Gender-affirming care had been a literal lifesaver for Salem. After years of dysphoria caused by a mismatch between their body and identity, and after multiple suicide attempts, hormone replacement therapy (HRT) and a hysterectomy had dramatically improved their mental health. With their family’s full support, Salem was scheduled for top surgery on March 24.
Mere days before the surgery, Salem’s family got a call from UPMC: the operation had been canceled because of U.S. President Donald Trump’s Jan. 28 executive order seeking to bar gender-affirming care for anyone under the age of 19.
“Just last Thursday, the surgeon called us and he said, ‘I’m so sorry, but UPMC says I can’t do the surgery until you’re 19 because of this executive order,’” Cori Fraser, Salem’s parent, tells Pittsburgh City Paper. Fraser says the surgeon and other staff at the hospital seemed upset on their behalf. “He was very clearly livid; I think his exact words were, ‘I’m boiling.’”
As an 18-year-old, Salem can legally vote and donate organs. But since Trump’s order, UPMC has decided Salem can’t yet receive a key piece of their treatment. This development follows a Pitt News story finding that the healthcare giant had denied gender-affirming care previously approved for patients at UPMC Children’s Hospital. Trump has continued issuing broadsides and executive orders aimed at the trans community since his Jan. 20 inauguration.
City Paper learned of the canceled surgery from an anonymous staff member at UPMC who was upset by the decision. “That was pretty disturbing,” they say. “Obviously, the optics are bad, and no one can get a comment from UPMC.”
“UPMC is fully committed to providing exceptional care for all our patients,” a spokesperson for the healthcare nonprofit told CP via email. “We continue to monitor directives coming from the federal government that affect the ability of our clinicians to provide specific types of care for patients under the age of 19. We continue to offer necessary behavioral health and other support within the bounds of the law.”
“We empathize with the patients and families who are directly affected by these ongoing changes,” the spokesperson added.
The anonymous UPMC employee says the hospital’s decision stems from a March 5 memo circulated by the Centers for Medicare and Medicaid Services (CMS) after Trump’s Jan. 28 order: “It essentially reads, in really offensive language, if your hospitals or doctors are performing gender-affirming surgery and or offering gender-affirming puberty blockers or hormone replacement therapy, and you do not stop doing that right now, we will withhold all of your Medicare and Medicaid funding in its entirety.”
Both the employee and Fraser agreed with a description of UPMC’s decision to comply as “obeying in advance.”
It’s not an exaggeration to say that gender-affirming care saves lives. A large majority of trans individuals contemplate suicide at some point in their lives, with 40-56% attempting it. A study by the Trevor Project found that anti-trans legislation can be linked to an increase in suicidality. Fraser says that, before beginning gender-affirming care, including hormone blockers, Salem had made multiple “really serious” attempts to take their own life and, at one point, needed to be “fished out of the river.”
“Within a couple months of starting blockers and hormones, [the attempts] completely stopped,” Fraser tells CP.
In a few months, Salem can reschedule top surgery, but the episode has shaken them and resurfaced feelings of dysphoria. Fraser says they have another family member receiving gender-affirming treatment, but, in recent weeks, UPMC has been less communicative about that person’s care plan. The family has discussed safety and a potential exit strategy if receiving care becomes impossible.
“We’re just trying to get through this,” Fraser says. “We’ve been in talks with our loved ones about, where is the line where we have to leave the country?”
Fraser and the UPMC employee say Trump’s executive order relies on misinformation. Gender-affirming care “is a very complicated and long process to go through,” the UPMC employee says, noting that it’s extremely rare for minors to receive gender-affirming surgery at all.
“There’s this idea that a kid says they’re trans, and then you take them to the doctor and they start hormones the next day, and then, next week, they’re sterilized, and the week afterwards they have chest surgery,” Fraser says. “We need education that, for most people, for young people, transition starts with social transition … really reversible things like trying a different name or haircut or a gender pronoun.”
While the UPMC employee says that, to their knowledge, existing care plans for trans patients over the age of 19 will continue, a proposed HHS rule would strip coverage of trans care from the Affordable Care Act (ACA), something Fraser says would deal a massive blow to trans people’s ability to receive life-saving treatments without paying out of pocket, as was the case prior to the ACA.
“People are like, ‘Oh no, my tax dollars are going to buying people new genitals,’” Fraser says, “the reality is, yes, Medicaid covers trans care, but in the long run, trans care is much less expensive than repeated psychiatric hospitalization that tends to happen when people are living in a body that their brain says is completely wrong.”
Local advocates aren’t waiting to see what happens next — TransYOUniting, alleging that UPMC is “choosing politics over people,” is planning a protest in front of UPMC’s headquarters on April 3.
“When institutions target the most vulnerable among us, it’s the first step in a much larger and more dangerous agenda. Denying gender affirming care is a slow and calculated form of violence,” TransYOUniting executive director Dena Stanley said in a release. “This is how people die, not just from lack of care, but from the message that their lives don’t matter. As a Black trans woman, I know how these systems are built to erase us. We’re not just fighting for healthcare, we’re fighting for our right to exist.”
“There’s this impression that most people don’t support trans people,” Fraser says. “I think Pittsburghers need to show electeds that we reject that narrative.”
Fraser says folks could also find and support alternative care providers who are less dependent on CMS funding and, therefore, more flexible in the face of the Trump administration’s attacks on the trans community. In the shorter-term, Fraser says locals who value their trans loved ones need to stand up for their access to care sooner rather than later.
“Trans people are people’s friends and neighbors. We’re here. We’ve always been here,” Fraser says. When it comes to trans care, “this is literally life-saving stuff we’re talking about.”
This article appears in Apr 2-8, 2025.
