Gender-related medical interventions for minors are continuing in some U.S. clinics, reports show, even in the face of strong opposition from the Trump administration and bans on the procedures in about half of U.S. states.
Some of these treatments are occurring covertly, people on both sides of the controversy suggest. A few clinics, which initially said they would halt procedures, have resumed after an outcry from transgender advocates.
The changes reflect a rapidly evolving situation amid public debate and court battles over whether puberty-blocking drugs, hormones, and surgeries should be allowed for minors in the United States.
The Florida-based group is among several smaller physicians organizations that oppose medical and surgical interventions for gender-confused minors. Such dissenting voices are gaining more attention as political winds have shifted and detransitioners have publicly expressed regret over permanently altering their bodies.
Gender-altering drugs and surgeries fall under the umbrella of so-called gender affirming care. While countries around the world are increasingly reversing course and prohibiting these procedures, major medical societies in the United States overwhelmingly support prescribing the treatments for gender dysphoria, a psychiatric condition diagnosed when a patient describes a mismatch between biological sex and self-perceived gender.
Since 2021, 35 major clinics have shut down and 28 others have restricted their services, according to the Florida group’s charts.
Transgender advocates are fighting back with lawsuits seeking to overturn state laws and Trump’s order. At least 17 states face legal challenges, according to KFF, a nonpartisan research group. KFF was formerly known as the Kaiser Family Foundation; it was renamed to avoid confusion with Kaiser Permanente, a health care company that states on its website that it has no connection with KFF.
Both Sides Say Some Treatments Are Covert
In an X post on Aug. 6, the American College of Pediatricians said its latest report “reveals a major shift in pediatric gender clinics performing sex-trait interventions on children with gender dysphoria.”The group stated that its list of closed and open clinics is not all-encompassing, adding, “We have no way of knowing if procedures are still happening behind closed doors.”
Doctors who oppose medical interventions told The Epoch Times why it can be difficult or even impossible to accurately tally the status of clinics.
Proponents may obfuscate with vague language and falsified diagnostic or treatment codes. They also can secretly refer patients to privately funded providers, the doctors said.
Even advocates of “gender-affirming care” say treatments are flying under the radar as restrictions tighten.
In addition, dozens of smaller facilities may continue unfettered if they are not reliant on the federal funding that Trump’s order is withholding, according to two doctors who spoke to The Epoch Times.
Probes are underway at the Justice Department, the Federal Trade Commission, and the Centers for Medicare and Medicaid Services.
Even so, Dr. Eithan Haim predicts that it will take years of investigations to yield possible criminal indictments and to reveal what has really been happening behind the scenes.
Miceli called the “affirming” mode of treatment “dangerous and irreversible.”
But, without a federal ban to stop the procedures altogether, “loopholes may remain,” allowing the interventions to continue, he said.
Gender Treatment Data
Miceli’s group compiled the Stop the Harm database, which catalogs gender-alteration treatments performed on minors through U.S. health care facilities.
Based on health insurance claims and multiple other sources for the 2019 through 2023 period, Do No Harm found that almost 14,000 minors underwent gender-alteration treatments. Of that number, almost 6,000 had gender-alteration surgeries, and more than 8,500 received hormones and puberty blockers. Almost 63,000 transgender-related prescriptions were written for minors.
Miceli said those numbers shocked some physicians even though the database’s figures are admittedly “an undercount.”
Some data, including that from Kaiser Permanente, a large nonprofit health care company, was inaccessible.
Miceli also said, “If procedures were done under different codes—like ‘endocrine disorder, not otherwise specified’—we wouldn’t have picked that up in our database.”
What Clinics Say—and Don’t Say
Using the Stop the Harm national database, The Epoch Times found 27 gender clinics with more than 100 young patients apiece.Of those clinics, three were closed or had moved to mental health services only. Two more were likely closed, although online information was unclear; those clinics did not respond to requests for clarification.
The remaining 22 clinics appeared to be still offering medication-based services and/or surgeries on minors, based on information from their websites and other reports.
In all, The Epoch Times contacted 30 clinics.
One of the two hospitals that replied to The Epoch Times, Yale New Haven Health in Connecticut, had four documented patients listed on the Stop the Harm database. Yale New Haven Health said it was eliminating “the medication treatment component of the gender-affirming program for patients under age 19.”
The hospital said it would continue to offer mental health counseling as the medication treatment component of its program winds down.
The other hospital that responded, Children’s Hospital Los Angeles, shuttered its Center for Transyouth Health and Development on July 22.
That clinic had at least 265 young patients, according to Stop the Harm.
The hospital initially paused services after Trump’s executive order, but reinstated them under pressure from advocates, then followed with permanent closure months later.
In its response to The Epoch Times, the Los Angeles hospital said that “operational, legal, and financial risks” tied to “the shifting policy landscape at both the state and federal levels,” led to its closure decision.
The hospital said “care teams” would help patients “identify potential alternative providers.”
Other clinics also appear to have reversed course, based on some media reports, but The Epoch Times was unable to independently verify those reports.
Haim, the Texas whistleblower, told The Epoch Times that some children’s hospitals may be looking for less obvious ways to connect youths with medicalized gender treatments.
“They are providing a message externally that’s meant to assuage the Trump administration, in order to get the regulatory authorities off of their back,” he said, “but it is my suspicion that they’re doing the exact opposite behind closed doors.”
Private clinics affiliated with hospitals can be enlisted to provide the services, funded by “big donors” whose contributions are hard to track, Haim said.
In addition, the surgeon said he has been in contact with gender doctors who admitted using false diagnosis codes to fit conditions for which insurance companies or federal programs would pay.
The nation’s busiest youth gender clinics are tied to hospitals that get about half of their funding from Medicaid, Haim said; losing those funds would drive the hospitals out of business.
When announcing changes, gender clinics have tended to use the word, “pause,” he said.
Looking Ahead
Haim has become known nationally for his outspokenness on this topic, and has testified before Congress. He said his ethical obligation to report harm to patients compelled him to speak out.
Haim said he learned through his wife’s former job investigating false medical claims for the Justice Department that those cases usually take a long time to investigate.
“I think it’s going to be a slow roll of whistleblowers and undercover reporters who reveal these schemes,” he said, predicting that “the really major offenders” will be indicted in 2027 or 2028.
In the meantime, disputes over public policy and perceptions continue.
The group also argues that politicians have no business meddling in youths’ health care—especially because the nation’s largest medical organizations “all support access to evidence-based, developmentally appropriate gender-affirming care.”
Calls for Action
Miceli, the Do No Harm spokesman, called upon the medical community to give a fair hearing to dissenting voices.Only recently have major U.S. medical societies begun considering opposition to the “gender affirming” approach, he said. Miceli said he was pleased to see the American Psychiatric Association air alternative views at its annual meeting in Los Angeles in May—possibly a first, he said.
“Professional medical associations must seriously examine the evidence, recognize that it does not support these interventions in minors, and take decisive steps to protect children from these dangerous and irreversible procedures,” he told The Epoch Times.
“The medical establishment must make it unequivocally clear that chemical and surgical sex changes for minors do not constitute the standard of care,” Miceli said. “Such a stance would exert significant pressure on practitioners to honor their ethical and legal obligation to ‘do no harm.’”
