affirming care remains legal in Massachusetts and defended it as evidence-based treatment. Recent federal actions threatening hospital funding have put providers “in an impossible position,” he said.
“Decisions about a young person’s medical care belong in the exam room, guided by patients, families, and clinicians — not by politicians in Washington,” Goldstein said.
According to federal health data, about 3.3 percent of US high school students identify as transgender or nonbinary. Fewer than .1 percent of adolescents with private health insurance identified as gender diverse and received puberty blockers and gender-affirming hormone treatment between 2018 and 2022, according to a recent study by researchers at the Harvard T.H. Chan School of Public Health.
Critics of the treatments argue that minors are too young to make decisions with potentially irreversible consequences and that such interventions should be delayed until adulthood. Health and Human Services Secretary Robert F. Kennedy Jr. has said that physicians who provide gender-affirming care to minors are violating the Hippocratic Oath to do no harm and has characterized gender-transition surgeries as causing “lasting physical and psychological damage.”
Recently, two major medical groups have stated that gender-affirming surgeries should wait until adulthood. The American Medical Association told reporters earlier this year that “surgical interventions in minors should be generally deferred to adulthood,” while the American Society of Plastic Surgeons said gender-affirming surgeries should be delayed until a patient is at least 19 years old, although the society said it respects the individual decision making of its members. Already, these procedures are exceedingly rare among minors in the United States.
Advocates for transgender youth say the growing patchwork of restrictions has created confusion and anxiety for families, even in states where no formal ban exists. Massachusetts has positioned itself as a refuge for transgender patients, with state leaders pledging to protect access to care.
Earlier this year, when the Trump administration subpoenaed records from Boston Children’s Hospital and several others nationwide that provide gender-affirming care, Attorney General Andrea Campbell led a coalition of 19 states in fighting the administration. The suit is ongoing.
Families have filed discrimination lawsuits against two of Connecticut’s largest pediatric health systems after abruptly ending gender-affirming care for minors.
Boston College psychologist Amy Tishelman said that while medical treatment for gender dysphoria should be approached carefully, eliminating access altogether would halt research needed to determine when such interventions might be effective. Tishelman was a clinician and the director of research at Boston Children’s Hospital’s gender clinic for eight years and a lead author of the international standards of care for treatment of gender-diverse children.
“It’s really heartbreaking to see the ‘ping-pong around’ all or nothing approaches,” Tishelman said Tuesday. “It’s clear we need a careful process, but it’s hard to fathom that services will disappear altogether.”
She emphasized that for young people and their families, there is often “a complex set of risks and benefits to contemplate” before starting medical interventions.
Tishelman said that for youth who don’t have access to puberty blockers, “it means they will go through a puberty incompatible with their identified gender,” which can be distressing for some. But, she added, “not everybody wants puberty blockers,” citing complexities and risks associated with their use, including potential fertility impacts and implications for future gender-affirming surgeries.
Tishelman said she’d like to see psychologists “front and center” developing more research and priorities before cutting off care, because there are risks. There’s also a lack of data to predict who will need the medications, she said: “These decisions must be careful and made in light of education about what is known or unknown.
“Risks of delaying care are individualized and can be quite extreme for some people,” she said.
Sarah Rahal can be reached at sarah.rahal@globe.com. Follow her on X @SarahRahal_ or Instagram @sarah.rahal. Marin Wolf can be reached at marin.wolf@globe.com.