Inside the Battle Over Trans Care at Rady Children’s Hospital

Rady Children’s Hospital San Diego is facing the prospect of “an organizational death sentence” as it fends off dueling threats from Washington and Sacramento over transgender care for kids.

On Jan. 20, the hospital announced that it would close its Center for Gender-Affirming Care to appease the Trump administration, which seeks to financially cripple any institution that provides trans care to children. But Rady, which earlier tried to hide its transgender program in an apparent bid to avoid White House scrutiny, isn’t out of the woods.

Last week, California’s attorney general filed a lawsuit against Rady alleging that its move violates a legal agreement with the state. An emergency court hearing is scheduled for Thursday.

If Rady is forced to restart the program, it could lose federal funding and be forced to close.

At stake is more than the fate of 1,000 transgender patients who have lost gender-transition therapy at Rady. The hospital, which treats more than a quarter-million patients annually and spends nearly $2 billion a year, could go under if it’s on the losing end of a fight with Trump.

Here are five things to know about the battle over trans care for local children:

Rady’s Decision Decimates Trans Care for SoCal Kids

Rady’s Center for Gender-Affirming Care was widely known before it went underground last year. Local media gave it positive coverage, and clinicians contributed to multiple medical studies about treating transgender kids with hormone therapy, puberty blockers, and surgery.

But as Voice of San Diego exclusively reported, the hospital last year tried to hide the program from the public as other children’s hospitals eliminated trans care under Trump administration pressure. Some trans advocates feared that news coverage would endanger the center, which had already been highlighted by a prominent anti-trans organization, while others rapped Rady for hiding the program and urged it to fight back in court.

Rady chose to fold. Hospital officials announced in late January that the trans care program will be shuttered due to “escalating federal actions” and a federal investigation launched by a tip to the U.S. Department of Health & Human Services.

The decision, which also applies to Rady’s sister hospital in Orange County, means that no children’s hospital in Southern California is providing trans care. Los Angeles Children’s Hospital, the other provider, shut down services last summer amid a “shifting policy landscape.”

Rady has not responded to requests for comment.

Kathie Moehlig, executive director of the San Diego-based TransFamily Support Services advocacy organization, said Rady was treating about 1,000 patients in San Diego and about 200 in Orange County. LA Children’s Hospital treated about 3,000, she said.

It’s “devastating” that patients are losing care, she said, but that’s not all. “We’re also losing the expertise and skill sets of providers. It’s hard for doctors to give up institutional jobs with all the benefits and protections that come with them.” (Several of the providers of trans care at Rady were affiliated with UC San Diego.)

Trans patients who were treated via the hospitals will now need to find private providers, Moehlig said, but many of them are laying low because “the government is tracking them.”

Indeed, last year, the federal government tried and failed to force a telemedicine clinic to cough up confidential medical records of its trans patients. It also demanded confidential records of trans patients treated at LA Children’s Hospital but later modified its request.

State Attorney General’s Legal Strategy Has Evolved

One year ago, state Attorney General Rob Bonta sent a stark warning to medical providers and LA Children’s Hospital in particular: Don’t mess around with trans care.

“Hospitals and clinics have a legal obligation to provide equal access to healthcare services,” he said in a press release that highlighted anti-discrimination law and noted the state’s lawsuit against the federal government over its trans care crackdown.

LA Children’s Hospital ignored the threat and shut down its program. In September, I asked the attorney general’s office why it wasn’t suing that hospital in line with its earlier statement. It didn’t respond.

Now, California is suing Rady over trans care — but not on anti-discrimination grounds. The lawsuit, filed last week in San Diego Superior Court, says Rady violated the terms of its merger agreement with the Orange County children’s hospital.

“The state does have a strong case,” said Dov Fox, law professor and director of the Center for Health Law Policy & Bioethics at the University of San Diego. According to him, Rady specifically agreed to continue providing gender-transition care in the merger agreement.

“This is a straightforward breach of contract claim with specific, written terms,” Fox said. “The hospital explicitly agreed to maintain these services through 2034. There was no ambiguity and no notice given either. Rady did not notify the attorney general as required under the conditions, and the attorney general did not approve Rady’s decision.”

Why did the state ditch the anti-discrimination argument? Fox said making that case would be more difficult in light of the federal government’s power over states. In contrast, “federal authorities can’t claim to override a private contract” like the one between Rady and the state.

Rady Faces Dire Financial Prospects If It Loses Case

The Trump administration, which believes there are only two genders, has launched what law professor Fox calls “a coordinated, multi-agency attack on gender-affirming care.”

The White House has proposed to cut off all federal Medicaid and Medicare funding to hospitals that provide trans care to kids, including medication and surgery. (Medicaid is the insurance program for low-income individuals and families. Medicare is mainly for older adults but also covers some kids.)

“Sex-rejecting procedures on children — which include puberty blockers, cross-sex hormones, and surgical operations — expose them to irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other irreversible physiological effects,” the Department of Health & Human Services declared in December.

If Rady restores its trans clinic, it will face the risk of losing hundreds of millions of dollars in federal funding, law professor Fox said, the equivalent of an “organizational death sentence.” And he said it could also face Department of Justice subpoenas and even criminal prosecution.

“Rady gambled that complying with federal threats was safer than honoring their state contract,” he said. “Now they’re defending on both fronts, exactly the nightmare scenario they were trying to avoid.”

Controversy Over Teen Trans Care Heats Up

For years, major associations of physicians have lined up in favor of gender-transition care for kids. But this week, the American Society of Plastic Surgeons advised against gender-transition surgeries for patients under 19, drawing praise from the Trump administration.

The American Medical Association, the leading physician organization, told The Washington Post that there’s “insufficient evidence” to support surgery.

Advocates of transgender care say that major surgeries — such as breast removal in teens transitioning from female to male — are rare. One study estimated that 3,678 gender-transition surgeries, mainly breast/chest procedures, were performed in U.S. kids aged 12-18 between 2016 and 2020.

Trans advocate Moehlig’s child was the first patient to be treated at Rady’s trans clinic. Sam Moehlig, who’s now a trans man in his 20s, underwent a double mastectomy at the age of 14 at an LA surgical center. At the time, Rady reportedly didn’t recommend surgery for trans patients under 16.

On another front, in a “legal first that could change gender medicine,” as a Free Press headline put it, a New York awarded a $2 million malpractice award to a woman who underwent a double mastectomy as a transgender child but later “detransitioned.”

As The New York Times noted, “individuals who decide to detransition have often been cited by the Trump administration in its efforts to ban gender-affirming care for minors.”

Trump Is Targeting Trans Care for Adults Too

It’s not just care for trans kids that’s in jeopardy nationwide. “There is no question that the Trump administration wants to end gender-affirming care for all trans people,” said Dara Purvis, a law professor who studies trans law at Temple University in Philadelphia. “They want to legislate trans people out of public life entirely.”

On this front, the Trump administration has done more than make proposals and issue threats. The military paused gender-transition care last year, and the insurance program that serves federal employees eliminated it as of 2026. Meanwhile, Congress has tried to kill all Medicare and Medicaid funding for treatments such as hormone therapy.

Without ongoing treatment such as hormones, the bodies of transgender adults will partially revert to their sex prior to transition.

Last fall, I wrote an article about this process for a medical news site. Physicians told me that transgender men who go off testosterone therapy could start ovulating and experience breast growth even as they continue to grow beards and have deeper voices. 

“You can have a situation where somebody has a full beard and is perceived as a man, but they need to go into the men’s restroom and use a tampon. That’s complex,” one physician said.

Transgender women who lose their estrogen therapy would “go through menopause in 48 hours,” another physician said, although some breast growth wouldn’t go away.

One physician reported “a dramatic increase in patients I’ve seen who are experiencing suicidality or engaging in self-harm behaviors” — even if they’re not in current danger of losing care.

San Diego County reports estimate that nearly 1 percent of local residents identify as transgender or gender-non-conforming along with 2.3 percent of local teenagers.

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