2026-05-21T10:06:58.979Z / 路透社
概述
- 医院因法律和财务风险限制性别确认护理，而非基于临床证据
- 面临药物短缺的患者转而囤药、使用远程医疗以维持治疗
- 美国多数主要医学团体认为此类护理可能挽救生命
5月21日（路透社）——据医生、患者、政策专家和倡导组织透露，面对特朗普政府对青少年跨性别者性别确认护理的威胁，美国家庭正在权衡是否搬离本州以获得所需的医疗服务。
唐纳德·特朗普总统第二次就职后发布了一项行政命令，旨在限制19岁以下患者获得性别确认护理，这是在27个多数由共和党掌控的州已出台限制此类护理的立法或规则基础上做出的举措。该命令已被法官临时叫停，但政府仍在推动新的禁令。
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去年7月，司法部开始传唤医疗服务机构提供与性别确认护理相关的患者记录——这一行动同样被法院临时叫停——来自阿拉巴马州的19岁跨性别女孩哈莉·沃克当时正在考虑搬迁。
“我和家人当时在讨论高中毕业后我该去哪上大学，我来自阿拉巴马州的奥本，附近有该州最好的学校之一，”沃克说，“但我不能留在阿拉巴马州，因为我的父母、我的医生和我都面临被定罪的风险。”
她现在就读于马里兰州的一所大学，该州保护性别确认护理的可及性。“这里有安全感，这是一个非常包容、相当进步的州，”沃克说道。
她的父亲杰夫·沃克表示，家人如今仍每天都在讨论要么搬到一个对跨群体友好的州，要么搬离美国。
非营利组织特雷弗项目（为LGBTQ+青年提供免费专业支持）于2025年3月4日至10月15日开展的一项调查最新公布的数据显示，哈莉的经历并非个例。在1.6万名13至24岁的LGBTQ+受访者中，近三分之一表示他们或家人正在考虑搬到其他州以获得护理。
美国各州对未成年人性别确认护理的限制
加州大学洛杉矶分校基于健康记录开展的一项研究发现，美国约有150万13至24岁的年轻人认同自己为跨性别者。
政策与科学之争
特朗普政府终止性别确认护理的举措包括威胁医院，将切断其获得利润丰厚的联邦医疗保险（Medicare）付款的资格。这项为65岁及以上人群或残障人士设立的项目服务着7000万人。
美国卫生与公众服务部拒绝置评。
性别过渡护理的范围涵盖采用偏好姓名或代词的建议、青春期阻断药物和激素治疗，乃至手术。医疗服务通常提供给被诊断为性别烦躁（即个人性别认同与出生时指派的性别不符所带来的痛苦）的人群。
包括美国医学协会、内分泌学会和美国儿科学会在内的多数医学团体都表示，此类护理可以挽救生命。
今年2月，美国整形外科医师协会建议推迟为年轻人开展性别相关手术。
LGBTQ健康倡导组织GLMA的执行董事亚历克斯·谢尔顿表示，医院减少或暂停此类服务的决定是基于法律和财务风险评估，而非临床证据或患者需求的变化。
特雷弗项目的调查发现，约75%的年轻人在获得性别确认护理方面遇到过困难。
选择愈发有限
STAT新闻网今年2月基于自身分析报道称，自2025年1月以来，已有40多家医院限制为年轻人提供此类护理。
但包括明尼苏达儿童医院在内的一些医院，在联邦法院裁定撤销美国卫生机构的限制后，已于今年2月27日暂停护理后重新提供服务。
密歇根大学医疗系统去年8月停止为18岁以下人群提供激素治疗和青春期阻断药物作为性别护理项目，理由是7月份的联邦传票以及“对我们的临床医生和机构前所未有的法律和监管威胁”。
43岁的克莱尔·卡布雷拉是一名青少年的母亲，她的孩子从所在州的农村地区长途跋涉前来接受治疗。这名青少年已经花了六年时间规划自己的性别过渡历程，从四年级时使用新的代词和穿搭，到后来使用青春期阻断药物和睾酮。
在用完三个月剂量的睾酮后，他们现在依靠远程医疗服务来避免错过注射，否则可能会出现激素波动、痛经和焦虑等症状。
“我们会尽一切所能支持我们的孩子，包括考虑州外乃至国外的其他选择，”卡布雷拉说道。
争相寻找替代方案
跨性别权利倡导智库“运动推进项目”的健康政策顾问凯伦·贝克表示，随着美国护理渠道减少，加拿大和欧洲国家已成为更具吸引力的选择。
在加利福尼亚州，知名医疗服务机构洛杉矶儿童医院于2025年关闭了运营30年的性别诊所，称其因外部压力“没有可行的发展路径”。
洛杉矶LGBTQ中心的组织者玛丽亚·杜表示，诊所关闭后，美国家庭都在争相寻找替代方案，包括囤积药物和寻求国外治疗。
来自罗德岛州的妇产科医生贝丝·克朗宁表示，她有来自德克萨斯州和佛罗里达州的患者，为了获得“蓝州”的稳定治疗而前来就医。
目前，关于罗德岛州一家医院是否必须交出跨性别青少年医疗记录的 opposing 法院判决正在上诉中。
克朗宁表示，一名在加拿大有亲属的患者正考虑搬到那里，而另一位年轻父亲则表示搬迁成本过高。
“我认为这对大多数患者来说都不是一个现实的选择，”克朗宁说道。
本文由班加罗尔的玛丽安·桑妮报道；卡罗琳·休默、米纳利卡·罗伊和比尔·伯克罗特编辑
Families weigh moves with gender-affirming care access under assault in US
2026-05-21T10:06:58.979Z / Reuters
Summary
- Hospitals restrict gender-affirming care due to legal, financial risks, not clinical evidence
- Patients facing medication shortages turn to stockpiling, telehealth to maintain treatment
- Most major US medical groups support such care as potentially life-saving
May 21 (Reuters) – Confronted with Trump Administration threats to gender-affirming care for young transgender people, American families are weighing moves out of their states to gain access to needed healthcare, according to doctors, patients, policy experts and advocacy groups.
Upon taking office for the second time, President Donald Trump issued an executive order aimed at limiting access to gender-affirming care for patients under age 19, building on legislation or rules in 27 mostly Republican-led states that restrict such care. The order has been temporarily blocked by a judge but the administration continues to push new bans.
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By the time the Justice Department began subpoenaing healthcare providers for patient records related to gender-affirming care last July – another action temporarily blocked by courts – Harleigh Walker, a 19-year-old transgender girl from Alabama, was considering a move.
“My family and I were discussing, after high school where I might go to college, and I’m from Auburn, Alabama, next to one of the best schools in that state,” Walker said. “But I could not stay in the state of Alabama because my parents, my doctors, and I were being criminalized.”
She now attends college in Maryland, a state that protects access to gender-affirming care. “There’s a level of safety here. This is a very accepting, pretty progressive state,” Walker said.
The family still talks daily about a move either to a friendly state or out of the country, her father, Jeff Walker, said.
Newly released data from a survey conducted from March 4 to October 15, 2025, by the non-profit Trevor Project, which provides free, specialized support to LGBTQ+ youth, found that Harleigh’s story is a common one. Nearly one-third of 16,000 LGBTQ respondents aged 13 to 24 said they or their families were considering moving to a different state for care.
US States limiting gender affirming care for minors
Nearly 1.5 million people aged 13 to 24 identify as transgender in the U.S., a UCLA study based on health records found.
POLICY VS SCIENCE
The Trump Administration’s effort to end gender-affirming care includes threatening hospitals with cutting off access to lucrative Medicare payments. The program for people aged 65 and older or with disabilities serves 70 million people.
The U.S. Department of Health and Human Services declined to comment.
Gender-transition care can range from advice on adopting a preferred name or pronoun to puberty-blocking drugs and hormones or surgery. Medical care is often given to people diagnosed with gender dysphoria, or distress when a person’s gender identity doesn’t align with their sex assigned at birth.
Most medical groups, including the American Medical Association, the Endocrine Society, and the American Academy of Pediatrics, say such care can be life-saving.
In February, the American Society of Plastic Surgeons recommended delays in gender-related surgeries for young people.
Decisions by hospitals to reduce or pause these services are driven by legal and financial risk assessments, not changes in clinical evidence or patient need, said Alex Sheldon, executive director at LGBTQ health advocacy group GLMA.
The Trevor Project survey found about 75% of young people had experienced difficulties in accessing gender-affirming care.
FEWER OPTIONS
Since January 2025, more than 40 hospitals have restricted such care for young people, STAT News reported in February based on its own analysis.
But some hospitals, such as Children’s Minnesota, have begun offering care again following a federal court ruling that vacated the U.S. health agency’s restrictions. It had paused care on February 27.
University of Michigan Health stopped providing hormone therapies and puberty blockers as gender-care treatments for people under 18 last August, citing the July federal subpoena and “unprecedented legal and regulatory threats to our clinicians and our institution.”
Claire Cabrera, 43, is the mother of a teenager who traveled from a rural part of the state where they live to receive care there. The adolescent spent six years navigating their gender journey, from new pronouns and clothes in fourth grade to puberty blockers and testosterone.
After running out of a three-month supply of testosterone, they now rely on a telehealth service to prevent missing an injection, which can lead to hormonal shifts, menstrual cramps and anxiety.
“We will do whatever it takes to support our child, including looking at other options outside of the state and outside of the country,” Cabrera said.
SCRAMBLING FOR ALTERNATIVES
Canada and European countries have become more attractive options as U.S. care access dwindles, said Kellan Baker, a health-policy adviser at Movement Advancement Project, a transgender rights advocacy think tank.
In California, prominent healthcare provider Children’s Hospital Los Angeles shut its gender clinic in 2025 after 30 years, describing external pressure and “no viable path forward.”
Maria Do, an organizer with the Los Angeles LGBT Center, said families were scrambling for alternatives since the closure, stockpiling medicines and seeking treatment abroad.
Dr. Beth Cronin, an obstetrician-gynecologist from Rhode Island, said she has patients coming from Texas and Florida, looking for ‘blue state’ stability for treatment.
Opposing court rulings on whether a Rhode Island hospital must comply with handing over medical records of trans youth are currently being appealed.
One patient with family in Canada was considering a move there, while another young father said such a move was too expensive, Cronin said.
“I don’t think it’s a realistic option for most patients in general,” Cronin said.
Reporting by Mariam Sunny in Bengaluru; Editing by Caroline Humer, Mrinalika Roy and Bill Berkrot
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