The medical profession is at a crossroads. For decades, the medical establishment has insisted that so-called “gender-affirming care” for minors is settled science, despite weak evidence. Now, as the truth about the dangers is becoming impossible to ignore, a recent change from a California hospital system is signaling a shift from ideological obedience to evidence-based accountability in the medical profession.
Sutter Health, a health system with 25 acute care hospitals and over 200 clinics across northern and central California, quietly announced on Nov. 20 that it will stop providing “gender-affirming care” services to minor patients under age 19, beginning on or around Dec. 10.
This is the fourth California system to make changes this year following President Donald Trump’s Jan. 28 executive order that ended any federal funding or support of “transition” for individuals under 19 years old and promised to enforce laws that limit or ban those practices. Children’s Hospital L.A., Stanford Medicine, and Kaiser Permanente have announced changes in compliance with that order, but for Sutter Health to do so is shocking. It was recognized as a leader in LGBT healthcare equality by the Human Rights Campaign Foundation last year.
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Just a week prior to the announcement, California Attorney General Rob Bonta released guidance on the rights individuals and providers have regarding “gender-affirming care,” assuring providers that they are legally protected to practice gender medicine in the state. So why give in now?
The day before Sutter Health’s announcement, the Department of Health and Human Services released the most comprehensive review of the data on gender medicine for minors. It concluded that there is not enough research to fully understand the outcomes and that the long-term risks likely outweigh alleged benefits.
There are major risks associated with gender medicine, including weakened bone density, infertility, sexual dysfunction, cognitive decline, psychiatric disorders, and surgical complications. The available research is also very limited, with few randomized control trials, small sample sizes, homogenous groups, and short follow-up periods. This calls into question the credibility of any possible benefits. Other countries — such as New Zealand, Brazil, the United Kingdom, and Denmark — have come to the same conclusions on the evidence and have already abandoned gender medicine for minors.
Despite this international momentum and recent federal pressure from the Trump administration, medical associations have stood by their support of gender medicine for minors. For example, the Endocrine Society, which declared its support in 2017 when it released a report and practice guidelines on the subject, reaffirmed its support in 2024. The Endocrine Society also criticized the HHS report; however, it used many of the same studies HHS did.
Most notably, both reports highlighted the Dutch Protocol, a series of widely criticized studies that is popularly used as supportive evidence for youth gender medicine. The Endocrine Society does discuss the limitations of the evidence in its report. In fact, in its summary of recommendations section, seven of the 10 recommendations are labeled as being based on very low- or low-quality evidence, as are all 12 suggestions.
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This shows that it is political ideology and self-interest that have been motivating health professionals’ actions over the past decade. But the medical profession is finally breaking away. For Sutter Health to stop providing gender medicine services to minors signals a deep shift toward acknowledging that experimental gender medicine is not compassionate care, but extremely harmful.
This moment marks the beginning of a broader reckoning, one in which treatment for gender dysphoria is based on evidence and the medical profession recommits to its duty of doing no harm. Hopefully, more health systems and medical professionals around the country will follow this courageous example of putting patients and their health above all else.
Miranda Spindt is a healthcare policy analyst at Independent Women. Follow her on X @miranda_spindt.