Guest Commentary written by

Pamuela Halliwell

Pamuela Halliwell is director of behavioral health services at the San Diego LGBT Community Center

In California, many of us want to believe transgender and nonbinary people will always have access to equitable and affirming health care, just like anyone else. 

What we are seeing across the state, however, tells a different story. Even in the most LGBTQ-affirming states in the nation, access to medically necessary care is fragile, and families are paying the price.

In January, Rady Children’s Hospital in San Diego and Children’s Hospital of Orange County announced they would halt gender‑affirming care for patients age 18 and under, citing threats from the Trump administration to cut off federal funding to any hospital serving transgender minors. 

Families quickly felt the consequences. One San Diego teen had gender‑affirming surgery canceled just weeks before the scheduled date; others saw long-planned appointments suddenly disappear.

Now California Attorney General Rob Bonta has sued both hospitals for closing their gender-affirming care services, and a San Diego judge has ordered them to continue to temporarily provide services through April 27, when a court hearing is scheduled. Youth and families remain unsure if essential care will be available to them in the future.

At The San Diego LGBT Community Center, I see the impact of these disruptions in real time, in the fear families carry, in the uncertainty young people are forced to sit with and in the harm that falls hardest on trans/nonbinary youth, youth of color and our Black and brown communities. If gender-affirming care is taken away, the consequences will be immediate, and the harm is life‑threatening. 

Transgender and nonbinary youth face significantly elevated risks of depression, anxiety and suicide attempts, the Trevor Project’s national survey shows. 

In its 2024 report, nearly half of transgender and nonbinary young people said they seriously considered suicide in the prior year. Access to gender‑affirming care — including puberty blockers, hormones, and supportive mental health services — has been shown in peer‑reviewed studies to dramatically reduce these risks.

Taking away access to care after families and providers have already made thoughtful, informed medical decisions is not just disruptive; it is cruel. It sends a devastating message to young people that their health, safety and futures are negotiable. Health care organizations are deferring to a political agenda over evidence-based medical care that saves lives.

The federal government’s threats have created a chilling effect across the country. Since 2025, more than 40 gender‑affirming clinics have restricted or paused youth care, because losing Medicare and Medicaid reimbursements would jeopardize their ability to operate. Even institutions in supportive states like California are making decisions driven by political fear.

At the LGBT Community Center, we are doing everything we can to respond. Our Project TRANS, Youth Services and Behavioral Health Services teams are offering crisis support, mental health services and resource connection for families who suddenly have nowhere else to turn. 

But community organizations cannot replace hospitals. We cannot perform surgery. We cannot prescribe hormones for minors. At a time when institutions are retreating, our community must show up louder, stronger and more united than ever.

State Assemblymember Chris Ward in February introduced Assembly Bill 1775 to support troops discharged under the Trump administration’s anti-trans military policies. We need more of these types of actions that call attention to the need to support our transgender community. 

Our state needs funding structures that cannot be dismantled by shifting federal politics, and a statewide network of gender‑affirming providers — so care does not hinge on the decisions of a few large hospitals.