Read more at the Charlotte Observer.

Atrium Health recently stopped providing gender-affirming medication for people 18 and younger, a move that transgender rights and other LGBTQ organizations around the Charlotte region immediately decried. They claimed that the Charlotte area’s largest health care provider buckled under political pressure.

Four LGBTQ rights groups issued a blistering statement on Facebook late last week condemning the move. The statement was on the page for Time Out Youth, a Charlotte nonprofit providing resources for LGBTQ+ people ages 13 to 24. The group was joined by Charlotte Trans Health, the Gender Education Network, and PFLAG Charlotte. The groups said Atrium and its parent company, Advocate Health, are making a decision “based on fear of retaliation by hostile federal agencies or funding cuts.”

Atrium refused to make anyone available for an interview with The Charlotte Observer. Instead, it emailed a statement from parent company Advocate Health confirming it no longer provides or prescribes gender-affirming care medications for patients younger than 19. That’s a departure from a 2023 state law, which restricted gender-affirming care for minors, defined as people younger than 18. In January, President Donald Trump issued an executive order limiting youth access to gender-affirming care nationwide. It defines individuals under 19 as “children” and directs federal agencies to take action to restrict care. Advocate Health said it has been closely following the evolving health care regulatory environment, and acknowledged a “changing federal environment.”

“We recognize that this is a deeply complex issue, and this decision was made after a multi-disciplinary team spent numerous hours carefully considering the options and outcomes,” Advocate Health stated. “This new policy allows our hospitals, clinics and pharmacies to continue caring for all patients’ health needs in the changing federal environment.” Advocate leaders announced the policy change to Atrium-affiliated clinicians and pharmacists during what they called a “difficult” Microsoft Teams meeting on July 31. A doctor associated with Atrium Health who was in that meeting provided an audio recording of it to The Charlotte Observer, and asked not to be named because they were not authorized to share the recording. “We understand the complexity of this, we understand the emotion, the real concern around it. We share it, which is why there has been so much time and so many people weighing in on this,” Dr. Scott Rissmiller, chief clinical officer of Advocate, said on the recording. “And at the end of the day, ultimately, it is to protect our clinicians, our patients and our organization as we move forward.” The Justice Department also issued a new policy memo that could have significant implications for healthcare professionals, Advocate leaders said during the meeting.

It suggested that doctors and other clinicians who provide specific types of gender-affirming care, both medical and surgical, to individuals under 19 may face criminal charges. The memo also includes provisions that encourage and protect whistleblowers who report violations within their healthcare organizations. Atrium Health had not previously provided surgical gender transition procedures for minors under age 18, the company told the Observer. About gender-affirming care Advocate Health defines gender-affirming care as services including social, psychological, behavioral or medical interventions (including hormonal treatment or surgery) designed to support and affirm an individual’s gender identity. That’s according to the draft of a policy shared with physicians in July and provided to the Observer by the doctor associated with Atrium Health. Advocate reviewed protocols for gender-affirming care and considered the potential impacts of federal actions on patients, clinics and employees before deciding to end the medications for people younger than 19, according to the draft policy. “Gender-affirming care is medical care,” the advocacy groups stated. “It is endorsed by every major medical and behavioral health association. It saves lives.”

Gender-affirming care is a supportive form of health care, according to the U.S. Department of Health and Human Services. That may include medical, surgical and mental health services as well as non-medical services for transgender and nonbinary people. Atrium’s policy change wasn’t just about Trump’s executive order, but also took into consideration actions coming from the Federal Trade Commission, the Centers for Medicaid and Medicare, and other “elements,” according to Advocate officials on the audio recording. While health care companies may face regulatory threats, executive actions and other risks, the LGBTQ groups said “the real harm will fall on young people who already face disproportionate rates of depression, anxiety and suicidality when affirming care is withheld.” Advocate Health physicians have been reaching out to patients affected by the policy change so they are aware of what it means for their care and to provide support, according to the company. In its statement to the Observer, Advocate said it recognized “that this will be difficult news” for patients affected by the policy change, and created a 24/7 hotline to assist them, focusing on providing personalized counseling that might be needed.

‘Operating out of fear’ Dr. Holly Savoy, executive director for Charlotte Trans Health, an advocacy group for transgender people, expressed concern and disappointment over Atrium’s decision.

“One of the biggest challenges for trans people is stigma and discrimination,” Savoy said. “(Atrium) is operating out of fear, rather than standing up for evidence-based care,” Savoy said. “It’s not standing behind the science of gender-affirming care and their values of being an organization that says that they support health care for all.” Advocate Health will focus on alternative, non-invasive care, such as behavioral health and peer support for patients, health care officials said at the July meeting. The company is the third-largest nonprofit health system in the U.S. It serves about 6 million patients. More than 155,000 employees work in 68 hospitals and more than 1,000 locations. Novant Health is the second largest health care provider in the Charlotte region. The Winston-Salem-based company did not respond to an Observer request about the status of gender-affirming care for youths.

Concerns over resources LGBTQ advocates feared that Atrium’s decision could make it harder for patients to find new care in the area. “Our kids are now having to suffer because they are struggling now to find care that they’ve had at Atrium, some of them for a couple of years now,” said Joshua Jernigan, founder of the Gender Education Network, a nonprofit providing support and resources to transgender and gender-diverse children. “And it’s just very, very sad to us.”

The state law enacted in 2023, N.C. House Bill 808, prohibits puberty blockers and surgical gender transition procedures for minors who had not already started treatment as of Aug. 1, 2023. And it created penalties for doctors who perform those procedures or who prescribe, provide or dispense puberty-blocking drugs or cross-sex hormones to a minor. Atrium Health hasn’t provided surgical gender transition procedures for minors under 18 since the law passed and has followed the law, Advocate Health told The Charlotte Observer. Advocate’s medication changes went into effect Aug. 4, and also impacts patients previously grandfathered in to receive gender-affirming care services under the N.C. law, according to the draft policy. Gender-affirming care medications can still be prescribed for patients 19 and older, according to the policy. For patients under 19, these same medications can be prescribed for other medical reasons, such as post-chemotherapy needs, tumor removal surgery or to treat precocious puberty (when a child goes through puberty too early). Jernigan said transgender patients deserve access to care, regardless of age. “I would hope that major medical systems would treat their patients first and not act like the patient’s medical needs are not important,” Jernigan said.

Joshua Dumas, a board member of PFLAG Charlotte, said Advocate Health’s decision to cut gender-affirming care medication is a business decision based on the current political climate. The four advocacy groups want Atrium to rescind its decision. “To every trans and gender-diverse young person and their families: You are not alone,” they said. “We are fighting for you. And we will not stop.”