Since 2020, Josh Dumas’ 14-year-old transgender son has received gender-affirming care — including puberty blockers and testosterone — from an Atrium Health doctor in Charlotte.

Dumas said the gender-affirming health care has made all the difference for his youngest child’s gender dysphoria, a condition in which there is a conflict between the sex assigned at birth and the gender someone identifies with.

His son started puberty blockers around age 10 — shortly after he came downstairs one night sobbing, distraught after noticing the first signs of breast development. It was a distressing discovery for the child who had identified as a boy since he was five years old and lived as one.

“My heart just broke for him,” Dumas said. “I mean, he’s a boy. He looks like a boy. Everyone sees him as a boy.”

The puberty blockers have acted as a pause on puberty, stopping him from developing breasts or menstruating. Several years later, at age 13, his doctor prescribed testosterone.

“When he started testosterone, the changes were pretty quick in his shoulders and his arms. He started growing hair on his face and armpits,” Dumas said. “He just loves it. Body image for him is a big deal.”

Dumas said his son hasn’t wavered from his identity. He also said that the gender-affirming care provided at Atrium has been life-saving, allowing his son to blossom.

But now Dumas’ son won’t be able to receive the care at Atrium.

That’s because Atrium Health, part of the multi-state Advocate Health system, changed its policy this month to stop providing gender-affirming medications and surgeries to all patients under age 19 — a restriction exceeding North Carolina’s 2023 state law, which allows children who were already receiving such care to continue and anyone above age 18 to start it.

The news came as a “gut punch” to families who are left to scramble to find new providers — in some cases, leaving behind patient-doctor relationships they have had for years.

The number of patients in North Carolina affected by the decision to further limit gender-affirming care is not clear. Atrium Health did not respond to NC Health News’ question about how many patients would lose access to care. However, an advocate with knowledge of the impact, who requested anonymity, said about 120 patients being seen at the Atrium Health Levine Children’s Center for Gender Health in Charlotte were affected by the policy change and required transfers to other clinicians to continue care. The center provides gender-affirming care to transgender and gender-expansive children, adolescents and young adults up to age 25.

Other Atrium providers not affiliated with the center also had patients younger than age 19 who were affected by the move.

In an emailed statement sent to NC Health News, Advocate Health cited “the evolving regulatory environment” in its decision to end gender-affirming care for patients under 19, as access to such care has increasingly come under scrutiny from the administration of President Donald Trump.

“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,” a spokesperson for Advocate Health said in the statement. “This new policy allows our hospitals, clinics and pharmacies to continue caring for all patients’ health needs in the changing federal environment.”

Advocates for transgender youth denounced the decision as preemptive compliance with an unjust policy and argued that Atrium Health is “turning their back” on vulnerable patients.

“It signals to trans kids that your health care doesn’t matter, your identity is not valid,” said Mollie Burkholder, interim executive director at PFLAG Charlotte, a nonprofit support organization that serves the LGBTQ+ community.

‘A campaign issue’

This move by North Carolina’s largest health system is just the latest restriction on access to gender-affirming care in the state — medical care that has grown increasingly divisive in recent years. Since 2023, such care for transgender youth has been significantly limited after state lawmakers passed legislation banning gender-affirming care — including puberty blockers, hormones and surgeries — for people under the age of 18. The law was enacted over then-Gov. Roy Cooper’s veto and included a provision allowing minors who began treatment before Aug. 1, 2023, to continue receiving their care.

North Carolina’s law is part of a broader wave of legislation across the United States; 27 states have enacted bans on gender-affirming care for minors. The restrictions have come even though gender-affirming care for transgender adults and minors is considered medically necessary and often lifesaving by major medical organizations like the American Academy of Pediatrics, the Endocrine Society and the American Medical Association.

More than half of states in the United States have enacted laws limiting youth access to gender-affirming care. The first state to pass such a law was Arkansas in 2021. Credit: KFF

In addition to state-level restrictions, the Trump administration is focused on ways the federal government can discourage and prevent gender-affirming care for minors.

“This was a campaign issue the Trump administration ran on,” said Lindsey Dawson, director of the LGBTQ Health Policy program at KFF, a nonpartisan health policy and research organization. “It really made this an outsized issue.

“The share of people who identify as transgender or nonbinary is very small, and then not all of those people seek gender-affirming medical care, and so we’re actually talking about a very small share of the population who’s seeking these services, and when the service is provided, it’s not happening overnight. It’s a long, careful, thoughtful decision.”

In North Carolina, an estimated 21,800 people ages 13-17 identify as transgender, according to a 2025 report by UCLA’s Williams Institute, which researches sexual orientation and gender identity law and public policy.

Federal pressure

A week after Trump took office, he issued an executive order titled “Protecting Children From Chemical and Surgical Mutilation” that makes it U.S. policy to “not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another.” The order threatens to withhold federal funding from medical institutions that provide gender-affirming care to people under age 19. It has been met with lawsuits, and there is currently an injunction prohibiting the enforcement of the executive order.

In the months since, the federal government has taken additional measures to review and limit gender-affirming care practices.

Among the actions, the U.S. Department of Health and Human Services published a report in May questioning the benefits of such care. In July, the U.S. Department of Justice announced that it had subpoenaed more than 20 clinics and doctors “involved in performing transgender medical procedures on children” and is encouraging whistleblowers to come forward. That same month, the Federal Trade Commission held an all-day workshop examining whether unfair or deceptive trade practices are being used in the provision of gender-affirming care. And the Centers for Medicare and Medicaid Services has begun the rulemaking process focused on reimbursement policies related to gender-affirming care.

“The environment is one of hostility to providers offering this care, and one that understandably is creating an atmosphere of fear and uncertainty,” Dawson said.

As a result, a growing number of hospitals across the country — including in blue states where bans aren’t in effect — have restricted or even shut down gender-affirming care clinics. For example, in July, Children’s Hospital Los Angeles, one of the largest providers of gender-affirming care for minors in the country, closed its health clinic for transgender youth, citing pressure from the Trump administration. Hospitals in other states, such as Connecticut, Pennsylvania, Virginia and Montana, have also stopped offering gender-affirming care to people younger than 19.

Dawson said these hospitals are preemptively pulling back care before there’s formal law or regulations requiring them to do so. This leaves gaps for minors who need gender-affirming care.

Increased restrictions

Atrium Health is the first hospital system in North Carolina known to have changed its gender-affirming care policies to align with the shifting regulatory stance of the Trump administration.

During a 15-minute closed Microsoft Teams meeting on July 31 that NC Health News obtained an audio recording of, Advocate Health leaders announced to a group of physicians providing gender-affirming care that the hospital system would no longer prescribe gender-affirming medications or perform gender transition-related surgeries for patients under age 19. The move included minors who were grandfathered in under the 2023 North Carolina law. The policy applies across all hospitals operated by Advocate Health in six states, not just those based in North Carolina.

“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,” Scott Rissmiller, chief clinical officer at Advocate Health, said during the meeting. “At the end of the day, ultimately, it is to protect our clinicians and our patients, and our organization as we move forward.”

On the call, Advocate Health leaders said the policy change would take effect just days later on Aug. 4, citing the “culmination” of federal activity and its potential impacts as the reason. Doctors were told to notify all their affected patients no later than Aug. 15. To ease the transition, clinicians have been permitted to prescribe a one-time, final 90-day supply of medications to their patients and provide tapering recommendations. Tapering effectively ends hormonal support and, if patients do not find care elsewhere, they may begin developing unwanted physical traits associated with the puberty of their sex assigned at birth.

An Atrium provider, who spoke with NC Health News and requested anonymity because they were not authorized to speak to the media, said the news was “really upsetting.” Informing affected patients the week after the decision marked one of the most difficult weeks of their medical career, the provider said. Many patients felt blindsided and broke down in tears as they learned how the policy change would affect their care.

“The moral injury inflicted by this policy is incredible to the providers who are delivering the care,” the Atrium provider told NC Health News. The provider said they continue to believe in the benefits of gender-affirming care for some youth with gender dysphoria. They noted they have seen patients emerge from depression after beginning treatment.

Seeing that care get restricted beyond North Carolina’s legal limits, they said, is deeply concerning.

Advocate Health acknowledged in a statement that the policy change is “difficult news” for affected patients and said it has established a 24/7 hotline to assist them, with a focus on providing counseling support that may be needed.

Turning its back on patients

Holly Savoy, executive director at Charlotte Trans Health and a psychologist serving transgender youth, expressed disappointment over Atrium’s decision, arguing that the hospital system is operating out of fear, rather than standing by the evidence of gender-affirming care.

“The standards of care and the science have not changed,” Savoy said. “Atrium is succumbing to federal pressure and out of fear. We just need to get back to care being between a patient and the family and their provider, and get the politics out of there.”

Savoy worries about the consequences of making gender-affirming care less accessible, as she’s seen how transformative it can be. For many transgender youth, Savoy said access to affirming care reduces rates of depression, anxiety and suicidality among a population who face disproportionate mental health challenges.

“I’ve seen so many youth really be at that brink of suicide and by being affirmed and being accepted by their families and by friends and loved ones and getting access to affirming care and providers, really turn their lives around and have successful lives,” Savoy said.

Reducing the number of providers offering gender-affirming care to minors doesn’t change the number of people in need of care, Savoy said. She fears that Atrium’s move could set a precedent for other hospitals in North Carolina.

That concern is shared by parents of transgender youth who aren’t Atrium patients. Dana, a parent from Charlotte who requested NC Health News not use her last name for privacy and safety concerns, said her 14-year-old transgender child is on puberty blockers and that continued access to gender-affirming care is vital.

“They were, and still are, deathly afraid of male puberty,” Dana said about her child. “They do not want anything that’s going to happen to them physically, that’s going to have them basically present male in any way. That makes them very uncomfortable, makes them very distressed.

“If one organization and one health system can say, ‘We’re not treating this group of people because of this thing,’ then so could Novant, so could independent providers, and then our child’s left out in the cold,” Dana said.

So far, advocates say they haven’t learned of policy changes at other North Carolina hospitals.

Duke Health and Novant Health did not respond to questions from NC Health News about the status of care. A UNC Health spokesperson responded with a brief statement, saying the system follows North Carolina law about gender transition procedures and is “aware of the executive order which is directed at federal agencies and are continuing to monitor communications from those agencies.”

Scrambling to find new providers

Charlotte family physician Rhett Brown, who is not affiliated with a hospital system, is one doctor who has taken on several patients who lost access to gender-affirming care at Atrium. Brown, who has been providing gender-affirming care since 2010, said he plans to continue offering that care within the bounds of North Carolina law.

“We should be here to provide support, guidance and acceptance and care for people in a way that is evidence-based medicine, and that is also legal,” Brown said. “So in North Carolina, taking care of patients who are gender nonconforming or transgender between the ages of 18 and 19 is still legal in North Carolina and ethical, and is best practice to care for those patients.

I’m not sure why physicians would step back from taking care of such a vulnerable population.”

Nonprofit organizations like PFLAG Charlotte and Charlotte Trans Health said they received an influx of messages from families urgently seeking new providers in the wake of Atrium’s decision. They have been working to help point people to providers still offering care. However, some providers already have full caseloads.

Brown warned that disruptions in care can have serious mental health consequences.

“There’s a good chance that if they have gender dysphoria-related depression, the depression is going to come back very strongly,” Brown said. “The big thing is not feeling authentic anymore, feeling like you’re being victimized for something that you have no control over, and feeling that you’re being targeted for reasons that have nothing to do with optimizing your health care.”

Breaking point

Challenges to gender-affirming care come alongside broader rollbacks of transgender rights at the state and federal levels. Just last month, North Carolina state lawmakers overrode Gov. Josh Stein’s veto to pass House Bill 805 — legislation that recognizes only two sexes in state government rules and public policies, mandates retaining original birth certificates if a person changes their gender and extends the time doctors can be sued for malpractice for treating minors for gender transition.

For Dumas, the parent of a transgender teen, the past few years — and especially the last eight months of the Trump administration — have felt like a “relentless onslaught” against his son’s identity.

“You’re on pins and needles waiting for the next terrible thing to happen and trying to figure out how that affects your family and how it affects your situation,” Dumas said.

The Dumas family at the White House in 2024. Since taking office, President Trump and his administration have focused on ways the federal government can discourage and prevent gender-affirming care for minors. Credit: Courtesy of Josh Dumas

For years, Dumas and his wife have discussed backup plans they hoped they’d never need. But after years of advocacy work and speaking with lawmakers, Dumas said the family has reached a breaking point.

Dumas said they can’t live feeling like every day they are “fighting for their family’s existence.”

North Carolina and the United States no longer feel like a safe place for their transgender son, he said. Atrium’s decision to pull back on gender-affirming care was among the final straws for him and his family.

Dumas’ wife and transgender son plan to move to Canada in October, while he and their older son remain in North Carolina for his senior year of high school.

“It’s just time to go,” he said.

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