Tacoma children’s hospital stops offering gender-affirming care to new patients

The MultiCare Mary Bridge Children’s Hospital in Tacoma, the only place youth can receive gender-affirming health care in Pierce County, has stopped accepting new patients, is no longer taking a wait list and is no longer filling new prescriptions for hormone-replacement therapy or puberty blockers starting Sept. 12, The News Tribune confirmed last month.

The move comes as Mary Bridge Children’s also removed many gender-affirming care resources from its website.

Several parents of Pierce County trans children told the News Tribune that Mary Bridge’s gender-affirming care services saved their children’s lives. A majority of studies show that gender-affirming care is safe and can significantly reduce suicidality in trans and nonbinary youth under 18, in some cases by over 70%, according to the Human Rights Campaign.

Gender-affirming care describes various forms of cosmetic or medical treatment transgender people seek to feel more at peace with their gender identity. It might include surgery, counseling, puberty blockers and/or hormone therapy that delay puberty or promote the development of masculine or feminine sex characteristics. Surgery is rarely provided to people under 18, according to the Association of American Medical Colleges.

The Mary Bridge Gender Care clinic has offered gender-affirming care services to youth in Pierce County since 2015. The clinic offers puberty blockers and hormone therapy and does not provide gender-affirming surgeries. All new patients must be evaluated by a multi-disciplinary team of experts in endocrinology, adolescent medicine, behavioral health and social work before receiving care, according to its website.

After keeping a waiting list for gender-affirming care for the last year, on Aug. 4 the hospital system told The News Tribune it began notifying families that “we will no longer maintain a wait list as we assess the changing federal expectations around our provision of medical interventions to minors as a treatment for gender dysphoria.”

MultiCare told the News Tribune on Aug. 28 that patients currently receiving prescriptions would continue to receive their medications. Beyond Sept. 12, the hospital system will not start new or existing patients on medication, communications manager Kalyn Kinomoto told the News Tribune Aug. 29. Patients who are currently receiving medications “will continue to receive maintenance medical care,” Kinomoto said in an email.

“Mary Bridge remains deeply committed to our gender-diverse patients,” the hospital system said in an email Aug. 4. “While the wait list for medical interventions is no longer available, we will continue to provide new patients with behavioral health care, which includes mental health assessments, counseling and support services.”

Mary Bridge Children’s declined to provide information about how many people have received gender-affirming care in Tacoma or how many people were on the waiting list.

The closest place to receive gender-affirming care now would be Seattle Children’s Hospital Gender Clinic, which did not respond to multiple requests for comment from The News Tribune. As reported by The Stranger in February, Seattle Children’s is no longer providing gender-affirming surgery to patients under the age of 19. The Gender Clinic at Seattle Children’s offers other gender-affirming medical care and mental health support, according to its website.

More than half of the 50 states have enacted policies limiting gender-affirming care access for youth as of February.

In January, President Donald Trump signed an executive order seeking to “prohibit or limit” access to gender-affirming care in the United States, calling it “chemical and surgical mutilation.” In April, Attorney General Pam Bondi threatened physicians with felony charges for providing certain types of gender-affirming care, and the Trump administration cancelled $477 million of medical research grant funding as well as “making plans to remove gender-affirming care as a covered benefit for the children of federal employees and exploring ways to increase access to detransition care,” as reported by the American Academy of Pediatrics News. In July the Trump administration subpoenaed confidential patient information from more than 20 doctors and hospitals that provide gender-affirming care treatments to minors, including the names, birth dates, Social Security numbers and addresses of patients who received that care.

The American Medical Association and the American Academy of Pediatrics (the largest professional association of pediatrics in the United States), have publicly opposed policies that prohibit gender-affirming care, claiming bills supported by the Trump administration undermine and ignore best clinical policies and research-based practices. About 0.8% of the U.S. population older than 13 identifies as transgender, according to a report published by the UCLA Williams Institute this month.

In a response to questions about whether MultiCare has received any requests for medical information from the federal government, Mary Bridge said in a statement Aug. 27 that, “MultiCare takes patient privacy seriously and abides by HIPAA regulations when releasing patient information.”

This year Mary Bridge Children’s removed from its Gender Care website local gender-affirming care resources, appointment expectations and information about the board-certified physicians on the gender health team, according to information saved on the Wayback Machine, an online internet archive. As of Aug. 26, information about “Gender Care” could be found only under the Diseases and Endocrinology services webpage, where patients can find a list of suicide hotlines.

In response to questions about those changes, MultiCare media relations manager Scott Thompson wrote via email Aug. 6, “Many of the changes we’ve made to our gender care program, including changes to our website, are to ensure that we protect our patients, their families and our staff in this uncertain time.”

‘We’re having to make decisions almost out of fear’

For a Lakewood family, Mary Bridge’s decision to limit gender-affirming care comes at a time when their transgender daughter, 13-year-old Hope, was thinking about starting puberty blockers.

Hope’s mother, Kara, declined to publish the family’s last name out of fear for their safety in the current political climate.

Kara said Mary Bridge staff told their family the week of Aug. 18 they would have to decide by Aug. 25 if Hope wanted to start hormone therapy. Despite visiting the Gender Clinic for more than five years, if they waited any longer, Hope would not be eligible for a hormone-blocker prescription after mid-September, Kara told The News Tribune.

Hope’s female friends are already starting puberty. Kara said the family planned to wait another year or two to make the decision but ultimately felt pressured for Hope to start hormones now out of fear that she wouldn’t be able to get the care she needs in the future.

“Even though Washington has been very protective of its trans youth, I feel like that’s changing,” Kara said. “We thought, ‘We’re in this safe state, we’re in this blue state,’ and now we’re having to make decisions almost out of fear.”

Hope came out as a girl around the age of 4 and once it was apparent her feelings weren’t going to change, Kara and her husband helped Hope socially transition with a new name, haircut and clothes when she was about 6-1/2, Kara said. The family has visited Mary Bridge Children’s Gender Clinic for more than five years for annual appointments that have occurred more frequently as Hope begins puberty, she said. They’ve had extensive meetings with Hope’s pediatrician, counselors, social workers and their church pastor, and have more consent and readiness assessment meetings this week and next week before Hope’s request for hormone therapy is approved.

“This whole thing has really put us in a really tough spot with trying to help her make the best decision for her, knowing what the political climate is going to be for the next three years,” Kara said. “Now people are so much more vocal about their hate, about their disgust, and it hurts more now because she’s at an age where those things could potentially affect her.”

Kara said she appreciates Mary Bridge’s staff “being proactive” and calling parents like her who have children who might be ready to start hormones before the mid-September deadline. Although she understands Mary Bridge is likely making decisions “out of fear” of criminal prosecution and loss of federal funding, “I feel like now is the time to stand up to what’s happening and not let it happen, and not let it affect all of these kids.”

“I feel like they’re kind of stuck in a hard position, because either way, they’re putting patients’ lives at risk across the board, whether they do it or they don’t do it,” she said.

Parents of trans kids are “all running in, like, fear mode right now. We’re trying to be supportive of each other and provide as many resources and lift each other up in these times,” Kara added.

Hope is thriving and isn’t ashamed to be who she is, Kara said. Although she’s tried to protect Hope by keeping her isolated from politics and social media, Kara said with all the federal changes happening and Hope turning 13, “it’s more of a discussion now than ever has been.”

Kara said as a parent it hurts to be told she’s abusing or “grooming” her child by supporting her transition.

“I was a victim of child sexual abuse. Like, I know what grooming looks like. Being a trans parent is not grooming. The attacks aren’t just on our kids. They’re on us as parents,” she said. “This year has been so hard on me as a trans parent because it’s in my face, in my feed, on the news every single day. There’s no reprieve from it. As a parent, it’s been heartbreaking. But then I look at her, and I hear her saying things like, ‘I don’t care if anybody knows I’m trans.’ Knowing that she’s OK in who she is, does make me feel better.

‘HRT is really what saved my life’

Stella Keating is a 20-year-old transgender woman who said receiving gender-affirming care at Mary Bridge saved her life. Keating, who is studying political science in Bellingham, said when she grew up in Tacoma in the 2010s, there were fewer visible LGBTQ+ people and resources than there are now. Keating started socially transitioning to female at age 9 and began hormone replacement therapy (HRT) at Mary Bridge in eighth grade at age 13.

“HRT is really what saved my life. Without it, I wouldn’t be who I am today,” said Keating, who every year celebrates the anniversary of taking her first estrogen pill. “I felt like I was in my own body. I was happy to be in my own body. And I also got to look like every one of the other girls that I was in class with.”

Keating said taking estrogen and blocking the production of testosterone helped her feel more in tune with her emotions and more comfortable with her body.

“Without any of that, I would have begun to grow more and more into a masculine-appearing person. I would have grown facial hair. I would have grown much taller. My muscles would build a lot more quickly, because they’re filled with testosterone now, and my body’s responding to that. And I would have looked in the mirror and hated what I saw,” she said. “Every single day you wake up and you hate what you see, and you don’t feel yourself. And that just drives you into such a dark place, because it doesn’t feel worth it to live. If you can’t be yourself, it is harmful. It hurts. And so without HRT, I could have reached a point where I would have been willing to take my own life, because I couldn’t be the person that I wanted to be and look like the person that I know I am.”

Keating said she was disappointed to hear that Mary Bridge was rolling back gender-affirming care options and said “losing access to life-saving care is extremely dangerous.”

“We can’t be pointing our fingers at Mary Bridge and the people in the clinic itself who work so hard, because it’s not like they’re enjoying this in any kind of way,” she said. “If we’re going to point fingers, let’s point fingers at the systematic oppression that’s currently happening of transgender people in our care. Let’s point our fingers at the systematic oppression that’s happening for all life-saving care in general, and how politicized health care is being made right now.”

Keating said there’s a lot of misinformation and lies out there about transgender people and the reality of getting gender-affirming care. Surgeries are not regularly happening to minors, trans women are not dominating women’s sports and there are a lot of hoops you need to go through to access gender-affirming care, even in a blue state like Washington, she said. Stella’s mother, Lisa, confirmed that before Stella was allowed to get a hormone blocker from Mary Bridge both Stella and her parents had to separately meet with a clinical psychiatrist for about six months.

“There is a nuance to what age youth get to access certain procedures. So much of what a lot of gender-affirming care is for youth really revolves predominantly around hormone blockers and hormone replacement therapy. … Generally speaking, throughout the country, 18 is the age when you would be able to access specific surgical procedures,” said Lisa, who is the executive director of the Washington State LGBTQ Commission. “It’s ridiculous, but the idea that you go to junior high or middle school and you get gender affirming surgery in school, like, that’s stupid. … The hyperbolic rhetoric is specifically designed to cause confusion and fear, and it doesn’t matter how ridiculous the accusation is.”

‘It’s scary to watch the boiling water heat up’

One Tacoma family whose transgender child received care at Mary Bridge moved to another country to find refuge. The mother of the family, who asked to remain anonymous for fear of federal reprisals, moved with her 18-year-old trans daughter to Thailand five months ago, shortly after Donald Trump was sworn in to his second term.

Although she had no plan to leave the United States prior to the election, the woman said she was alarmed to see Trump sign a slew of executive orders in January, including mandating that federal departments define gender as an unchangeable male-female binary, denounce the promotion of “gender ideology,” end diversity, equity and inclusion practices, withdraw federal funding from schools that allow trans women to participate in girls sports, ban trans people from serving in the military and prevent gender-affirming care for Americans under 19.

In February, the Department of Homeland Security also eliminated policies prohibiting personnel from surveilling people based solely on their gender identity or sexual orientation, as reported by Bloomberg.

“Trans people have already been consistently accused of grooming and everything. That was already terrifying enough, but when he started saying ‘anti-American,’ ‘anti-Christian,’ I was like, ‘Oh, this is the setup to make my daughter someone that doesn’t have rights,’” she said on Aug. 25. “And I was like, OK, it’s time to go because that can’t happen.”

The woman’s daughter came out at age 5 and started establishing care at Mary Bridge Children’s around age 11. When she was 12 she received a puberty blocker after multiple appointments and meetings with a psychologist, and she began hormone-replacement therapy at age 14, her mother said. Her daughter switched to an adult doctor shortly before they left for Thailand.

“I cannot imagine a world where she didn’t have [this care]. Because if she had gone through a testosterone-based puberty, I think she’d have been suicidal,” her mom said. “It put terror in my daughter’s heart when she thought she might not be able to get blockers, or keep getting blockers and estrogen before we left. The amount of stress that caused was really, really high. And the amount of stress as parents, that was really scary. I was like, ‘OK, how do I make this happen? What do I have to do? How do I keep her safe and healthy?’”

When asked what she thought about Mary Bridge’s choice to roll back gender-affirming care options, the woman said she has mixed feelings. At first she felt frustrated Mary Bridge was complying before they were required to, but she understands that doctors are being threatened with legal repercussions for providing care and MultiCare’s loss of federal funding would impact its ability to care for other patients, not just trans kids.

“I think that as a whole, society needs to stand up,” she said. “There’s a lot of people saying, ‘Oh, … more people need to stand up,’ while they sit in front of their TV. And I think all those people need to stand up to support the hospital and fight back … It can’t just be that organization fighting back against the government when they’re being targeted. It needs to be a cultural shift that we stand for this.”

The woman doesn’t plan to return to the United States, even to visit, fearing she or her family could face criminal prosecution.

“It’s scary to watch the boiling water heat up and heat up and heat up. I will say, I’m not happy here. I want to go home. I miss home desperately. I’m not someone who would have ever chosen to move to another country. I like roots and depth and community. My family’s there, I can’t see them,” she said. “I feel like I’m watching the water boil from afar over here, where, yes, I’m desperately homesick, yes, it’s hard to repatriate and find a place and get to know a new culture — yet watching it from the outside, I can’t imagine still being there.”