Recently, I prescribed estrogen to a young woman with primary ovarian insufficiency — a condition in which her body doesn’t make enough estrogen naturally. This hormone replacement is standard care, medically necessary, and entirely uncontroversial.

Yet if I were to prescribe the identical medication to a transgender girl experiencing gender dysphoria, I could face felony charges in six states. The medication is the same. The careful medical evaluation is the same. But one is celebrated while the other is criminalized — with devastating consequences for the children whose futures hang in the balance. 

As a pediatrician, I never imagined having lawmakers decide which children’s suffering deserves treatment.

I have watched with alarm as policies restricting gender-affirming care have spread rapidly across the country. Since 2021, 27 states have enacted bans on gender-affirming hormones, surgery, or both for minors, despite decades of evidence demonstrating this care’s safety and efficacy. In January, the Trump administration escalated the attack by issuing an executive order threatening to cut federal funding to institutions providing gender-affirming care. What began as a patchwork of state restrictions became a federal campaign dismantling a vital part of adolescent health care.

Then, last week, the Supreme Court made the crisis even more dire. In a 6-3 decision in U.S. v. Skrmetti, the court upheld Tennessee’s ban on gender-affirming care for minors, ruling that it does not constitute sex-based discrimination. The court’s decision gives federal cover to what was once a patchwork of harmful state laws and sets a devastating precedent for the future.


Supreme Court ruling on gender-affirming care delivers major setback for transgender rights

Although several federal judges issued preliminary injunctions blocking enforcement of the executive order, the damage has been profound. Multiple children’s hospitals initially halted gender-affirming care for trans adolescents following the order, and others have closed their gender programs entirely under increasing pressure from the administration. Families have been devastated, forced to interrupt vital medical treatment while litigation proceeds. The present and future of gender-affirming care for youth remains deeply uncertain. 

Fewer than 1 in 1,000 adolescents receive gender-affirming care. So why has the health care of some of our most vulnerable youth become the target of a relentless national crusade?

The irony is stark: What the executive order deems “junk science” and “experimental” medicine is, in fact, long-standing, evidence-based practice. We routinely prescribe hormones to adolescents for a variety of medical reasons. As an adolescent medicine doctor, I’ve prescribed hormonal medication to suppress menstruation in teens with developmental delays to improve their quality of life, and to girls whose periods are so painful they can’t attend school. I’ve followed patients who were on puberty blockers as children because of precocious puberty. I’ve referred 15- and 16-year-olds to breast surgeons for breast reductions because of extreme physical discomfort. I’ve provided hormone therapy to young women whose ovaries fail to produce estrogen — without hesitation, and without controversy.

But the moment I provide the same evidence-based treatments to transgender youth, the executive order labels it as “chemical mutilation.”

No politician threatens to defund hospitals that provide care for teens with developmental delays or children who are starting puberty too early. The medical evaluation is just as rigorous. The medications are identical. The benefits and risks are carefully weighed in every case. Yet only the patient’s identity determines whether I am practicing medicine or committing a crime.

In the majority opinion in Skrmetti, Chief Justice John Roberts wrote that the Tennessee ban does not discriminate on the basis of gender because it simply “removes one set of diagnoses — gender dysphoria, gender identity disorder, and gender incongruence — from the range of treatable conditions.” He went on to say that the law separates minors into two groups: those seeking treatment for these diagnoses, and those seeking treatment for other conditions. It’s a neat trick to side-step the discrimination claim, but it doesn’t make sense.

What does it mean to strip an entire set of medical conditions of legitimacy, denying it the same treatment we offer other conditions? That a young person can get hormone therapy or a breast reduction to improve quality of life, but deny the same treatment the second the diagnosis of gender identity disorder is established even if it would also improve quality of life?

This legal decision does not create neutrality but instead enforces a chilling double standard — stripping the decision to pursue treatment away from the youth, their families, and their health care providers.

To declare that a person’s right to care can be revoked because of political opinion is to disregard the lived experiences of young people in pain, their families’ rights to make this decision, and the expert consensus of multiple medical societies that are on the frontlines of this care. The American Academy of Pediatrics, the Pediatric Endocrine Society, and the Society of Adolescent Health and Medicine have all provided evidence-based recommendations supporting this care. The conclusion of the very professional societies we trust to guide care for asthma, diabetes, and is unambiguous: Gender-affirming care is effective, safe, and medically necessary. 

Q&A: How institutions have responded to the gender-affirming care executive order, one week later

The stakes are life and death. According to a 2024 report from the Trevor Project, nearly half of transgender and nonbinary youth have seriously considered suicide in the past year — more than twice the rate a 2023 CDC study found among their peers. And research is clear: Gender-affirming care saves lives. Extensive studies have shown youth who received gender-affirming care had improved psychological functioning and long-term higher rates of life satisfaction. Gender-affirming medical care was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality. And timing matters: Accessing care during adolescence is especially critical, lowering suicide risk compared with starting treatment in adulthood.

We now live in a country that is forcing physicians to choose which youth deserve lifesaving care. Policies that prohibit gender-affirming care to youth turn what should be a private decision between a young person, their family, and their doctor into a persecution, perhaps even a prosecution. In Idaho, a physician can face up to 10 years in prison by prescribing gender-affirming hormone therapy. But these government officials are not in the clinic room when young people say how much better they feel because of gender-affirming care. And they are not the ones who have to help pick up the pieces when these policies threaten the mental and physical health of these youth. 

I became a pediatrician because I wanted kids to grow into the healthiest adults possible. Now, what I want more is for all children to simply be able to exist. For many of the trans patients I see, that requires helping them to live as authentically as possible, with dignity every human deserves. Today. Tomorrow. Next year.

When policies force physicians to provide identical medications and identical care protocols only to children the government deems politically acceptable, they don’t just interfere with medical practice. They create a fundamentally unjust health care system and deny vulnerable youth their right to live and to thrive. This isn’t about protecting children — it’s about erasing them. As a physician and a human being, I cannot accept this as the standard of care.

Candice Mazon, M.D., M.P.H., is a pediatrician and adolescent medicine specialist in Boston.