One of President Donald Trump’s first executive orders was to cut federal funding for hospitals providing gender-affirming care. That order was temporarily blocked by a federal judge. But it’s already impacted not just health care providers, but also families here in Wisconsin.
Phoebe Petrovic is a reporter at Wisconsin Watch who reported on Children's Wisconsin in Milwaukee refusing gender-affirming care to one of its patients in the wake of the Trump order. While Children’s eventually changed course, and rescheduled the appointment, the future of care for transgender kids in Wisconsin is uncertain.
WUWM’s Jimmy Gutierrez talked with Petrovic about the story. This conversation has been edited for length and clarity.
Jimmy Gutierrez: When we talk about gender-affirming care, what are we specifically talking about?
Phoebe Petrovic: Gender-affirming care is a combination of social support, therapy, medical interventions that help a person live as their gender identity rather than the sex they were assigned at birth. It means different things for different people and there isn't necessarily one specific way that it looks.
But for young young people, little kids, gender-affirming care can look like getting a haircut, changing your clothes, changing your pronouns and maybe seeing a gender clinic to talk to a provider about what medical interventions might look like in the future.
As kids get older and closer to puberty, it might look like taking puberty blockers that can that can delay the puberty that is sort of programed in a person's body from birth, so that they have a little bit more time to decide if they want to proceed down other paths.
There is also a component of surgery, though we know that is a minority of the trans population actually pursuing. And that might look like top surgery or bottom surgery — again, to undertake steps to make your physical outside appearance align with your gender identity.
It sounds like a lot of different options are based on age and what kind of is appropriate for those demographics or those individuals. When you're talking about the teen procedures and therapies, how common are those with minors?
First of all, just overall, transgender people and transgender minors take up a tiny fraction of the population. So a little over 1% of the population in the United States identifies as transgender. And one other thing that's really important to note is that gender-affirming care is considered best practice standard of care and the only evidence-based treatment for gender dysphoria in the country. And it is endorsed by every single major medical association and professional medical organization in the country.
You recently profiled a family that had gone on this long journey seeking care. And they had an appointment set with Children's Hospital here in Milwaukee. Can you tell me about the process that they went through, what ended up happening with that appointment and what the appointment even was that they were looking to get for their child?
So, I spoke with a mother named Sarah Moskonas. She has a 13-year-old daughter who's a transgender girl, and this little girl has been identifying as a girl since she was very little. The mom told me that she remembers the little girl at three years old saying, "Well, I don't know why everyone thinks I'm a boy when I'm clearly a princess." And she has been consistently, persistently, insistently saying, "I am a girl."
So, she's been seeing a therapist who specializes in supporting transgender youth for seven years — since she was five or six. And she's been a patient at Children's Wisconsin, which is a gender clinic, for about four and a half years. This little girl has been on puberty blockers for quite some time and had gone through the process with her family to request and get approval for starting hormone replacement therapy, so, moving off of the blocker and starting to go through puberty that aligns with her gender identity.
This is something that actually requires the hospital's approval from a higher board. It's not just the doctor saying, "OK, we're good to go." It requires a higher level of scrutiny and approval. That process had happened and Sarah, the mom that I spoke to, had gotten a notification on New Year's Eve that the hospital was ready to go. So then they’re going to set up another appointment to get informed consent from both parents to proceed with this.
Right before the appointment, a couple days before, I got a phone call that actually the hospital had reversed course and they were going to cancel the appointment and not let her daughter proceed on to gender-affirming hormone therapy. This mom was devastated and had to break the news to her 13-year-old, and the 13-year-old told her mom, "You know, I'm upset by this, but I also was sort of expecting this since the election happened."
We wrote that story up the next day, tried to get a response from Children's, didn't get a response, ran with the story anyway because we had heard that other people were also trying to contact Children's and hadn't heard back.
By the next morning, the mom got a call that the hospital had actually reversed course and was reinstating or rescheduling that appointment for that young girl. She had an appointment that afternoon.
The teenager had their finger on the pulse because what we're talking about here is Trump's executive order blocking funding to hospitals that provided this sort of care. What can we expect or what do we know we could expect from health care providers, hospitals and doctors going forward in the state?
I have heard from trans people in Wisconsin who said that their providers have expressed to them, "We're here for you, we're going to continue providing this care." But we don't know whether or not Children's is accepting new patients, whether they're sort of compromise for the Trump executive order, or to say, "Well, we'll keep serving our current patients, but we won't take any more on." That's unclear.
But what Sarah, the mom, told me and what many other transgender or activists or LGBTQ allies have said is that they're not going to stop fighting and that they're going to make sure that this care remains accessible to all who want it and need it, not just the lucky few who happen to be enrolled in treatment at this time.
Why did the hospital end up calling the family back? What happened there?
We don't know. I have been trying to get on the phone or to receive an email response from the press team at Children's, and they have not said anything publicly, as far as I know.
What we do know is — in between that time I published a story breaking the news that this family had, had their care canceled — two other news outlets followed up and reported similar findings. So there were three stories out there saying that Children's had done this sort of thing in quiet. That’s when they called this parent back and they were able to schedule the appointment and resume with the care. So we're still sort of waiting to find out and see what Children's says.
One thing that's important to know is that this executive order doesn't have the force of law, and it can't compel hospitals to take a particular action. It can't compel hospitals to stop providing gender-affirming care.
What it can do is create a culture of fear and a chilling effect that they might eventually lose their federal funding because they continue to provide this care. And so that's something that ultimately has to be challenged or litigated. And some hospitals around the country — including Children's Wisconsin — appear to have taken a sort of risk-averse approach, saying, "You know what? We don't want to lose our funding. We're just going to stop this." And some of them have also reversed course in response to public pressure or protest. Others are holding firm.
You've covered this topic for years across the state, or at least have talked to people who have been in this situation like Sarah and her daughter. And so, much of the talk is on policy and less really on the people — like, "What does this mean for the courts? What does this mean for federal funding?" But what effect does this all have on trans youth? Delayed affirming treatment, misinformation and disinformation campaigns, being the targets of like a legislative machine — all to an already incredibly vulnerable group of people. What impact does this have?
We know that it can be incredibly devastating and detrimental to young trans people’s mental health and their physical health. We know from research that the mere introduction of a bill seeking to ban gender-affirming care for trans youth has a detrimental effect on this population's mental health and can lead to things like increased risk of suicide attempts and self-harm.
So that's this sort of culture, this sort of sustained attack on this population has a marked and measurable effect on the population's mental health. There are young people and trans adults who have died by suicide as a result of this.
Sarah told me that her young daughter cried to her, saying, "I don't want to grow a beard. I don't want to develop in the way that my older brother is developing in puberty. I don't want to go through with this." And that her mental health was in a really poor state before she was getting gender-affirming care and being able to live as herself has allowed her to flourish.
I've spoken with an untold number of trans people across Wisconsin, young people and adults who say that being able to live as their authentic selves — being able to access this life saving medication and treatment that is life-saving and life-affirming — makes all the difference.
And these sustained attacks really impact their mental health, their well-being, and also are contrary to the scientific or medical consensus about what good care is.
