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President Trump's executive order to ban care for transgender minors is not in effect. A lawsuit has blocked it for the moment. So gender-affirming care for minors remains legal in 25 states. No matter what the law says, though, hospitals across the country are ending treatments like puberty blockers or hormone therapy because the president is threatening to pull funding unless they comply. Aaron Bolton with Montana Public Radio reports on the effects on people in his state.
AARON BOLTON, BYLINE: E still remembers the day when her daughter said she was transgender.
E: Very benign, sitting and brushing teeth early in the morning. And they were 4 years old, and they said, oh, I'm not who you thought I was. I'm actually a girl.
BOLTON: We're using E's middle initial because she worries about harassment and violence against her family. E's child has consistently presented as female.
E: She's happy and doing well, and looking forward to continuing that journey.
BOLTON: E's daughter is about a year away from puberty. They plan to go on puberty blockers and eventually hormone replacement therapy at a Missoula, Montana, hospital, Community Medical Center. Major medical associations say that's appropriate care for gender dysphoria. But in June, the hospital closed its gender clinic to minors. It was a big blow to E's daughter.
E: To her, it just wasn't even a thought that it wouldn't happen. And so she was like, no, well, I'm a girl, so when I go through puberty, I'm going through girl puberty.
BOLTON: The Trump administration calls gender-affirming care harmful, and says it needs to protect children from irreversible harm. Surgery on minors for gender dysphoria is very rare. This year, the Montana Supreme Court permanently protected gender care for minors. Community Medical said in a statement the regulatory and legislative environment is changing too fast for them to continue offering gender care. Hospital officials declined an interview request.
The nearest option for E and her daughter is a seven-hour drive to Seattle Children's Hospital. She doesn't know if she can afford that trip.
E: And it's just heartbreaking.
BOLTON: Lindsey Dawson with the nonpartisan health policy research group KFF says hospitals across the country are dropping gender care for minors because of the federal funding threat.
LINDSEY DAWSON: And this includes in both red and blue states and purple states, as well. So there have been reports in California, Colorado, Pennsylvania, Montana now.
BOLTON: Now that the hospital in Missoula has dropped gender-affirming care for minors, it's no longer available at all in Montana. Many families feel betrayed by hospital administrators who end gender-affirming care for minors, despite it still being legal. Transgender youth are four times more likely to attempt suicide than their peers. Liz is 18 and transgender in Missoula. Community Medical Center ended gender care for those under 19.
UNIDENTIFIED PERSON: (Reading) I feel it's their job as health care providers, is to stand up to this and to say, this is care that saves lives, which they didn't do.
BOLTON: Liz fears for her safety, so we're only using her first name and having someone else read her quotes. She plans to drive to Seattle Children's for now, but doesn't take it for granted she'll be able to get care there.
UNIDENTIFIED PERSON: (Reading) They're going to see even more of an influx of patients. And can they take that many people? How far out does their wait list become?
BOLTON: Seattle Children's didn't respond to an interview request about its plans to continue serving transgender kids. Liz worries it could be the next hospital to stop offering this care, leaving her once again without treatment.
For NPR News, I'm Aaron Bolton in Columbia Falls, Montana.
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