Kaiser Permanente just announced that as of August 29th they will stop offering gender-affirming surgeries for patients under the age of nineteen, following a similar pause by Stanford Medicine announced last month. The Trump administration has threatened to withhold federal funding to institutions that provide gender-affirming care of any kind, and a few weeks ago the DOJ announced they have issued subpoenas to at least twenty providers to investigate “healthcare fraud, false statements, and more.” Both Kaiser and Stanford are continuing other kinds of gender-affirming care, including hormone therapy.
The vast majority of gender-affirming surgery for minors are mastectomies (breast reduction) performed on cisgender males (i.e. removal of “man boobs”), which are not being paused or targeted by the Trump administration. Gender-affirming surgery for transgender youth is much more rare (probably fewer than 100 cases per year in all of Kaiser NorCal), with the vast majority being that exact same breast-reduction surgery. These will generally be the most extreme cases of gender dysphoria, where other forms of gender-affirming care aren’t enough and the risks and permanence of surgery are outweighed by the risks of self-harm or suicide. As an example, see this case study of a 16-year-old trans male patient who was admitted to the emergency room after an attempt to remove his own breasts.
So what are Kaiser and Stanford thinking? Stopping surgeries while continuing to provide other forms of gender-affirming care is unlikely to placate the Trump administration, which has vowed to end all forms of care. And Trump has repeatedly shown that he treats any capitulation as weakness and a reason to push even harder.
Both providers presumably know all this, so even if they think pausing surgeries will disrupt the least number of patients, why bother if it does no good? Do surgeries come with more legal jeopardy than hormone treatment or other forms of care, even though the administration suggests all forms of gender-affirming care are fraud? Or is this just the first step to giving up on all trans kids in their network?