In June of this year, the Department of Justice served the Children’s Hospital of Philadelphia with a subpoena ordering it to turn over medical records, provider documents, and even text messages related to gender–affirming care. It also demanded Social Security information, personal and medical patient history, addresses, and many other pieces of private information. This infringement violates HIPAA and the basic privacy rights to which all patients and families are entitled. The attack on transgender children and their families is scary—not only for them, but for everyone.
“You’re saving lives, period,” Grace Gilbert, a local orthopedic surgery resident who’s been vocal on her social platforms (@gilbert.md.rn on TikTok and Instagram), says about the importance of gender–affirming care. She’s used her training as a doctor and a nurse to create extensive educational content about gender–affirming care, especially for kids.
The Trump administration has campaigned for the investigation and halting of pediatric gender–affirming care across the country. Along with CHOP, nearly 20 other hospitals have been hit with subpoenas: Boston Children’s Hospital, Children’s Hospital Colorado, and many others are fighting to protect their patients’ privacy. In a recent ruling, a judge blocked the Justice Department’s subpoena for the records of Boston Children’s Hospital. Some clinics and hospitals, however, have had to stop offering gender–affirming care in the wake of the administration’s subpoenas and executive orders, leaving thousands of children vulnerable.
There are many misunderstandings in media and government alike about what gender–affirming care truly is. Many believe that gender–affirming care is always about taking some sort of hormone or having surgery, but it can actually come in many forms. Gilbert explains the major categories of gender–affirming care: therapy, puberty blockers, hormone therapy, and gender–affirming surgery. Gender–affirming therapy is a therapy that focuses on affirming and supporting a patient’s preferred gender identity. It can mean things like “changing your pronouns” and “having notes for school that say your need for certain things,” Gilbert explains.
Puberty blockers stop the body from producing estrogen and testosterone, therefore delaying the changes many experience during puberty. “The important part about it is knowing that it’s 100% reversible. It is a medication that we give kids to delay puberty so they have more time to decide what they want to do,” Gilbert says.
Gender–affirming hormone therapy can help a patient achieve physical characteristics that are more masculine or feminine through the use of hormones like testosterone or estrogen. “Those do have a lot more side effects. But it’s the same side effects as puberty,” Gilbert says.
Hormone replacement therapy guidelines recommend that HRT can be started no earlier than 13–14 for transfeminine teens and 14.5–15 for transmasculine teens. Before the age of 18, parental consent is required to start HRT, and in some states, HRT for gender–affirming care is even banned for minors.
Colloquially known as “top surgery,” “bottom surgery,” “feminization surgery,” or “masculinization surgery,” gender–affirming surgery is a broad term for a wide range of medical procedures a person can have done to align their gender identity with their physical characteristics. This type of gender–affirming care is rarely done for minors, especially bottom surgery. “No one in this country does genital surgery on trans kids,” Gilbert says. “There’s only a few surgeons in the country who even do it for adults.”
A large concern about performing gender–affirming surgery is the worry that patients may regret getting the surgeries or want to “transition back.” A systematic review found the overall prevalence of regret after gender–affirming surgery was 1%. When comparing this to total knee arthroplasty surgery outcomes, the overall rate of regret is ten times higher for total knee arthroplasty as compared to gender–affirming surgery.
White House Press Secretary Karoline Leavitt calls surgeries for transgender kids “barbaric.” But transgender care is no different from any other form of health care: It saves lives. A study published in the Journal of the American Medical Association found that receiving gender–affirming care (i.e., puberty blockers and/or hormone therapy) was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality in transgender youth.
It’s an indisputable fact that access to gender–affirming care is essential for transgender youth, but trans people aren’t the only ones who benefit from gender–affirming care. A study by researchers from the Harvard T.H. Chan School of Public Health examined the prevalence of gender–affirming surgeries among different groups of minors and adults in the United States. The numbers show that roughly 97% of breast reduction procedures done on male minors are done on cisgender male minors, while only 3% are for transgender and gender–diverse youth.
Breast reductions for cisgender males are typically done in response to gynecomastia, a relatively common disorder that results in an excess growth of breast tissue. The study also found that the rate at which top surgery was performed on transgender and gender–diverse minors was “2.1 per 100 000 minors aged 15 to 17 years, 0.1 per 100 000 minors aged 13 to 14 years, and 0 procedures among minors aged 12 years or younger.” These numbers clearly disprove the Trump administration’s claim that doctors are recklessly and carelessly performing surgeries on transgender children.
Youth who have already gone through these therapies before the Trump administration’s investigation are vulnerable as well. Their private records and medical information are at risk of being made public without their consent.
The privacy of our health care and livelihoods has been threatened since the overturning of Roe v. Wade, which not only established the right to abortion but also expanded the implied constitutional right to privacy. Although not explicit in the Constitution, an individual’s privacy is broadly seen as protected by the Fifth and 14th Amendments, which state that a person cannot be deprived of “life, liberty, or property, without due process of law.”
The overturning of Roe v. Wade sets a scary precedent, and so does the most recent wave of subpoenas from the Justice Department. “What, if any, are the positives that the government could be doing with this information?” Gilbert asks. “We’re not subpoenaing to make health care better. We’re not subpoenaing to make sure depressed kids get therapy. We’re not making sure that kids who need chemo, that their insurance covers it.”
We’re living in a world where pervasive violations of our privacy threaten our right to safe, secure health care. Providers are struggling to grapple with this challenge during conversations with patients and their families. “Families are bringing in their kids to these centers, even though they don’t fully support them.” Gilbert says. “Now, instead of getting abundant support and help, they’re being told that this might put your family at risk.”
Kids with gender dysphoria already struggle with bullying and harassment at school due to their gender identities. The possibility of having their health information exposed or losing access to the health care they need will further erode their ability to function in their own bodies. The Justice Department’s subpoenas have put up even more barriers for transgender kids to overcome in order to access gender–affirming care.
Gender–affirming care is health care, and we need to continue to fight for transgender youth as their right to feel safe in their own bodies comes under threat. In these times, it’s more critical than ever that we hold out our hands to those who don’t understand transgender issues and show them just how critical access to gender–affirming care can be. Should these violations of our privacy go unnoticed and unchecked, real lives are on the line.
