A year and a half ago, Rebecca and her wife moved out of North Carolina. They settled in Worcester because they thought it would be a more welcoming place for their family — especially their 9-year-old daughter, Leigh, who is transgender.
“I didn’t want her living in a place where people were actively seeking to cause her to be miserable,” Rebecca said, pointing to North Carolina’s restrictions on gender-affirming care for minors. GBH News agreed to use pseudonyms for Rebecca and Leigh because her classmates at school don’t know she’s transgender, and Rebecca is afraid of what could happen if they find out.
Leigh started seeing a doctor at Baystate Health in Springfield. Rebecca says the plan for when she got older was for her to take puberty blockers to delay or stop hormonal changes that would make her look more like a boy.
But now, even in Massachusetts, accessing those medications is getting harder.
Medical centers including Baystate Health, Fenway Health and Outer Cape Health Services have all stopped offering puberty blockers and hormone therapy to trans kids. Health experts and advocates say more providers could follow suit as the Trump administration puts out a litany of new declarations, regulations and investigations into providers to curtail transgender health care for minors.
But even if hospitals pare services for transgender youth, public officials and a few providers say they are determined to make sure families still have ways to access care in Massachusetts.
Proposed new federal rules would bar any hospitals that provide gender-affirming medications to minors from receiving any Medicare or Medicaid money — major sources of their funding. Those rules haven’t been finalized yet, but advocates worry what would happen if they take effect.
“It’s unprecedented,” said Jennifer Levi, who leads the transgender and queer rights project at the Boston-based LGBTQ+ legal group GLAD Law. “I don’t think anybody can name a single instance where the federal government targeted a group of vulnerable individuals ... and threatened hospital funding in order to shut down the care.”
Robbie Goldstein, who leads Massachusetts’ Department of Public Health, said state leaders and many providers continue to support transgender minors. While he hopes families trust the Healey administration to do what it can to preserve access to care, Goldstein acknowledges that “it’s incredibly challenging to sit with the uncertainty of this moment.”
“She’s a beautiful, happy child who is crazy and funny and sarcastic, and I don’t want to look at her and see that out of her eyes.”Rebecca, about her transgender daughter Leigh
Providers with several hospital systems, including Boston Medical Center, Boston Children’s Hospital and Mass General Brigham, currently offer gender-affirming medications to minors. But if the Trump administration’s proposals take effect, they’d be faced with a choice: Keep offering those medications or risk losing access to federal funding. So much federal funding that it would effectively shut them down, experts say.
Small health care providers are in a unique position because they don’t rely as much on federal funding. That’s good news for nonprofit organizations like Transhealth in Northampton.
CEO Jo Erwin said Transhealth is determined to continue offering gender-affirming medications to minors. The organization has between 600 and 700 patients under the age of 18, though not all of them are transgender. Erwin is expecting that number to increase, and is hiring more providers to prepare.
“One of the things that I want to make sure that families know is that all the options are not gone,” Erwin said. “We do know that it’s vital that we stay open. It’s vital that we are prepared to meet the moment and that we ramp up and get ready so that if there is a big influx — if other organizations have to close — families are not left with no option for their kids.”
In Southeastern Massachusetts, the nonprofit Health Imperatives plans to keep offering gender-affirming medication for minors, too. Health Imperatives runs seven sexual and reproductive health clinics, where trans patients can get prescriptions for hormone replacement therapy. But transgender minors who are on medications account for just a few dozen patients of the 20,000 they see annually, according to CEO Julia Kehoe.
Already, Massachusetts and other states are suing to preserve access to transgender health care. In one lawsuit, in which Massachusetts Attorney General Andrea Campbell is a plaintiff, a federal judge ruled last week that the Trump administration had overstepped with a December declaration that set the stage for these proposed federal rules. The ruling could strengthen future legal challenges.
“I stand with transgender youth and their families and will always fight to protect gender affirming care to ensure that it remains accessible to those who need it most,” Campbell said in a statement.
Levi at GLAD Law expects immediate lawsuits if the federal rules are finalized.
“For me, what’s so important is for hospitals to continue to provide the care,” Levi said. “There’s a long game that needs to be tracked before we allow the federal government to realize its goal, which is to get the care shut down without the federal government doing anything — other than announcing intentions and scaring people.”
Trump officials argue these changes are necessary to protect the health and safety of children, and regularly describe gender-affirming care as sex-rejecting procedures or chemical and surgical mutilation.
Gender-affirming medical care is rare among minors — and even more rarely involves surgeries.
In Massachusetts, no bottom surgeries for gender dysphoria — vaginoplasties or phalloplasties — were performed on anyone ages 18 or younger under the state’s Medicaid in 2024, billing data show.
Experts estimate there are about 14,000 transgender teens in the state. Not all of them want to take puberty blockers or undergo hormone replacement therapy. But limiting access to that kind of care is linked to more suicide attempts among trans youth.
In Worcester, Rebecca is worried about Leigh’s mental health if she starts going through “boy puberty” before they can find a new provider. She’s scared Leigh will “fall into a deep depression and not want to be in this world anymore.”
“She’s a beautiful, happy child who is crazy and funny and sarcastic, and I don’t want to look at her and see that out of her eyes. I don’t want to see her spark be gone because she can’t live her truth,” Rebecca said. “I’m going to fight for my kid — whether or not someone thinks I should be allowed to or not.”
