Seattle Children’s Hospital is declining to provide gender-affirming surgery for transgender patients under 19 again, according to a patient and sources familiar with hospital policy.

Last week, a doctor at the hospital told a 17-year-old trans teen that the hospital wouldn’t perform his masculinizing top surgery until he turned 19, according to him and his family. The hospital did not respond to The Stranger’s requests for comment.

Back in February, The Stranger broke the news that the hospital decided to halt gender-affirming surgeries. A 16-year-old boy, who we called Ethan to protect his privacy, had gotten a call from hospital staff on his way home from school, indefinitely postponing his surgery half a day before it was scheduled.

The call was a shock, but the reason was clear. President Donald Trump had just issued an executive order that banned all trans care for people under 19. Trump’s government considers all medical intervention, puberty blockers, hormone replacement therapy (HRT) and surgery, to be chemical and surgical mutilation. The order threatened the federal funding of any hospital or research institution that defied it. Across the country, hospitals folded almost instantly. (As we’re all learning, a lot of stuff, including hospitals, states and universities, need federal funding the way cars need oil).

A major research institution, Seattle Children’s was no exception. According to a court filing in support of Attorney General Nick Brown’s later lawsuit to block Trump’s order, millions of dollars and potentially hundreds of jobs were on the line. At the time, that filing was not public and the hospital wasn’t saying much, only cancelling gender-affirming procedures and removing mentions of surgery from its website.

A week after Brown announced his suit with the Attorneys General of Oregon and Minnesota, a federal judge blocked Trump’s order. From the courthouse steps, AG Brown encouraged hospitals to go back to work. Seattle Children’s said in a statement that Brown’s suit gave it the “clarity it needed at this time to deliver on our mission while ensuring we operate within all applicable laws.” It started rescheduling surgeries, including Ethan’s the week, said his mother Sarah, whose name we’ve also changed to protect her privacy..

Last month, Brown’s office also alleged the National Institutes of Health disobeyed the judge’s order by cancelling a grant for the hospital’s research into gender-affirming care.. The judge didn’t see the connection, noting the grants at Children’s that Trump had left untouched.

Grey’s family had more warning than Sarah and Ethan, but the news was no less frustrating for him and his family.

Grey, 17, whose name we’ve changed for his protection, said on a phone call with The Stranger and his mother that he’d been on the waitlist for top surgery. But when he had his consultation last week, the surgeon and his staff told Grey the hospital couldn’t operate before he turned 19.

The surgeon delivered the news matter-of-factly and didn’t explain why Grey had to wait, he says. The surgeon may not have betrayed his feelings, but one employee later had, grumbling that Trump was responsible.

Then he says one employee handed him a sheet of paper that warned him about “the rare but serious risk of regret” and warned of “permanent physical changes.” While every surgery carries the possibility of regret, the risk is far lower for gender-affirming surgery compared to other procedures. A review of 27 studies that involved 8,000 patients from Europe, Canada, and the US  found on average about 1 percent of teens and adults expressed regret.

The hospital did not respond to The Stranger’s questions about why it’s again drawing the line at surgery.

If it’s an attempt to shield funding, it’s a bad one. The hospital could stop these surgeries forever and its funding would still be at risk if it continued to prescribe hormones and puberty blockers, as was the case the last time the hospital halted surgeries. It still seems to be the case. Grey, who gets his testosterone from doctors at Children’s gender clinic, which operates separately from the gender affirming surgical program, says he hasn’t lost his prescription.

Surgery is by far the least common treatment for trans kids. Relatively few want or need surgery (and plenty are happy to call it a day with a new set of pronouns, a haircut, a name swap, and a shopping trip for new clothes—also called social transition). Those few who get it are usually trans boys and non-binary kids getting breast tissue removed, reducing their dysphoria and allowing them to stop binding their chests. Like an extremely tight sports bra, the compression hurts.   

Trump’s order does not consider surgery to be any better or worse than hormones. By the government’s definition, all trans care is mutilation and castration. It's about as measured as a stick of dynamite and surely designed to blow up the field as it exists today.

Doctors rarely operate on trans minors. A Reuters and Komodo Health Inc. analysis of insurance claims found that in the US, doctors performed 776 top surgeries on patients aged 13 to 17 between 2019 and 2021. Genital surgeries were even rarer, only 56 in the same time period (Seattle Children’s, like most US hospitals, doesn’t offer it to minors). Researchers at Harvard also found “little to no utilization” of surgery on minors–97 percent of breast-reduction surgeries on minors were on teens with gynecomastia, a hormonal condition that causes cis boys and men to grow breasts. 

Republicans have exploited the fear they’ve stoked about transgender kids for the last five years, steadily introducing thousands of  bills to ban or even criminalize their care, to keep them out of sports and to prevent them from being themselves at school. Speaking of school, during the campaign, Trump told voters that kids were going to class in the morning as one gender and coming home surgically altered that afternoon, a claim so plainly absurd it borders on confusing science with magic. But to an American who knows next to nothing about trans issues, it can sound at least plausible, even if it doesn’t really make much sense.

Study after study have found gender-affirming care improves the lives of children and adults. Claims that trans care has been “debunked” or is based on “low-quality evidence” are false. As are notions that gender-affirming care is less-regulated in the US, or that Europe has uniformly restricted such care. Gender-affirming care has a long history, but is regularly called “experimental.” Drugs used for gender transition are called dangerous when doctors regularly prescribe the very same medications to cisgender children for different medical reasons.

There is also no other known treatment for gender dysphoria and no evidence that waiting helps. There are those who say there’s no such thing as a trans kid, but they must be walking around with very dark sunglasses and cotton balls stuffed into their ears. These kids simply do exist. Still, the government crackdown continues. Last week, the Centers for Medicaid and Medicare Services, now led by famed charlatan Dr. Mehmet Oz, sent a letter telling State Medicaid agencies not to spend federal dollars on gender-affirming care for kids. Washington law protects access to gender-affirming care.

Sarah, mother of the boy in our first story, says top surgery has changed Ethan’s life for the better. After an uncomplicated recovery, he came out the other end less anxious and with a new freedom of dress. He used to pick clothes based on how well they could hide his chest, like baggy sweatshirts and unseasonably warm layers. He no longer has to worry about his chest outing him, a wonderful thing with summer weather on its way, she says.

It’s unclear why the hospital operated on her son but not on someone else’s. But Sarah couldn’t say the about face surprised her.

Grey is angry he has to wait.

Surgery isn’t intangible to him. Three years ago, doctors at Children’s fused Grey’s spine to correct his scoliosis. When he weighed his desire for top surgery against the reality of recovery, top surgery came out on top. Now he’s not sure what to do.