Trans youth are rattled by Trump's efforts to ban gender care. So are hospitals.

New York: The Trump administration's executive order seeking to bar hospitals from providing certain kinds of care for transgender youth has inspired anxiety among parents, at least one lawsuit, and demonstrations by transgender activists and progressive politicians.

But among some hospitals, the response has been rapid compliance. They could lose federal research funding if they don't comply, but there are also troubling ethical concerns about patient abandonment: A doctor has an ethical and legal duty to keep treating patients in need of immediate care.

"Hospitals ultimately are pragmatic," said Dr. Marci Bowers, a transgender woman and surgeon who played a key role in building a New York City hospital's transgender medicine and surgery program over the past decade. "They're acquiescing to what they need to do to stay alive."

New York City is a leader in what the medical establishment refers to as gender-affirming care, and most major hospitals have well-established transgender medicine programs. But at hospitals around the city, administrators have so far declined to say publicly what they intend to do. NYU Langone Health has begun to postpone planned surgeries such as mastectomies for older teenagers and to cancel appointments for patients scheduled to receive long-lasting puberty blocker medications.

"They are very uncertain as to how to proceed at the moment," said Dr. Robert Klitzman, a psychiatrist and professor who was a founder of Columbia University's Center for Bioethics. "Hospitals are trying to figure out what to do."

Though New York City hospitals have said little about the executive order, from Colorado to Washington, D.C., some hospitals have issued clear-cut statements declaring they would not issue new prescriptions for hormone therapy or puberty blockers to transgender youth, or would only do so through the end of this month. Some, like Children's Hospital Los Angeles, said they would continue providing hormone therapy to existing trans patients, but would not start new pediatric patients on hormones.

For New York City families with transgender children, the result has been intense concern about whether their children will be able to continue to receive puberty blockers, hormone therapy or other care.

One mother of a transgender child described trying to set up competing appointments at top New York City medical centers, just in case her daughter's current doctors dropped her as a patient. Another mother of a transgender child rattled off the names of several pediatric endocrinologists in private practice who are less likely to be affected by the executive order. (The parents agreed to speak to The New York Times about their children's medical care on the condition their names were not used.)

Gender-affirming care for children has sparked intense debate around the country and the world, and has led more than two dozen states to put restrictions or bans on certain medical interventions for transgender children. The executive order claims that many transgender children are "impressionable" and confused. The order states that providing gender-affirming care amounts to "maiming and sterilizing" them.

Many thought that New York City would be somewhat insulated from those forces. New York has a large number of transgender youth: About 3% of teenagers ages 13 to 17 across the state identify as transgender, roughly twice the national average, according to one survey. New York hospitals have built robust transgender health programs over the past decade, hiring leading surgeons and training new ones.

NYU Langone Health advertises a Transgender Youth Health Program on its website, offering to provide "puberty suppression, hormone therapy, and social and emotional support." The Mount Sinai Health System began a Center for Transgender Medicine and Surgery, with fellowships where surgeons are trained in gender confirmation surgery.

NewYork-Presbyterian's website advertised a program for transgender and gender-diverse children and adolescents, though it was recently changed to omit a reference to "puberty suppression and gender-affirming hormone and treatment," according to a development first reported by The City, an online news outlet covering New York.

Bowers, who works at Mount Sinai, said she was worried that the willingness hospitals had shown to invest in transgender health programs was vanishing in the face of the financial threats contained in the executive order. The order raises the prospect that hospitals that do not comply could lose access to federal research funding, among other things.

The order calls for hospitals to stop providing puberty blockers and hormone therapy to trans children, in effect putting pressure on them to cease care for these patients. Hormone therapy includes testosterone for trans boys, and estrogen and drugs that block testosterone for trans girls. A pediatric trans patient might receive puberty blockers and after a couple of years begin hormone therapy around age 14.

Trump's order is in some respects less flexible than some state laws that have sought to stop children from transitioning. A 2023 Texas law, for instance, included a provision that patients already on puberty blockers or hormone treatments "shall wean off the prescription drug over a period of time and in a manner that is safe."

Dr. Gabrielle Grinstein, a pediatric endocrinologist whose patients have included transgender children, said: "It's not ethical to stop treatment in any patient, whether it's hormone treatment or anything else, without measuring the consequences of what you're doing. You can't just stop medication and say, 'Good luck.'"

Beyond concerns about patient abandonment, the order also puts hospitals in a precarious position for another reason: Denying care to transgender youth could violate state anti-discrimination law, according to New York's attorney general.

State Sen. Kristen Gonzalez, whose district includes some major hospitals on Manhattan's east side, said, "We're seeing a lot of unfortunate responsiveness from hospitals to the Trump administration."

NYU Langone has repeatedly declined to comment about how the executive order is affecting what medical interventions it offers to transgender youth. The trade organization that lobbies for hospitals, the Greater New York Hospital Association, would say only that it was "in close contact with our member hospitals as we collaboratively work through the gender-affirming care E.O. and all its potential implications from both a legal and clinical perspective."

One unusual feature of the executive order is that it covers minors but extends to 18-year-olds as well; under New York law, an 18-year-old is considered an adult capable of making personal medical decisions.

Doctors at NYU Langone have started informing the families of some older teenagers that they will have to wait until they are 19 years old to have some surgeries, two families of transgender children said in interviews.

One father said his transgender son's top surgery was scheduled for this spring, in time for his son to start college in the fall looking like "the person he feels himself to be." But Wednesday the surgeon called to say it would probably need to be postponed to next year, when he turned 19, unless circumstances change, a reference to the executive order, the father said. The son can continue to receive hormone therapy from his doctor, as the father understands it.

A second teenager had a similar call Wednesday with an NYU Langone psychiatrist who worked with the surgical team. Despite being previously told he would be able to have top surgery this year, he was informed it would likely be another year of waiting, until he was 19, the boy's mother said.

The cutoff in federal research funding threatened in the executive order could mean the loss of hundreds of millions of dollars at leading hospitals and medical schools. The order also warns hospitals that not complying puts them at risk of being cut off from government insurance programs, like Medicare and Medicaid. That could force a hospital to close.

"It puts physicians in a terrible position," Klitzman said, leaving doctors to navigate how to "provide care without getting their institutions in trouble."

Klitzman said he expected that hospitals or perhaps local government or nonprofit organizations would explore setting up clinics for transgender pediatric medicine that were entirely separate entities from the hospital. There is precedent for such a maneuver.

In 2001, under pressure from anti-abortion groups, President George W. Bush announced in a televised address that his administration was placing federal funding restrictions on some human embryonic stem cell research, which held potential for new treatments for a range of diseases. University administrators prohibited some labs from pursuing some research projects because the building that housed the labs had been constructed with federal money.

State governments and private foundations filled the void. California spent billions of dollars to fund stem cell research in its state. New York State spent hundreds of millions and built laboratories to provide a "safe haven" from federal restrictions.

Klitzman predicted a similar path would be considered to keep treatments to transgender adolescents beyond the scope of the executive order. "No hospital wants to lose the vast majority of their funding," he said.