Federal efforts to end gender-affirming care for transgender youth have pushed remaining Pittsburgh-area providers to fly under the radar, and are driving families to look for out-of-state options.
In June, UPMC ended gender-affirming care for trans people under 19. The decision complied with a January executive order that threatened federal funds for organizations offering minors gender-affirming care including puberty blockers, hormone replacement therapy and related surgery, claiming the practices were “chemical and surgical mutilation.”
Dena Stanley, executive director of nonprofit TransYOUniting, said UPMC’s decision caused a “domino effect” among other health care agencies in the region. She said no health system receiving federal funding in the county is offering gender-affirming care to trans youth and she is not, at this time, aware of any private practitioners that are.
TransYOUniting, which has organized protests against UPMC’s decision and provides resources for trans individuals and families, is referring people out of state for care.
The organization has a mutual aid fund on its website to offset travel and medical costs. Stanley said applications for it will open Oct. 1. The fund however, is not a long-term sustainable option as it is not garnering enough money, Stanley said.
Activists were guarded about where and how to get care. The recurring message for trans youth: Seek help from community groups such as TransYOUniting and ACT UP.
“It’s so word-of-mouth at this point,” said Olivia Mincone, a staff nurse at UPMC’s Services for Teens at Risk [STAR] Center who spoke out against her employer’s decision at a “Die In + Funeral to Protect Trans Youth” sponsored by ActUp and TransYOUniting on Sept. 8.
Mincone, along with nearly 460 other UPMC staffers, signed an open letter condemning UPMC’s compliance with the executive order.
UPMC said in a statement to Pittsburgh’s Public Source that it continues to provide “behavioral health support and other necessary care within the bounds of the law while seeking to protect the confidentiality of the physician/patient relationship.”
Allegheny Health Network, the region’s second-largest medical system, wrote to Public Source that it has “traditionally provided very minimal such care for patients under 19, given our relatively small pediatrics specialty-care footprint in the region.”
Discharged by two providers
A South Hills parent who requested anonymity over safety concerns is exploring care options including Planned Parenthood in Virginia for her 17-year-old’s gender-affirming treatment. The single mother and full-time worker said that would likely mean traveling every three months for puberty-blocker shots. It could also mean switching from a weekly estrogen patch to pills because they’ll need a three-month prescription.
When the parent got the call from UPMC informing her that her child would be losing care and that they would need to come in for a final visit, she didn’t tell her child until she had a backup plan: an appointment scheduled at Metro Community Health Center in Swissvale, which does not receive federal funding.
Her child received care in June from Metro. In late August, a nurse practitioner called the week of their appointment and told her that the health center no longer offered gender-affirming care for people under 19 effective immediately, she said.
Metro Health wrote in a statement to Public Source that for 25 years it has served Pittsburghers “no matter their background, income or ability to pay.”
“Metro Health has and will continue to provide gender-affirming care for individuals over 19,” the statement read.
Care targeted, but not illegal
While it’s become a Trump administration target, gender-affirming care for trans youth is still legal in Pennsylvania, said Jason Landau Goodman, board chair of the Pennsylvania Youth Congress.
“We know of providers, but … we are very careful to make sure that those providers are protected. And so we can really just say at this time that there are providers in Pennsylvania,” Goodman said.
Many families, though, are leaving Pennsylvania for places including Chicago, Boston and Maryland that are more “outwardly protective of gender-affirming care for those who are under 19 years old,” Landau Goodman said.
The executive order spurred a lawsuit from 17 Democratic officials, including Gov. Josh Shapiro, which contends the Trump administration is unlawfully intimidating health care providers into cutting gender-affirming care.
“No federal law prohibits, much less criminalizes, the provision or receipt of gender-affirming care for transgender adolescents,” the lawsuit states.
Subpoenas stoke fears
The South Hills parent and others said they are concerned about Department of Justice subpoenas for patient information sent by UPMC and 20 other doctors and clinics.
According to a 90.5 WESA article, UPMC’s legal officer outlined records to be preserved including: patient records and identities, diagnoses, informed consent documents and parent or guardian authorization, disclosure of risks, adverse events and side effects as well as disclosures about off-label use of medications.
UPMC has also instructed staff to preserve billing records, coding practices and insurance claims, according to WESA.
The parent said she has looked into online providers, but is hesitant to put any information online because she doesn’t want it to be subject to any future federal action.
“They’re already serving subpoenas to hospitals … they potentially know where we live,” she said. “I’m terrified.”
According to the Philadelphia Inquirer, the Children’s Hospital of Philadelphia is fighting to lessen the scope of the records subpoena — a choice that protesters on Sept 8. hoped UPMC would mirror.
Chaco Iwase, 22, who is on the trans justice sub-committee at ACT UP, said he treated with UPMC but is now exploring other options because he doesn’t want UPMC to have access to his medical records.
‘It is grief that walks with us’
Protesters clad in mourning black marched in a funeral-inspired procession from Mellon Square Park to the steps of the U.S. Steel Tower last week. They laid down for 375 seconds, marked by drumbeats, to grieve for 375 trans youth who lost care following UPMC’s decision — cardboard gravestones propped up on their bodies.
The die-in was meant to show the sweeping health and mental health detriments of UPMC’s compliance with the Trump order, according to organizers.
Katherine Anderson, a behavioral health therapist at the STAR Center, said during a speech that UPMC’s changes in care led some “to expect a large influx of suicidal, dysphoric, depressed teenagers, even with the possibility of experiencing psychosis induced by this decision.”
Andy and Melissa, parents from the North Hills who requested anonymity for the safety of their child, said they are worried about increased suicide rates among trans youth.
“I don’t know that our kid would still be alive today,” without receiving care as a teen, Melissa said.
Kaiah Scott, now 21, has received gender-affirming care since she was 16. It’s how trans kids stay secure in their identity, she said in a speech to the crowd.
“This is about us as young people being told that we do not deserve to grow up whole. It is about us being told that we cannot have the health care we need to survive, to breathe, to live as who we are,” Scott said.
“It was not just a policy change, it was a message. It was them saying our lives are not worth protecting.”
Ember Duke is an editorial intern at Pittsburgh’s Public Source. She can be reached at ember@publicsource.org.
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