Trump administration probes lead to trans care cutbacks

• That's despite a judge temporarily halting President Trump's executive order that would strip federal funding from hospitals providing gender-affirming medical services to minors.

What they're saying: "Certainly there have been a lot of threats, which have translated into a lot of fear," said Kellan Baker, executive director of the Institute for Health Research and Policy at Whitman-Walker, the LGBTQ+ health center.

• "I think it's really important, now more than ever, that institutions in our lives, whether that is hospital systems or the states themselves or the courts, are standing up for transgender young people," he said. "What this administration is doing is serious overreach."

Driving the news: The Federal Trade Commission will hold a public workshop on Wednesday to "gauge the harms consumers may be experiencing" surrounding gender-affirming care for minors.

• Speakers at the hearing include prominent voices against youth gender-affirming care, including a Texas doctor accused of illegally obtaining information on patients and sharing it with a conservative activist. The Trump administration dropped the case in January.

It's the latest in a string of Trump administration actions that show the federal government isn't backing down from its goal to stop surgeries, hormone treatments and puberty blockers for youth with gender dysphoria and and tie the awarding of federal funding to recognizing only a person's sex assigned at birth.

• Attorney General Pam Bondi earlier this year directed prosecutors to investigate providers of gender-affirming surgical procedures, which she characterized as female genital mutilation.
• She also directed the Justice Department's civil division to investigate drug manufacturers and distributors for making false claims about on- or off-label use of puberty blockers and hormone therapies, as well as providers for billing Medicaid related for what she called "radical gender experimentation."
• The FBI last month requested tips from the public on hospitals and providers offering gender-affirming care for youth.
• The Centers for Medicare and Medicaid Services in May sent letters to nine hospitals seeking information about informed consent protocols for kids with gender dysphoria, adverse events related to procedures and financial data for all pediatric gender-affirming surgeries covered at least in part by a federal program.

The Trump administration has said its actions are necessary to protect minors from fraud and medical complications as a result of gender-related medical interventions, as well as regret from having undergone care.

• "President Trump has been clear: America will protect kids from life-altering and experimental procedures. CMS has warned hospitals and state Medicaid programs about these dangers — and is taking regulatory enforcement actions. It's time for children's hospitals to do the right thing," CMS administrator Mehmet Oz said in a statement to Axios.
• The White House referred queries to CMS.

Reality check: Gender-affirming care for kids with gender dysphoria is supported by major medical organizations including the American Medical Association.

• A broad medical evidence review published by the University of Utah in May at the request of the state's legislature found that gender-affirming hormone treatments are safe, and effective for promoting mental health.
• Drugs like puberty blockers are temporary and reversible and used for both trans and non-trans youth who experience early onset puberty. Surgeries for transgender children are rare, and most people who accessed transition-related care as adolescents are happy with that decision as adults, research shows.

Still, the federal actions taken together are creating significant risk for health care providers, even in states where families of transgender kids are moving to seek better access to care.

• While some providers that paused gender-affirming care for kids after January's executive order have since resumed services, other providers have decided they can't weather the prospect of prosecution or losing federal funds.

Case in point: Children's Hospital Los Angeles announced last month that it will close its Center for Transyouth Health and Development and gender-affirming care surgical program on July 22 because of the threat of losing federal funding.

• "This decision does not come lightly. ... However, it follows a lengthy and thorough assessment of the increasingly severe impacts of federal administrative actions and proposed policies that have taken place since that time," hospital leadership wrote in a letter to staff.
• If the hospital lost all access to federal funding, it would only be able to sustain operations for about 50 days, the letter says.

Stanford Medicine last month also paused gender-related surgical procedures for patients under 19 years old after considering federal government actions, the health system confirmed to Axios.

• Community Medical Center in Montana and UPMC in Pennsylvania also both recently stopped providing gender-affirming medical services to minors.
• "As we continue to monitor executive branch memos, directives, and other guidance from the federal government, these actions have made it abundantly clear that our clinicians can no longer provide certain types of gender-affirming care without risk of criminal prosecution," a UPMC spokesperson said in a statement to Axios.

Between the lines: Providers that stop caring for transgender youth may be in violation of California's anti-discrimination laws, said Shannon Minter, legal director of the National Center for LGBTQ Rights.

• CHLA did not respond to a request for comment on concerns that it would violate state anti-discrimination laws.

What we're watching: Whether the administration takes action against gender-affirming care providers based on any of its investigations as litigation over the executive order continues.

• "Everyone is on hyper-alert monitoring these escalating threats ... to see if they'll actually try to follow through and initiate some sort of civil or criminal prosecution," Minter said, adding, "I think their goal is to bully and intimidate people."