California warns hospitals not to withhold trans youth healthcare

As Donald Trump seeks to block transgender youth healthcare across the country, California’s attorney general has sent a clear message to providers, reminding them of their duty to provide gender-affirming treatment under the state’s nondiscrimination laws.

“The law requires [hospitals] to continue to provide gender-affirming care to our transgender community,” Rob Bonta, a Democrat who heads the California justice department, told the Guardian on Wednesday. “We will have the transgender community’s back. We will fight for their rights, for their protections, for their freedoms.”

His comments come a week after Trump issued an executive order decreeing that medical institutions that receive federal funding and grants do not provide gender-affirming care, including hormone therapy and puberty blockers, to youth under age 19.

In response, some hospitals have paused treatments, which are considered part of the standards of care for gender dysphoria endorsed by all major US medical associations. Trans patients, their families and civil rights groups have said the interruption of care could have dire consequences for patients’ physical and mental health. They’ve also argued that Trump’s order is unlawful, violating patients’ constitutional rights and parental rights, and that hospitals have no legal obligation to preemptively deny care, particularly while the policy is being challenged in court.

More than half of US states have already passed laws in recent years restricting gender-affirming healthcare for youth, but Trump’s order has led institutions in progressive states, including New York and California, to cancel care.

On Tuesday, Children’s Hospital Los Angeles (CHLA), a major local provider, said it was pausing the initiation of hormone treatments for trans youth. The hospital told the LA Times it was not starting new patients’ gender-affirming care while it evaluated Trump’s order “to fully understand its implications”, but said treatment for existing patients would continue.

On Wednesday, Bonta wrote a letter to CHLA warning that “withholding services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria” would violate the state’s Unruh Civil Rights Act, a longstanding law that prohibits discrimination against LGBTQ+ people.

CHLA did not respond to requests for comment on Wednesday. An official told the Los Angeles Times it was continuing hormone therapy and puberty blockers for cisgender youth prescribed the treatments for other medical needs – a move Bonta said illustrates how the institution was discriminating against trans patients. Some cisgender youth with delayed puberty, for example, are prescribed hormones.

“The Unruh Act does not allow you to provide care to cisgender patients while withholding it from transgender patients,” Bonta said in the interview.

If providers such as CHLA continue to deny care, his office could take legal action, seeking a court injunction that compels institutions to comply with the state’s civil rights laws, he said, noting violations can lead to monetary penalties.

The state previously sued a gym that barred a trans woman from the women’s locker room under the Unruh Act, and in 2021, she won damages.

Withholding gender-affirming care could also violate nondiscrimination protections in the federal Affordable Care Act, he said.

Bonta’s letter further noted that he and 22 other attorneys general sued to block Trump’s order, and that a court ruling has temporarily blocked federal agencies from taking any action to withhold funding from institutions that provide gender-affirming care.

New York’s attorney general, Letitia James, also sent a warning to hospitals earlier this week that the law compels them to provide fender-affirming care.

Institutions and providers who offer gender-affirming treatment and abortion care have been facing immense pressure and scrutiny as Trump and Republican leaders across the country seek to erode their rights. Bonta said California would continue to defend doctors in the face of threats: “We will do everything in our power to use the full force of the law and the full authority of the office to make sure that both providers of gender-affirming care and patients are protected.”

Bonta spoke to the Guardian shortly after Trump announced an executive order seeking to ban trans female athletes from women’s sports and directing state attorneys general to identify enforcement best practices.

“I’m disappointed, but there’s no surprise. We’re ready,” Bonta said of the sports order. He said he would be assessing the impact on the state and what actions could be taken to challenge it, but added that revoking trans athletes’ rights at the federal level would not undo California nondiscrimination regulations: “State laws protecting trans athletes will remain.”

Trump’s efforts to erode trans youth care – part of a series of broad attacks on LGBTQ+ rights in his first weeks in office – have already had far-reaching consequences for families, advocates said. Trans youth and their parents, represented by the ACLU and Lambda Legal, filed a lawsuit on Tuesday challenging Trump’s order, outlining how the abrupt interruption of care had devastated youth who depend on the treatment.

Kristen Chapman, a plaintiff and mother of a 17-year-old trans girl, had moved to Virginia to help her daughter access care after Republican lawmakers in her home state of Tennessee outlawed youth gender-affirming treatment. After a long struggle to schedule an appointment, her daughter was due to be seen on 29 January. But hours before, the hospital canceled, due to Trump’s order signed the day prior, she said in a statement: “I thought Virginia would be a safe place for me and my daughter. Instead, I am heartbroken, tired, and scared.”

Bonta said defending trans youth remained a top priority. He said: “When you see children being harmed, being attacked by federal action, the stakes are high. This is targeting certain communities based on who they are and their ability to live their own authentic lives … This is about their rights and freedoms to seek healthcare based on who they are. These are fundamental protections. That’s why we’re acting urgently and aggressively.”