Nemours Children’s Hospital cuts back on gender-affirming care for new patients

Nemours Children’s Hospital will no longer provide gender-affirming care beyond behavioral health services to new patients, joining other hospitals in the Philadelphia region and nationally that have limited healthcare for transgender people under pressure from President Donald Trump’s administration.

Nemours’ Gender Wellness Clinic, launched in 2018, provided hormone therapy and puberty blockers as well as mental health support to transgender patients in Delaware. It is the only hospital in the state that provides gender-affirming care for children.

Now, its clinic will accept only new patients who need behavioral healthcare. Existing patients receiving hormones or puberty blockers at the clinic will be allowed to continue their treatment, the hospital said.

The move follows a flurry of Trump directives aimed at blocking access to gender-affirming care and halting research into LGBTQ health. In January, Trump issued an executive order that bars federal funding for gender-affirming care, including hormone therapy, puberty blockers, or surgeries, for transgender patients younger than 19.

This care is widely accepted in the medical community, as it helps patients’ bodies match their gender identity.

Nemours said it will continue providing high-quality care while abiding by local, state, and federal regulations.

“This change reflects evolving communications and actions from federal agencies directed at healthcare providers related to gender-affirming care,” Nemours spokesperson Shelley Meadowcroft said in a statement.

The Nemours move underscores the challenges facing the transgender rights movement under Trump, even in a state known for trailblazing support of the community. Delaware, one of the smallest states in the country, last year elected the first openly transgender member of Congress as its at-large U.S. House representative.

Delaware’s governor, Democrat Matt Meyer, has been an outspoken champion for the state’s LGBTQ community, and last month signed an executive order protecting doctors who provide gender-affirming care and patients who seek it, including those from out of state.

Now transgender rights advocates in Delaware — including a state representative whose children have relied on gender-affirming care at Nemours — are disappointed by Nemours’ move. But they acknowledge that Nemours is in a difficult situation.

They called on the state to expand care for transgender patients and find alternate funding sources to better withstand threats from the federal government.

The stakes are personal for state Rep. DeShanna Neal, a Democrat who represents a district outside Wilmington. Neal is the Delaware state legislature’s first nonbinary representative and has two children who are transgender. The oldest child, Trinity, was the first trans child treated at Nemours, they said.

“This will kind of deter the ability to get the care these kids need. And I don’t like that for Delaware,” Neal said.

Penn Medicine, UPMC, and Penn State Health have all cut back gender-affirming care for youth in recent months, citing similar fears of funding cuts.

Penn will no longer provide gender-affirming surgical procedures for youth under 19, such as those that change a patient’s facial features, breasts, or genitals. Medication and hormone therapy, which are more common treatments for transgender children, are still available at Penn.

The Philadelphia region’s most prominent provider of gender-affirming care for youth, the Children’s Hospital of Philadelphia, did not respond to a request for comment. CHOP’s website says it offers “medical care and mental health support” for trans patients.

While not legally binding, Trump’s executive order has had a chilling effect on health systems. It’s unclear how far funding restrictions could reach, or whether providers could lose federal funding for any services they offer if they continue to provide gender-affirming care.

In May, the U.S. Department of Health and Human Services sent a letter to state medical boards and healthcare providers urging them to comply with the department’s new guidance, which would restrict hormone therapy and surgery for trans youth. The Centers for Medicare and Medicaid Services sent notices to select hospitals looking for information about their gender-affirming care programs.

In Delaware, Meyer’s latest order attempts to protect providers from subpoenas from other states seeking information about gender-affirming care.

The state already requires private insurance companies to cover gender-affirming care and has other protections in place for LGBTQ residents.

But many hospitals, including Nemours, rely on funding from the federal government that states do not control.

» READ MORE: What Trump’s ban on federal support for gender-affirming care means for Philly transgender teens

Neal, the state representative whose child received care at Nemours, said they had spoken with Nemours representatives about the change.

They understand the political pressure the hospital is under, but are concerned about children who already have few options to receive gender-affirming care in Delaware.

“I think a lot of people understand [Nemours’ decision]. It doesn’t mean they’re happy about it, but they also understand this is the landscape we’re in,” Neal said. “It’s not Nemours doing it purposely.”

When their oldest daughter, Trinity, came out as transgender, Neal fought to get her care covered by Medicaid, which provides state- and federally funded health coverage for low-income families and people with disabilities. Now, one of Neal’s younger children, who identifies as nonbinary, is considering starting puberty blockers.

Neal called Nemours recently to ask whether their younger child, who’d had an appointment at the gender clinic years ago, could still receive the medication. They were told that their child would be considered a new patient at the hospital’s gender clinic and could only receive behavioral healthcare, Neal said.

No longer on Medicaid, Neal now has more options to get her younger child gender-affirming care. But seeking care out of state or at a private practice is expensive and time-consuming, they said.

A top priority of the governor’s recently formed LGBTQ+ Commission is to identify where Delawareans can receive gender-affirming care and work to expand that care throughout the state, said the group’s chair, Cora Castle, who is transgender.

The commission’s aims include finding funding for gender-affirming care that’s not dependent on the federal government.

“It’s unethical for Delawareans’ healthcare to be held hostage, effectively, by agents working outside the state,” Castle said.

Castle said that she didn’t want to “villainize” hospitals like Nemours that are making decisions based on actions from the federal government.

“This is just a tough situation, and we all have to work through it together,” she said.

Staff writer Sarah Gantz contributed to this article.