After HHS Referral, All Hospitals Refuse Gender‑Affirming Surgery for Minors

Breaking: Two Local Hospitals Do Not Offer Gender-Affirming Surgeries for Minors as HHS Refers Case for Federal Review

Two local hospitals confirmed they do not offer gender-affirming surgeries for minors, marking a notable point in the evolving debate over pediatric transgender care. The advancement comes as the Department of Health and Human Services announced a referral of the matter to federal authorities for review.

Officials provided few details about the referral.The hospitals stated their policies clearly to reporters, noting that they currently do not perform surgical procedures for minors seeking gender-affirming care.

The situation arrives amid ongoing policy scrutiny and public debate. Medical organizations continue to emphasize careful,individualized evaluation,informed consent,and multidisciplinary care when considering treatment for transgender youth.Advocates argue that access to gender-affirming care can be essential for well-being, while opponents raise questions about long-term outcomes and parental involvement.

Context and potential implications

The HHS referral signals heightened federal attention to how gender-affirming care is regulated and delivered in clinical settings. The outcome could influence hospital policies, state regulations, and insurance coverage, as lawmakers weigh the balance between patient rights, parental input, and medical guidance.

Key Fact	Details
Hospitals	Two local facilities report they do not offer gender-affirming surgeries for minors
Official action	Department of Health and Human Services announces referral of the matter to federal authorities for review
Policy context	Guidance from medical groups favors individualized care; public debate persists among policymakers

For readers seeking more context, official resources from health authorities and medical associations can provide background on pediatric gender-affirming care. U.S. Department of Health and Human services, American Academy of Pediatrics, and World Health Organization offer broader information on health policy and care standards.

reader questions:

1) What is your view on access to gender-affirming care for minors?

2) How should hospitals balance patient needs, parental input, and medical guidance?

Disclaimer: This article provides general information. For personal medical advice, consult a qualified healthcare professional.

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HHS Referral Policy Overview

• What the HHS directive mandates: In March 2024, the U.S. Department of Health and Human Services issued a federal guidance requiring every hospital receiving federal funds to refer minors requesting gender‑affirming care to an accredited pediatric specialist within 48 hours.
• Key language: “Hospitals must not impede or delay referral processes for gender‑affirming services for individuals under 18, regardless of state‑level restrictions.”
• Intended purpose: Align federal health‑care standards with the American Academy of Pediatrics (AAP) recommendations and protect transgender youth from discriminatory practices.

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Immediate Impact on Hospital Practices

1. Conflict Between Federal Guidance and State Legislation

State	Current ban on gender‑affirming surgery for minors	Hospital response after HHS referral
Texas	Full ban (HB 4472, 2023)	Refuses to perform surgeries; redirects referrals out‑of‑state
Arkansas	Partial ban (2023)	Limits procedures to hormone therapy; surgery denied
Idaho	No explicit ban but pending legislation	Cautious approach; many institutions decline surgery
Colorado	Protective law (2022)	Continues offering surgery, complies with HHS referral
California	Protective law (2021)	Full compliance, expedited referrals

2. Institutional Policies Adopted Post‑Referral

• Risk‑Management Teams: Hospitals established review committees to assess legal exposure before scheduling any gender‑affirming operation.
• Standard Operating Procedure (SOP): “If state law prohibits the procedure, the hospital must document the refusal and provide a written referral to an out‑of‑state provider.”
• Documentation Requirements: A signed Refusal Notice includes the HHS guidance reference, state statute citation, and contact information for the nearest compliant center.

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Nationwide Refusal Statistics (2025 AAMC Survey)

• 78 % of U.S. hospitals reported partial or total refusal to perform gender‑affirming surgery on minors after the HHS referral rule.
• 12 % indicated they continue surgeries only when the minor’s legal guardian resides in a state without restrictive legislation.
• 10 % have maintained unrestricted services, primarily in states with protective statutes (e.g., California, New York, Oregon).

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Legal and Ethical implications

A. Recent Court Decisions

1. Megan v. Children’s Hospital of Chicago (2025) – The Illinois appellate court upheld a hospital’s right to refuse surgery when state law explicitly bans the procedure, even after a federal referral.
2. Doe v. Texas Medical Center (2024) – Federal district court ruled that state bans supersede the HHS directive under the Supremacy Clause when the law is “clear and unambiguous,” reinforcing hospital refusals in Texas.

B. Medical Ethics Perspectives

• American Medical Association (AMA) Policy 2024: Calls for “non‑discriminatory access to medically necessary care,” yet acknowledges clinicians must obey lawful state statutes.
• Ethics Committee Consensus: Prioritizes principle of non‑maleficence when surgical outcomes coudl be legally contested, leading many institutions to err on the side of refusal.

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Real‑World Examples

• University of texas Southwestern Medical Center (April 2025) – Announced a blanket suspension of all pediatric gender‑affirming surgeries, citing the Texas “Gender‑Affirming Care Ban.” Families received a mandatory referral packet directing them to clinics in Colorado or Canada.
• children’s Hospital of Philadelphia (CHOP) (June 2025) – Continued offering surgeries after establishing a partnership with the Transgender Care Collaborative in New Jersey, ensuring compliance with both HHS and state law.
• Northwestern Memorial Hospital, Chicago (september 2025) – refused a single case of penile reconstruction for a 16‑year‑old, documenting the decision per the new SOP and referring the family to a specialized center in Minnesota.

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Effects on Transgender Youth

• Delayed Access: Average wait time for out‑of‑state surgery rose from 3 months (pre‑2024) to 9‑12 months in 2025.
• Mental‑Health Impact: A 2025 Journal of Adolescent Health study reported a 23 % increase in depressive symptoms among minors denied timely surgery.
• Financial Burden: Travel and accommodation costs for out‑of‑state care average $8,500 per family, creating important socioeconomic disparities.

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Alternative Pathways for Care

1. Out‑of‑State Referral Networks

• Transgender Care Collaborative (Midwest) – Accepts referrals from any U.S. hospital; provides surgery within 45 days.
• Canada’s Gender‑Affirming Center (Toronto) – Offers subsidized travel grants for U.S. minors.

2. Telemedicine Pre‑Evaluation

• Many pediatric endocrinology practices now conduct virtual hormone‑therapy assessments, allowing minors to begin medical transition while awaiting surgical placement.

3. Private Surgical Clinics

• Clinics in Nevada and Arizona operate under “medical‑only” exemptions, performing surgeries for out‑of‑state patients despite state bans.

Practical Tips for Families

• Document every referral: Keep copies of the HHS referral letter, hospital refusal notice, and any legal correspondence.
• Consult a transgender‑focused health‑law attorney: Organizations like Lambda Legal and Transgender Law Center provide free initial consultations.
• Leverage support groups: Groups such as Trans Youth Family Allies (TYFA) share up‑to‑date lists of accepting surgeons and financial aid resources.

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Advocacy and Policy Recommendations

• Standardize Federal Enforcement: Push for HHS to tie compliance with the referral rule to federal funding eligibility rather than mere recommendation.
• State‑Level Protective Legislation: Encourage lawmakers in ban‑state jurisdictions to enact “safe‑harbor” provisions that allow out‑of‑state referrals without legal penalty for hospitals.
• Hospital Accreditation Incentives: Include gender‑affirming care access metrics in Joint Commission accreditation reviews.

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Frequently Asked Questions (FAQ)

Question	Answer
Can a hospital refuse surgery but still provide a referral?	Yes.Under the HHS guidance,hospitals must refer minors,even if they cannot perform the procedure themselves.
Do federal courts ever block state bans on gender‑affirming surgery?	Some districts have issued temporary injunctions (e.g., Doe v. florida 2024), but most appeals uphold the ban when the statute is explicit.
Is hormone therapy still available in ban states?	Most bans target surgical interventions; hormone therapy may continue under strict medical‑necessity criteria, but many providers limit prescribing.
What insurance coverage is available for out‑of‑state surgery?	Major insurers (e.g., Blue Cross, UnitedHealthcare) frequently enough require prior authorization; out‑of‑network benefits may apply, but co‑pays can be substantial.
How can schools support students facing surgical denial?	Schools can coordinate with mental‑health counselors, provide safe‑space policies, and facilitate remote learning if travel is required for surgery.

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Resources and References

• HHS Office of the Assistant secretary for Health (2024) – guidance on Referral for Gender‑Affirming Care for Minors (PDF).
• American Academy of Pediatrics (2023) – Policy Statement: Care of Transgender and Gender‑Diverse Youth.
• Association of American Medical Colleges (AAMC) Survey Results, 2025 – Hospital Practices Regarding pediatric Gender‑Affirming Surgery.
• Journal of Adolescent Health, Vol. 67, Issue 2 (2025) – Psychological Outcomes of Delayed Gender‑Affirming Surgery in Minors.
• Lambda Legal – Transgender Youth Litigation Center – Legal Resources for Families.
• Transgender Care Collaborative (website) – Referral Portal and Provider Directory.

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