Atrium Health Halts Gender-affirming Care For Patients Under Age 19, Leaving Some Families Scrambling

By Rachel Crumpler

Since 2020, Josh Dumas’ 14-year-old transgender boy has received gender-affirming attraction — including puberty blockers and testosterone — from an Atrium Health expert successful Charlotte. 

Dumas said nan gender-affirming wellness attraction has made each nan quality for his youngest child’s gender dysphoria, a information successful which location is simply a conflict betwixt nan activity assigned astatine commencement and nan gender personification identifies with.

His boy started puberty blockers astir property 10 — soon aft he came downstairs 1 nighttime sobbing, distraught aft noticing nan first signs of bosom development. It was a distressing find for nan kid who had identified arsenic a boy since he was 5 years aged and lived arsenic one.

“My bosom conscionable collapsed for him,” Dumas said. “I mean, he’s a boy. He looks for illustration a boy. Everyone sees him arsenic a boy.”

The puberty blockers person acted arsenic a region connected puberty, stopping him from processing breasts aliases menstruating. Several years later, astatine property 13, his expert prescribed testosterone. 

“When he started testosterone, nan changes were beautiful speedy successful his shoulders and his arms. He started increasing hairsbreadth connected his look and armpits,” Dumas said. “He conscionable loves it. Body image for him is simply a large deal.”

Dumas said his boy hasn’t wavered from his identity. He besides said that nan gender-affirming attraction provided astatine Atrium has been life-saving, allowing his boy to blossom. 

But now Dumas’ boy won’t beryllium capable to person nan attraction astatine Atrium. 

That’s because Atrium Health, portion of nan multi-state Advocate Health system, changed its argumentation this period to extremity providing gender-affirming medications and surgeries to each patients nether property 19 — a regularisation exceeding North Carolina’s 2023 authorities law, which allows children who were already receiving specified attraction to proceed and anyone supra property 18 to commencement it. 

The news came arsenic a “gut punch” to families who are near to scramble to find caller providers — successful immoderate cases, leaving down patient-doctor relationships they person had for years.

The number of patients successful North Carolina affected by nan determination to further limit gender-affirming attraction is not clear. Atrium Health did not respond to NC Health News’ mobility astir really galore patients would suffer entree to care. However, an advocator pinch knowledge of nan impact, who requested anonymity, said astir 120 patients being seen astatine nan Atrium Health Levine Children’s Center for Gender Health successful Charlotte were affected by nan argumentation alteration and required transfers to different clinicians to proceed care. The halfway provides gender-affirming attraction to transgender and gender-expansive children, adolescents and young adults up to property 25.

Other Atrium providers not affiliated pinch nan halfway besides had patients younger than property 19 who were affected by nan move.

In an emailed statement sent to NC Health News, Advocate Health cited “the evolving regulatory environment” successful its determination to extremity gender-affirming attraction for patients nether 19, arsenic entree to specified attraction has progressively travel nether scrutiny from nan management of President Donald Trump.

“We admit that this is simply a profoundly analyzable issue, and this determination was made aft a multi-disciplinary squad spent galore hours cautiously considering nan options and outcomes,” a spokesperson for Advocate Health said successful nan statement. “This caller argumentation allows our hospitals, clinics and pharmacies to proceed caring for each patients’ wellness needs successful nan changing national environment.”

Advocates for transgender younker denounced nan determination arsenic preemptive compliance pinch an cruel argumentation and based on that Atrium Health is “turning their back” connected susceptible patients.

“It signals to trans kids that your wellness attraction doesn’t matter, your personality is not valid,” said Mollie Burkholder, interim executive head astatine PFLAG Charlotte, a nonprofit support statement that serves nan LGBTQ+ community. 

‘A run issue’  

This move by North Carolina’s largest wellness strategy is conscionable nan latest regularisation connected access to gender-affirming attraction successful nan state — aesculapian attraction that has grown progressively divisive successful caller years. Since 2023, specified attraction for transgender younker has been importantly constricted aft state lawmakers passed authorities banning gender-affirming care — including puberty blockers, hormones and surgeries — for group nether nan property of 18. The rule was enacted complete then-Gov. Roy Cooper’s veto and included a proviso allowing minors who began curen earlier Aug. 1, 2023, to proceed receiving their care.

North Carolina’s rule is portion of a broader activity of authorities crossed nan United States; 27 states person enacted bans connected gender-affirming attraction for minors. The restrictions person travel moreover though gender-affirming attraction for transgender adults and minors is considered medically basal and often lifesaving by major aesculapian organizations for illustration nan American Academy of Pediatrics, nan Endocrine Society and nan American Medical Association.

More than half of states successful nan United States person enacted laws limiting younker entree to gender-affirming care. The first authorities to walk specified a rule was Arkansas successful 2021. Credit: KFF

In summation to state-level restrictions, nan Trump management is focused connected ways nan national authorities tin discourage and forestall gender-affirming attraction for minors.

“This was a run rumor nan Trump management ran on,” said Lindsey Dawson, head of nan LGBTQ Health Policy program astatine KFF, a nonpartisan wellness argumentation and investigation organization. “It really made this an outsized issue.

“The stock of group who place arsenic transgender aliases nonbinary is very small, and past not each of those group activity gender-affirming aesculapian care, and truthful we’re really talking astir a very mini stock of nan organization who’s seeking these services, and erstwhile nan work is provided, it’s not happening overnight. It’s a long, careful, thoughtful decision.”

In North Carolina, an estimated 21,800 group ages 13-17 place arsenic transgender, according to a 2025 report by UCLA’s Williams Institute, which researches intersexual predisposition and gender personality rule and nationalist policy.

Federal pressure

A week aft Trump took office, he issued an executive bid titled “Protecting Children From Chemical and Surgical Mutilation” that makes it U.S. argumentation to “not fund, sponsor, promote, assist, aliases support nan alleged ‘transition’ of a kid from 1 activity to another.” The bid threatens to withhold national backing from aesculapian institutions that supply gender-affirming attraction to group nether property 19. It has been met pinch lawsuits, and location is presently an injunction prohibiting nan enforcement of nan executive order. 

In nan months since, nan federal authorities has taken further measures to reappraisal and limit gender-affirming attraction practices. 

Among nan actions, nan U.S. Department of Health and Human Services published a report successful May questioning nan benefits of specified care. In July, nan U.S. Department of Justice announced that it had subpoenaed much than 20 clinics and doctors “involved successful performing transgender aesculapian procedures connected children” and is encouraging whistleblowers to travel forward. That aforesaid month, nan Federal Trade Commission held an all-day workshop examining whether unfair aliases deceptive waste and acquisition practices are being utilized successful nan proviso of gender-affirming care. And nan Centers for Medicare and Medicaid Services has begun nan rulemaking process focused connected reimbursement policies related to gender-affirming care.

“The situation is 1 of hostility to providers offering this care, and 1 that understandably is creating an ambiance of fearfulness and uncertainty,” Dawson said.

As a result, a increasing number of hospitals crossed nan state — including successful bluish states wherever bans aren’t successful effect — person restricted aliases moreover unopen down gender-affirming attraction clinics. For example, successful July, Children’s Hospital Los Angeles, 1 of nan largest providers of gender-affirming attraction for minors successful nan country, closed its health session for transgender youth, citing unit from nan Trump administration. Hospitals successful different states, specified arsenic Connecticut, Pennsylvania, Virginia and Montana, person besides stopped offering gender-affirming attraction to group younger than 19. 

Dawson said these hospitals are preemptively pulling backmost attraction earlier there’s general rule aliases regulations requiring them to do so. This leaves gaps for minors who request gender-affirming care. 

Increased restrictions 

Atrium Health is nan first infirmary strategy successful North Carolina known to person changed its gender-affirming attraction policies to align pinch nan shifting regulatory stance of nan Trump administration.

During a 15-minute closed Microsoft Teams gathering connected July 31 that NC Health News obtained an audio signaling of, Advocate Health leaders announced to a group of physicians providing gender-affirming attraction that nan infirmary strategy would nary longer prescribe gender-affirming medications aliases execute gender transition-related surgeries for patients nether property 19. The move included minors who were grandfathered successful nether nan 2023 North Carolina law. The argumentation applies crossed each hospitals operated by Advocate Health successful six states, not conscionable those based successful North Carolina.

“We understand nan complexity of this, we understand nan emotion, nan existent interest astir it. We stock it, which is why location has been truthful overmuch clip and truthful galore group weighing successful connected this,” Scott Rissmiller, main objective serviceman astatine Advocate Health, said during nan meeting. “At nan extremity of nan day, ultimately, it is to protect our clinicians and our patients, and our statement arsenic we move forward.”

On nan call, Advocate Health leaders said nan argumentation alteration would return effect conscionable days later connected Aug. 4, citing nan “culmination” of national activity and its imaginable impacts arsenic nan reason. Doctors were told to notify each their affected patients nary later than Aug. 15. To easiness nan transition, clinicians person been permitted to prescribe a one-time, last 90-day proviso of medications to their patients and supply tapering recommendations. Tapering efficaciously ends hormonal support and, if patients do not find attraction elsewhere, they whitethorn statesman processing unwanted beingness traits associated pinch nan puberty of their activity assigned astatine birth.

An Atrium provider, who said pinch NC Health News and requested anonymity because they were not authorized to speak to nan media, said nan news was “really upsetting.” Informing affected patients nan week aft nan determination marked 1 of nan astir difficult weeks of their aesculapian career, nan supplier said. Many patients felt blindsided and collapsed down successful tears arsenic they learned really nan argumentation alteration would impact their care.

“The civilized wounded inflicted by this argumentation is unthinkable to nan providers who are delivering nan care,” nan Atrium supplier told NC Health News. The supplier said they proceed to judge successful nan benefits of gender-affirming attraction for immoderate younker pinch gender dysphoria. They noted they person seen patients look from slump aft opening treatment. 

Seeing that attraction get restricted beyond North Carolina’s ineligible limits, they said, is profoundly concerning.

Advocate Health acknowledged successful a connection that nan argumentation alteration is “difficult news” for affected patients and said it has established a 24/7 hotline to assistance them, pinch a attraction connected providing counseling support that whitethorn beryllium needed.

Turning its backmost connected patients

Holly Savoy, executive head astatine Charlotte Trans Health and a scientist serving transgender youth, expressed disappointment complete Atrium’s decision, arguing that nan infirmary strategy is operating retired of fear, alternatively than opinionated by nan grounds of gender-affirming care. 

“The standards of attraction and nan subject person not changed,” Savoy said. “Atrium is succumbing to national unit and retired of fear. We conscionable request to get backmost to attraction being betwixt a diligent and nan family and their provider, and get nan authorities retired of there.”

Savoy worries astir nan consequences of making gender-affirming attraction little accessible, arsenic she’s seen really transformative it tin be. For galore transgender youth, Savoy said entree to affirming attraction reduces rates of depression, worry and suicidality among a organization who look disproportionate intelligence wellness challenges. 

“I’ve seen truthful galore younker really beryllium astatine that brink of termination and by being affirmed and being accepted by their families and by friends and loved ones and getting entree to affirming attraction and providers, really move their lives astir and person successful lives,” Savoy said.

Reducing nan number of providers offering gender-affirming attraction to minors doesn’t alteration nan number of group successful request of care, Savoy said. She fears that Atrium’s move could group a precedent for different hospitals successful North Carolina.

That interest is shared by parents of transgender younker who aren’t Atrium patients. Dana, a genitor from Charlotte who requested NC Health News not usage her past sanction for privateness and information concerns, said her 14-year-old transgender kid is connected puberty blockers and that continued entree to gender-affirming attraction is vital.

“They were, and still are, deathly acrophobic of antheral puberty,” Dana said astir her child. “They do not want thing that’s going to hap to them physically, that’s going to person them fundamentally coming antheral successful immoderate way. That makes them very uncomfortable, makes them very distressed.

“If 1 statement and 1 wellness strategy tin say, ‘We’re not treating this group of group because of this thing,’ past truthful could Novant, truthful could independent providers, and past our child’s near retired successful nan cold,” Dana said.

So far, advocates opportunity they haven’t learned of argumentation changes astatine different North Carolina hospitals. 

Duke Health and Novant Health did not respond to questions from NC Health News astir nan position of care. A UNC Health spokesperson responded pinch a little statement, saying nan strategy follows North Carolina rule astir gender modulation procedures and is “aware of nan executive bid which is directed astatine national agencies and are continuing to show communications from those agencies.”

Scrambling to find caller providers

Charlotte family expert Rhett Brown, who is not affiliated pinch a infirmary system, is 1 expert who has taken connected respective patients who mislaid entree to gender-affirming attraction astatine Atrium. Brown, who has been providing gender-affirming attraction since 2010, said he plans to proceed offering that attraction wrong nan bounds of North Carolina law.

“We should beryllium present to supply support, guidance and acceptance and attraction for group successful a measurement that is evidence-based medicine, and that is besides legal,” Brown said. “So successful North Carolina, taking attraction of patients who are gender nonconforming aliases transgender betwixt nan ages of 18 and 19 is still ineligible successful North Carolina and ethical, and is champion believe to attraction for those patients. 

I’m not judge why physicians would measurement backmost from taking attraction of specified a susceptible population.”

Nonprofit organizations for illustration PFLAG Charlotte and Charlotte Trans Health said they received an influx of messages from families urgently seeking caller providers successful nan aftermath of Atrium’s decision. They person been moving to thief constituent group to providers still offering care. However, immoderate providers already person afloat caseloads.

Brown warned that disruptions successful attraction tin person superior intelligence wellness consequences.

“There’s a bully chance that if they person gender dysphoria-related depression, nan slump is going to travel backmost very strongly,” Brown said. “The large point is not emotion authentic anymore, emotion for illustration you’re being victimized for thing that you person nary power over, and emotion that you’re being targeted for reasons that person thing to do pinch optimizing your wellness care.”

Breaking point

Challenges to gender-affirming attraction travel alongside broader rollbacks of transgender authorities astatine nan authorities and national levels. Just past month, North Carolina authorities lawmakers overrode Gov.  Josh Stein’s veto to walk House Bill 805 — authorities that recognizes only 2 sexes successful authorities government rules and nationalist policies, mandates retaining original commencement certificates if a personification changes their gender and extends nan clip doctors tin beryllium sued for malpractice for treating minors for gender transition.

For Dumas, nan genitor of a transgender teen, nan past fewer years — and particularly nan past 8 months of nan Trump management — person felt for illustration a “relentless onslaught” against his son’s identity. 

“You’re connected pins and needles waiting for nan adjacent unspeakable point to hap and trying to fig retired really that affects your family and really it affects your situation,” Dumas said.

The Dumas family astatine nan White House successful 2024. Since taking office, President Trump and his management person focused connected ways nan national authorities tin discourage and forestall gender-affirming attraction for minors. Credit: Courtesy of Josh Dumas

For years, Dumas and his woman person discussed backup plans they hoped they’d ne'er need. But aft years of defense activity and speaking pinch lawmakers, Dumas said nan family has reached a breaking point. 

Dumas said they can’t unrecorded emotion for illustration each time they are “fighting for their family’s existence.”

North Carolina and nan United States nary longer consciousness for illustration a safe spot for their transgender son, he said. Atrium’s determination to propulsion backmost connected gender-affirming attraction was among nan last straws for him and his family. 

Dumas’ woman and transgender boy scheme to move to Canada successful October, while he and their older boy stay successful North Carolina for his elder twelvemonth of precocious school. 

“It’s conscionable clip to go,” he said.

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