Under Pressure, Rady Children’s Hospital Strikes Shaky Middle Ground on Trans Care

Rady Children’s Hospital San Diego’s gender-transition clinic is lying low as hospitals across the country kill their transgender medicine programs to avoid the Trump administration’s wrath.

Rady has deactivated the webpage of its high-profile Center for Gender-Affirming Care, and visitors now land on a page that says, “You seem to be lost.”

Hospital spokesperson Carlos Delgado declined to comment on the status of the clinic in a phone call with a reporter and added, “I don’t think I owe you an explanation.”

However, sources say gender-transition care remains still available at the hospital, which is striking a shaky middle ground as it navigates the cultural and political war over trans rights. At stake are the survival of the 71-year-old hospital and access of local trans children to puberty blockers, hormone therapy, and surgery.

On one side, the Trump administration’s threats to defund providers who offer trans medical care poses “an existential threat” to children’s hospitals, in the words of a law professor, and an anti-“woke” organization has named Rady as one of the worst providers of pediatric transgender care in the country.

Meanwhile, a trans advocate told me that Rady’s strategy represents “compromised care” because it hides services from children who need them. And if the hospital eliminates or shrinks its trans health program, it risks being sued by the state of California on grounds of violating anti-discrimination laws.

Rady Trans Clinic Once Had a Big Public Profile

It’s now hidden. But for years, Rady’s Center for Gender-Affirming Care was one of the hospital’s most prominent medical programs, drawing positive media attention and support from prominent politicians.

The program opened in 2012, and its first patient was Sam Moehlig of Rancho Bernado. He is the trans son of Kathie Moehlig, who’s now the executive director of the San Diego-based nonprofit group TransFamily Support Services.

“Back then, most people didn’t even know what the word transgender meant, much less that it affected young kids,” she said. “We had no doctors in San Diego who were willing to treat him.”

At an LA surgical center that’s separate from Rady, Sam Moehlig underwent the surgical removal of his breasts at age 14.

Since 2012, the Rady clinic has treated hundreds of children, providing services such as puberty blockers that pause sexual development and hormonal treatments that spur masculine or feminine traits. 

Delgado, the hospital’s spokesperson, refused to confirm whether the Center for Gender-Affirming Care still exists. “We don’t have a status,” he told Voice of San Diego. “We’re not sharing any information about that program right now.”

A person who answered the phone in early September at the center’s phone number said the clinic was still providing care, although it has a long waiting list. Moehlig also confirmed that the program is still alive.

Data Offers Limited Insight Into Size of Rady’s Program

Public data about the transgender therapy provided at Rady’s clinic is sparse.

In a 2021 study, Rady physicians reported on providing “gender-affirming” subcutaneous testosterone therapy to 119 transgender patients who began therapy from ages 13-19. The study, which looked back at the years 2012-2020, found that three stopped therapy “due to desire to end masculinizing therapy.”

As for surgical procedures in trans children, which can include the insertion of implants that provide hormones and the removal of breasts, Rady physicians interviewed for a 2015 KPBS article said they “do not recommend gender reassignment surgery until teens turn 18 or are heading to college.”

However, a 2016 Union-Tribune article about Sam Moehlig’s transition reported that the hospital “will not recommend surgery for anyone younger than 16.”

(Critics of trans care have focused on breast removal in children amid a fierce debate over how common these surgeries are.)

According to a database created by Do No Harm Medicine, which opposes gender-transition care for children, Rady provided therapy to 136 transgender children under 17.5 years old from 2019-2023. Total billing for the treatments was reported to be $926,506.

The data, which is based on insurance claims and excludes some data from the Kaiser Permanente system and the military, couldn’t be independently verified.

Five physicians who work with the Rady clinic and are affiliated with UC San Diego didn’t reply to requests from Voice to discuss their work and tell the story of the program. Another physician who was briefly the chief of Rady’s Adolescent Medicine Division and now works elsewhere also declined to comment. He co-wrote a 2022 report on strategies to bypass parental-consent requirements for pediatric trans procedures when parents and kids disagree about treatment.

Across the Nation, Children’s Hospitals Are Running Scared

Os A. Keyes, a researcher who studies the history of trans medicine at the University of Massachusetts Lowell, said hospitals that offer pediatric trans care are facing three types of pressure: “Federal threats to cut funding or launch investigations, public harassment including bomb threats, and institutional risk-aversion that makes them quick to fold.”

On the financial front, the Trump administration is using federal funding “as a hammer in a way that no presidential administration has before,” said Dara Purvis, a law professor who studies trans law at Temple University in Philadelphia. “It is an existential threat, a very effective one because it is so high stakes for the hospital.”

On his first day on the job last January, President Donald Trump declared that there are only two genders that cannot be changed. He signed an executive order that said the federal government will not “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another.”

The order, which has been paused by a federal judge, hints that the government may pull Medicaid funding from providers and hospitals who offer pediatric transgender care.

According to a tax filing, the nonprofit Rady Children’s Hospital made $1.74 billion in revenue in the 2023-2024 fiscal year and has $3.97 billion in assets.

It’s unclear how much of the hospital’s money come from the federal government. However, an reported half of all children in California are covered by Medi-Cal, as the federal Medicaid program is known here.

The Trump administration also subpoenaed personal information about transgender patients from a Philadelphia children’s hospital, demanded general information about gender-transition care from institutions, and reportedly launched criminal investigations into providers at three children’s hospitals.

In California, children’s hospitals are bending the knee:

• In July, Los Angeles Children’s Hospital killed its entire transgender medicine program, telling staffers that its existence was in jeopardy due to federal threats. The hospital, which reported that 65 percent of its revenue comes from federal sources, said it “has a responsibility to navigate this complex and uncertain regulatory environment in a way that allows us to remain open as much as possible for as many as possible.” Gabriel Kahn, a University of Southern California journalism professor with a trans child who was treated at the hospital, wrote a scathing LA Times commentary accusing the hospital of “caving to blackmail.” He added: “Who will it be next time? Disabled children? Children born outside the U.S.?”
• The children’s hospital affiliated with Stanford University in the Bay Area no longer performs transgender surgeries.
• Kaiser Permanente, a major provider of health care in San Diego and nationwide, announced it would no longer provide transgender surgeries to children under 19. 

Representatives for three other major providers of pediatric transgender care in California — UCSF Health Saint Francis Hospital, UCSF Medical Center at Mount Zion, and Children’s Hospital of Orange County – didn’t respond to multiple requests for information about the status of their programs.

The Orange County hospital is a sister institution to Rady and opened a transgender medicine program in 2017.  

Rady Faces Legal Jeopardy If It Buckles to Trump

The state of California could target Rady if it closes its program. State Attorney General Rob Bonta, who’s joined a federal lawsuit targeting Trump’s anti-transgender policies, threatened to haul Los Angeles Children’s Hospital into court if it eliminated its trans health program.

“Hospitals and clinics have a legal obligation to provide equal access to healthcare services,” wrote Bonta in a February 2025 statement. His office didn’t respond to requests for an update.

The threat means that a hospital that kills a transgender health program “could be subject to a court order saying that not providing this care violates the state constitution,” law professor Purvis said. “But if the hospital reopens its program in response to the order, then the federal government says, ‘Fine, we’re cutting off all your funds.’ Then the hospital might go out of business.”

Rady executives could choose to keep the gender clinic alive while betting that federal judges will protect trans medicine programs, Purvis said. “The problem is that lawsuits take forever. The bills are due. In the meantime, the federal government cuts off funding.”

If Rady did close due to financial collapse, it’s not clear where tens of thousands of local children with illnesses — including life-threatening diseases — would get care. The hospital says its system treated 269,196 patients in the 2023-2024 fiscal year, including 329 with newly diagnosed cancer. The hospital also said it performed 20,499 surgeries and had 101,272 emergency care visits.

Physicians Are Fiercely Debating Trans Care

Supporters of gender-transition care include a long list of mainstream medical groups such as the American Medical Association and American Academy of Pediatrics. Advocates argue that this kind of care is crucial for the well-being of trans children, whom are reported to be at high risk of considering suicide.

However, some left-leaning skeptics, such as the editorial page of The Washington Post, warn there’s been a rush to embrace pediatric trans therapies despite a lack of high-quality research.

Conservative critics of pediatric transgender medicine, including many who oppose the LGBTQ+ community on religious grounds, have gone further. They often use apocalyptic language to warn of the dangers of “gender ideology.”

Attorney General Bondi, for example, has attacked “the barbaric practice of surgically and chemically maiming and sterilizing children.”

Do No Harm Medicine put Rady on a “Dirty Dozen” list of the “worst-offending children’s hospitals promoting sex change treatments for minors.” The group believes that “there is not enough evidence to justify these interventions that have significant, irreversible consequences,” said Dr. Kurt Miceli, an assistant professor at Drexel University College of Medicine in Philadelphia and the group’s medical director.

Critics such as Miceli point to the United Kingdom, which has temporarily banned puberty blockers following a blockbuster report about pediatric transgender care that said “there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.”

However, the report author supports the use in puberty blockers in research studies and said “we’re certainly not saying that no one is going to benefit from these treatments.”

Miceli didn’t respond to questions whether his organization believes, as some conservatives do, that transgender people are mentally ill.

Rady Faces Criticism From Trans Advocates

On the pro-trans side, University of Massachusetts scholar Keyes said the Rady hospital’s current strategy is a case of “compromised care” – “trying to find a middle path between legal threats and actually providing treatment.”

The problem is that some kids who need treatment won’t be able to find it when programs are hidden, said Keyes, who is transgender. Providers “are going to be damned if they provide care, whether it’s very publicly or very privately, so they might as well have the courage of their convictions.”

Journalism professor Kahn, the author of the LA Times commentary, told Voice that providers of trans care need to be bold while they’re under fire: “If you don’t stand up to defend your values and morals when they’re under threat, then you don’t have them in the first place.”

If Rady’s Clinic Vanishes, Others Won’t Be Able to Pick the Slack

What happens if Rady follows the lead of its counterparts and closes its trans health clinic?

Providers of gender-transition care to children already have long waiting lists, and it will be much harder to find care as clinics close, Keyes said. “When one clinic shuts down, the next one’s waitlist doubles, meaning it may as well be closed too.”

Part of the problem is this kind of care often relies upon teams of clinicians such as endocrinologists and mental health professionals. “Solo practitioners rarely provide adolescent [trans] care,” Keyes said.

According to the Do No Harm database, Rady provided by far the most gender-transition care to minors from 2019-2023 compared to other local hospitals and clinics. None of them treated more than 24 patients.

Moehlig, the executive director of TransFamily Support Services, said getting transgender care as a child isn’t a simple process, making the reduction of services even more dire for those who need treatment.

“You don’t pick up a phone, call a doctor, get an appointment, then all of a sudden you’re starting care,” she said. “There’s a process that has to be gone through. There are standards of care that are established and used. Having even just one provider who stops providing this care would be devastating.”

The current atmosphere only adds to the stress facing trans kids, she said. “It is hard being an adolescent in our post-Covid world already, and then you add that the federal government doesn’t want you to have access to your essential health care, and they’re trying to strip all of your rights away. It is challenging. I’ve had dozens of families that have moved out of the country because of the level of fear and attack that they feel like they’re under.”

Moehlig’s son Sam, who’s now 24, spoke to 10News earlier this year about his experiences as a trans teenager. “Then, I didn’t see a point in living in a body that wasn’t mine. I used to pray every night and say, ‘God, let me wake up as a boy, or don’t let me wake up at all,’” he recalled.

His mom “told me there’s this term called transgender, and you can become a boy. I said, ‘Yes, Mom, all I ever wanted was to be your son.’”

Now, he said, “I can say I love myself with full pride, and I want that for the rest of the trans community.”

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