Under Pressure From Trump, UVA Ends Gender-Affirming Care for Patients Under 19
On Friday, January 31, UVA Health announced that they would no longer offer gender-affirming care for patients under nineteen years of age. An FAQ on the UVA Health Children’s website states that “UVA Health continues to offer screening, counseling, general medical, and behavioral and mental health care,” but they will no longer provide hormone therapy drugs or puberty blockers for transgender youth.
Along with the FAQ, UVA provided the following explanation: “Like many health systems across the country, the University of Virginia and UVA Health are working to analyze and interpret the federal order and related state guidance . . . to ensure we are always delivering care in accordance with the law and without potentially jeopardizing federal funding that is critical to UVA Health’s daily clinical and research operations.”
Photo Credit: UVA Hospital Source
UVA Health attributed the decision to a recent executive order from the Trump administration and related guidance from the Virginia Attorney General, Jason Miyares. The order also prompted VCU Medical Center in Richmond to suspend its provision of gender-affirming care for transgender youth.
President Trump’s order directs agencies to “take appropriate steps to ensure that institutions receiving Federal research or education grants end” their provision of gender-affirming care. Researchers seeking funding from the National Institutes of Health (NIH) are currently facing increased scrutiny for mentions of transgender, genderfluid, nonbinary, or other gender minorities. Mr. Trump also ordered agencies to take action to rescind or amend federal policies on gender-affirming care.
The Trump administration has issued other orders targeting transgender Americans in recent weeks, including one banning trans women from women’s sports and another barring people from updating their sex designation on their passports.
Two days after the Trump administration issued its executive order, Virginia Attorney General Jason Miyares sent a memo to UVA and VCU advising them to “end immediately” their provision of gender-affirming care. “Any institution that continues,” Miyares wrote, “unacceptably and unjustifiably endangers not only itself and the Commonwealth, but also the vulnerable children of this Commonwealth.”
Speaking at a panel hosted by the Virginia Law Review Online, UVA Law Professor Craig Konnoth, who specializes in health and civil rights, harshly criticized the University’s decision to comply with the order, saying that it was “not only groundless but illegal to do so.”
“There have been competing agency interpretations over the last few years as to whether federal law prohibits gender identity discrimination,” said Konnoth. “But the fact is, after Loper Bright, we don’t care what the agency says. We care what the courts say,” said Konnoth, referring to the Supreme Court’s overturning of Chevron, which required courts to defer to agencies’ interpretations of ambiguous laws.
Professor Konnoth noted that the Fourth Circuit has “said very clearly section 1557 of the Affordable Care Act and Title IX . . . by prohibiting discrimination based on sex also prohibit discrimination based on gender identity.” Professor Konnoth suggested that parents damaged by UVA Health’s refusal of gender-affirming care could thus sue under the ACA and Title IX.
Konnoth also pointed out that Virginia state law prohibits discrimination based on gender identity, referring to the Virginia Human Rights Act. “These institutions will also be in violation of those statutes.” Professor Konnoth also suggested that terminating gender-affirming care to patients mid-treatment may violate medical malpractice laws and laws prohibiting patient abandonment.
Despite capturing the attention of media and legal commentators, Trump’s executive order did not come as a total surprise. Last November, speaking at a panel on United States v. Skrmetti, a pending Supreme Court case on the constitutionality of Tennessee’s ban on gender-affirming care for minors, UVA Law Professor Wyatt Rolla ’13 predicted that the incoming Trump administration might attempt to restrict the availability of gender-affirming care. “We have a presidential administration coming in that has announced its intent to attempt to prohibit Medicaid funding” and other federal funds for gender-affirming care, said Rolla.
The impact of UVA and VCU’s suspension of gender-affirming care services may be felt especially strongly in the South. As Professor Rolla noted in November, Virginia is “the only state in the South to provide this care.”
As reported by WVIR, the decision by UVA Health prompted protestors to descend on the hospital just hours after the change was announced. In a joint statement, UVA Medical School organization Trans Outreach and qMD, a group of LGBTQ+ medical students, also criticized the decision, writing that “gender-affirming care for transgender and gender-diverse youth consists of measures that lead to marked improvement in youth’s mental health.”
A lawsuit, filed by the American Association of Physicians for Human Rights Inc., LGBTQ+ advocacy groups, and transgender youth against Trump and the Department of Health and Human Services, is already underway over the January 28 Executive Order banning gender-affirming medical care to those under nineteen years old. In their initial complaint, the plaintiffs assert that the order was an unconstitutional use of executive power, explaining Trump “does not have unilateral power to withhold federal funds that have been previously authorized by Congress and signed into law.” Additionally, plaintiffs are seeking relief for a violation of the Equal Protection Clause of the Fourteenth Amendment. The results of this lawsuit, along with others filed by the American Civil Liberties Union, will address pivotal questions not only for UVA Health but for transgender individuals nationwide about the state of gender-affirming care.
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