Sarah Celotto doesn’t know if she was being naive.
Celotto, a Guilford resident and mother to a 17-year-old transgender son, thought Donald Trump’s rhetoric on the campaign trail, which vowed to stop “left-wing gender insanity” and “the chemical, physical, and emotional mutilation of our youth,” was frightening at the time — but she also thought it may have been “empty campaign promises, like most politicians,” she said.
But then Trump became president again and quickly issued an executive order banning gender-affirming care for transgender youth under the age of 19.
“I certainly didn’t think that the first week of him in [the White House] would be just so focused on the transgender and LGBTQ community,” Celotto said. “I don’t want to say I’m shocked, but I really am surprised that he’s done this, and he’s done this as fast as he has. … I feel like right now he is a bull in a china shop.”
Trump signed last Tuesday an executive order that would, if enacted, withhold federal funding from institutions, including medical schools and hospitals, that provide gender-affirming care to kids. The directive also seeks to restrict coverage of those services from federally-run insurance programs, like Medicaid.
Gender-affirming care for children can involve counseling, hormone therapy and puberty blockers. Current medical protocols do not recommend medication or hormones for children who haven’t yet gone through puberty, according to the Yale School of Medicine, but those kids can receive counseling.
Surgery is rarely used as treatment for transgender and gender-diverse children in the U.S., a 2024 Harvard study found. A study published in 2023 found that, out of a total 48,000 gender-affirming surgeries performed in the U.S. between 2016 and 2020, 7.7% were performed on children between the ages of 12 and 18. The vast majority of the procedures performed on children were breast and chest surgeries.
“He wants to make all of these marginalized communities absolutely terrified, which he’s done,” Celotto said. Her son Cameron, who has medically transitioned and is legally a male on all identification documents, is now having “serious conversations” about leaving the United States as uncertainty continues to grow around trans rights and what Celotto, other parents of transgender youth and their advocates are fearful is becoming “a shrinking number of safe spaces.”
In just over a week in office, Trump has also signed executive orders prohibiting transgender people’s participation in military service, mandating the recognition of only two genders and calling for a pullback of federal funding for “illegal and discriminatory treatment and indoctrination in K-12 schools, including based on gender ideology and discriminatory equity ideology.”
“I worry about who’s next. Is it going to be gender affirming care for adults?” Celotto said. “I kept saying to Cameron, ‘We’re safe. We’re safe. We’re in Connecticut. We’re safe.’ But I’m worried about if [Trump’s] going to say, ‘Where are those really safe states? Let me take the federal funding that’s going to Connecticut.’”
Connecticut reaffirmed Title IX protections last year under former President Joe Biden that schools must treat all students equitably, regardless of their gender identity, in academic and extracurricular settings, even as a handful of other states sued the Biden administration for its Title IX expansion that extended protections to the LGBTQ+ community.
Concerns from providers
Connecticut Children’s CEO Jim Shmerling said that the political backlash against gender-affirming care is unlike anything he has seen in his 45-year career managing children’s hospitals.
“There’s a tremendous amount of misinformation and lack of understanding and emotion around this issue,” Shmerling said.
The treatment options provided at Connecticut Children’s follow guidelines provided by major medical associations, including the American Academy of Pediatrics, the Pediatric Endocrine Society and the Society of Pediatric Psychology. The hospital does not provide medication or hormonal treatments for children who are prepubescent and does not perform any surgeries. Shmerling added that families are always involved, and care is only provided with parental consent.
Since Trump’s executive order, hospitals around the country that provide pediatric gender-affirming care are grappling with the “existential crisis” of whether to continue providing those services even if it means risking federal funding.
At least three hospitals have made changes to their policies regarding gender-affirming care for children since the executive order published, according to reports from the Associated Press. Denver Health in Colorado and VCU Health and Children’s Hospital of Richmond both confirmed they had stopped or suspended gender-affirming surgeries for people under 19 years old.
Spokespeople for Denver Health and VCU Health declined to provide specific details regarding the frequency of gender-affirming surgeries for children at their facilities or how providers determined when surgery was an appropriate course of treatment.
Threats to federal funding carry serious weight for hospitals around the country. Medicaid accounts for roughly 57% of Connecticut Children’s patient revenue, Shmerling said. The hospital also receives $3 million to $4 million in educational funding because it serves as the training site for UConn School of Medicine’s pediatric department.
As of today, Connecticut Children’s remains “committed” to providing gender-affirming care to its patients, Shmerling said. But he worries about the impact on people if the executive order does go through.
“I think we’ll see a significant rise in suicide ideation and potential attempts in suicide,” he said. “Every action has a reaction. There will be some type of reaction that will be unpleasant if this all goes into effect.”
Family responses
Melissa Combs, who leads the Out Accountability Project and has been a vocal advocate for transgender rights, began to cry when she spoke about her son’s transition journey that took months of mental health services and waitlists before they could be treated for their gender dysphoria.
She described her son as “snarky, wicked smart” and “so much fun,” before his transition. She felt she had lost those sides of him for several years as he struggled with mental health.
Health care access for transgender people “is one of the reasons that I got my child back,” she said. “It’s one of the reasons that my child is alive today.”
About 39% of young people in the LGBTQ community have seriously considered suicide in the past year, and the rate is even higher (46%) for transgender youth, according to the Trevor Project, a nonprofit that provides suicide prevention and crisis intervention to queer youth. The Trevor Project also reported that more than one in 10 LGBTQ young people had attempted suicide in the last 12 months.
For Maria Kokiasmenos, of Glastonbury, the biggest concern she had at the beginning of her son’s journey was those staggering statistics. Her son has socially transitioned, which has included a name change and changes to his physical appearance, and is considering a medical transition in the future.
“We were completely supportive of him, and at the same time, I think even in a sort of friendlier administration, we were still scared because we know about the suicide rates and just the way people are treated,” Kokiasmenos said.
The journey isn’t just difficult on the patient undergoing the changes, but their families as well.
“It is a long process,” Combs said. “If the people creating these policies or the people opposing them actually spent time in a gender clinic or with transgender people, they would realize that it’s not how they describe it.”
Part of navigating the ongoing journey and its challenges is also wrestling with what next steps are to keep all their families safe both physically and mentally.
“It feels like safe spaces are shrinking and that’s a concern,” Kokiasmenos said. “Nobody wants to uproot their lives. … And as [safe haven states] get chipped away, it’s like, ‘Well, what’s left?’ It’s feeling like the rug is being pulled out from under people constantly.”