What the Trump administration’s hospital settlements mean for the future of trans youth care

According to Department of Justice settlements, at least six major healthcare facilities have agreed to refuse gender-affirming surgery and hormones for young transgender patients. Under the pacts, institutions will instead remit funds to the federal government for patients seeking to reverse transition procedures.

The most recent agreements were finalized last week.

Most of these institutions had already halted treatments because of state-level bans or earlier pressure under President Donald Trump’s administration.

The Department of Justice agreements conclude active investigations into past care provided and eliminate the possibility that hospitals could be forced to surrender patient records. Justice Department officials stated that certain healthcare providers have also pledged financial help toward medical costs for youth seeking to "detransition."

The hospitals have not admitted to any wrongdoing.

"It’s a really dangerous precedent when the federal government is allowed to politicize any one group of people’s care and end it," said Eliel Cruz, a cofounder of the Gender Liberati.

Two hospital networks, New York University Langone Hospitals and the University of Pittsburgh Medical Centers, have reached settlements with the Justice Department to halt gender-affirming care for patients under 19. The facilities agreed to stop offering puberty blockers, hormones, and gender-affirming surgery—treatments the administration describes as "sex-rejecting procedures."

"The Department of Justice is fighting to protect our nation’s children and working tirelessly to reach agreements with hospitals to end so-called ‘gender-affirming care’ for minors," U.S. Attorney General Todd Blanche said in a statement last week.

NYU will pay the federal government $8.5 million and UPMC will pay $950,000 under the terms. The pacts follow similar resolutions reached since May with Cleveland Clinic, Connecticut Children’s Hospital, Mount Sinai Health System in New York, and Texas Children's Hospital.

Hospital officials noted that the agreements will not affect how their pediatric mental health programs support transgender children.

A federal review published last year by the Trump administration urged limiting youth care strictly to therapy. However, leading medical groups, including the American Medical Association and the American Academy of Pediatrics, advocate for keeping medical care available.

Mount Sinai is the only healthcare system among the six to finalize a settlement without first announcing a policy change.

Providers in Texas and Ohio had already halted treatment due to state prohibitions. The other institutions revised their policies after Donald Trump returned to office in January 2025 and introduced measures targeting youth transitions. These included a January 2025 executive order seeking to end federal support for gender transitions for under-19s, alongside restrictions on federal Medicaid coverage for the care.

Such medical treatment remains accessible through various other hospitals, clinics, and individual physicians.

First unveiled in July 2025, the administration's major effort involved issuing subpoenas to hospitals for information on youth gender-affirming care, including specific patient names.

NYU Langone noted in a statement that accepting the settlement shields patients and their families by eliminating "the threat that NYU Langone would have to provide the confidential information previously demanded about patients under 18 who received gender-affirming care at our institution."

Multiple medical centers petitioned courts to avoid turning over those records, with most securing favorable rulings in district courts.

However, an appeals court decision last month provided federal officials with a significant boost.

In a 2-1 decision, the San Francisco-based 9th U.S. Circuit Court of Appeals held that seeking to end pediatric gender-affirming care is not an improper administrative objective and cannot serve as legal grounds to prevent subpoenas.

Legal bans or restrictions on gender-affirming care for minors are now active in at least 27 states.

Additionally, over two dozen hospitals, health systems, and clinics in states without bans have halted care since last year, even in areas with legal protections. Democratic state officials have sued the Trump administration, arguing its measures unlawfully intimidate medical providers.

While surgical transition for minors is rare, many transgender youth use hormones to delay puberty or develop features matching their gender identity.

Cruz’s Gender Liberation Movement has picketed hospitals ending treatment. Cruz noted some families relocated to other states for care only to find local providers stopping it, while others relocated abroad.

He said agreements with the Trump administration reveal "who has the courage to do what their calling and education calls them to do — which is do no harm — and those (who do) not."