A judge on Wednesday ordered the Rady Children’s Hospital San Diego to continue providing hormone therapy and puberty blockers to transgender kids for another month amid fears that the Trump Administration will force the facility to close rather than allow the services to continue.
“This is an extraordinarily thorny issue,” said Superior Court Judge Matthew Braner, whose ruling encompasses the entire Rady health care system, which also includes a major hospital in Orange County.
Braner agreed that the Rady system faces an “existential risk” because it’s in the crosshairs of the White House, which is trying to shut down transgender services for minors. Rady had planned to eliminate gender-transition care for 1,900 patients as of Feb. 6 to avoid retribution from the Trump administration. The White House wants to eliminate Medicaid funding, which makes up 37 percent of Rady’s operating revenue, for hospitals that provide trans care to kids.
But the state of California sued the Rady system, arguing that its decision would violate an agreement that the San Diego hospital signed in order to merge with its sister hospital in Orange County. As part of the agreement, Rady said it would continue services such as gender-transition care.
In light of the conflicting pressure from both the federal government and the state, Braner told Rady attorneys that “you are between a rock and a hard place. The issue is how close is the rock and how close is the hard place.”
Braner was skeptical that Rady is in immediate jeopardy of losing federal funds and then shutting down. As he noted, the Trump Administration’s efforts to kill gender-transition care in children are still in the works.
On the other side, the judge said, “I see kids at risk of relative degrees of harm” if the care is eliminated at the Rady system.
Last week, Braner temporarily stopped Rady from eliminating hormone therapy and puberty blockers care for transgender kids pending the ruling this week. His Wednesday order forces Rady to continue providing the care until another hearing on March 10.
What Happens Now: Trans Care Continues But with a Twist
Under the judge’s order, the Rady system will continue providing hormone therapy, such as estrogen for transgender girls whose birth sex was male and testosterone for transgender boys whose birth sex was female. As for puberty blockers, which delay puberty so children can explore their gender identity and figure out next steps, Braner said Rady must continue to offer them via medication or surgical implants.
However, the hospital will not provide surgery such as mastectomies to remove breasts in transgender boys. These procedures, which critics call “mutilation,” have come under more scrutiny in recent days as leading organizations of plastic surgeons and physicians cast doubt on their use in children.
It’s not clear how comfortable Rady clinicians will be about continuing to provide care. They may face criminal prosecution from the government, and the hospital’s CEO warned about concerns over safety.
In December, an anti-trans activist posted an account of her experience attending a transgender health symposium at UC San Diego, whose doctors work with the gender clinic at Rady’s San Diego hospital. The post named multiple clinicians and included photos of them.
In a legal brief, Dr. Patricio “Patrick” Frias, a Rady co-CEO, said the post prompted social-media attacks on clinicians and calls for their prosecution. “Not only are these intimidating, but the rhetoric around this case—describing RCH providers as ‘mutilating’ children or engaging in ‘child abuse’—leads RCH to fear for the safety of its physicians and staff.”
Mixed Reactions to Ruling at Courthouse
Kathie Moehlig, executive director of San Diego-based TransFamily Support Services, told Voice of San Diego that the ruling is a partial victory. It does give families more time to set up care elsewhere if they lose it at Rady’s, she said.
However, many patients now have to go to Los Angeles or Orange County health systems for trans care that’s not available locally, she said, and those systems are vulnerable to the same Trump Administration pressures as Rady.
Three women wearing “Do Not Harm” T-shirts attending the court hearing and said they oppose gender-transition care in kids.
Mary Davis, who described herself as a government watchdog from East County, called transgenderism a mental illness, and MaryAnn Campos, a registered nurse from San Diego, said “parenting is an issue,” although “I’m not saying it’s bad parenting.”
Marci Strange, a gay woman from Solana Beach who’s semi-retired, said she may have been tempted to transition to male as a child if she knew it was a possibility. “I would have jumped on that train,” she said. Instead, she grew up to have children.
Could End of Hospital Services Lead to Careless Care?
There’s a divide among transgender advocates about whether gender-transition care in children has outpaced research amid a boom in the number of kids who don’t view themselves in traditional ways. But one prominent skeptic thinks moving care out of children’s hospitals is a bad idea.
Erica Anderson, a Minnesota-based psychologist who served as a leader in transgender medicine associations, told Voice that eliminating trans care at children’s hospitals is harmful because it’s harder for clinicians in private practice to give kids the care they need.
It’s best that gender-questioning children get treatment that’s carefully coordinated among clinicians such as endocrinologists, adolescent medicine specialists, and mental health professionals, said Anderson, who’s transgender herself.
Private providers aren’t as well-suited as hospitals to provide this kind of “multi-disciplinary” care, Anderson said.
“I’ve been critical for many years about people who are not qualified trying to jump into this care, both on the mental health side and the medical side. Too often there’s an ideological bias by some providers who say, ‘If a kid says they’re trans, treat them as such.’”
Last year, Anderson provided written testimony in a lawsuit that pits two Escondido elementary school district teachers against the state of California regarding a law that prevents teachers from telling parents if their kids say they’re transgender.
Many transgender advocates support the law, but Anderson told me that it’s “a bad idea for a lot of reasons to deprive parents of knowing what’s going on with their kids. We know from research that the gender-questioning kids who do well are those who have family support.”
The U.S. Supreme Court may ultimately decide whether the law will stand.
Anderson also offered testimony in favor of a New York woman who sued providers over a double mastectomy she underwent as a transgender child but later “detransitioned.” The woman just won a $2 million lawsuit.
Anderson said she told the court that the patient was not treated appropriately in alignment with standards of care.