MARYLAND (WBFF) — Hospitals and health systems across the U.S. are scaling back access to puberty blockers and cross-sex hormones for minors with gender dysphoria, but Maryland providers and state leaders are holding course.
The divide reflects a rapidly escalating national debate that stretches from pediatric clinics to courtrooms, statehouses and federal agencies.
Spotlight on Maryland spoke with local clinics and public officials who said gender affirming treatment improves children’s mental health, medical experts who warned the approach is not backed by high-quality evidence, and a former pediatric gender clinic patient who said medical workers caused her serious mental and physical harm.
The U.S. Department of Health and Human Services (HHS) issued a formal declaration in December stating that puberty blockers, cross-sex hormones, and gender surgeries do not meet accepted medical standards for minors, alongside proposed rules that could bar providers from Medicare and Medicaid funding.
Maryland Attorney General Anthony Brown joined a lawsuit with more than 20 states challenging the funding policy. A federal judge blocked the HHS action in April, but litigation is ongoing.
A spokeswoman for the Maryland AG’s office told Spotlight on Maryland that Brown’s litigation against the federal government aims to “protect access to medically appropriate, evidence-based healthcare for individuals diagnosed with gender dysphoria.”
Roughly 40 hospitals and health systems have scaled back medical interventions for minors with gender dysphoria over the past year, according to a STAT analysis. Hospitals, in many cases, cited legal uncertainty and potential loss of federal funding.
However, a spokeswoman for the Maryland Department of Health (MDH) said the national trend has not appeared to hit Maryland.
“Maryland providers and facilities are not required to notify MDH if they discontinue gender-affirming care services. At this time, MDH has also not received any notices of discontinued services,” the MDH spokeswoman wrote in an email to Spotlight on Maryland.
The spokeswoman pointed to a December statement from MDH Secretary Meena Seshamani, who said that “Maryland wholeheartedly supports the care needs of Maryland’s transgender and gender-expansive people.”
Maryland Gov. Wes Moore’s office did not respond to questions about whether he wants health providers in the state to reassess medical interventions for children with gender dysphoria. Moore signed an executive order in 2023 directing state agencies to “take whatever action is necessary” to protect providers of “gender-affirming treatment.”
Moore was asked this week on the PBD Podcast whether he would hypothetically support his 14-year-old son’s desire to transition genders.
“If this is how he’s feeling, and I feel like I’m closely tied to him, I’m not going to advise him on something that he feels is right,” Moore said.
When asked how parents should be involved in the decision to put a child on puberty blockers, Moore responded, “It’s not a choice that I would make.”
Minors can access puberty blockers and cross-sex hormones at several hospitals and clinics in Maryland, where parental consent is generally required under state law.
Johns Hopkins Medicine hosts a “Center for Transgender and Gender Expansive Health,” which, according to its website, includes an “Emerge Gender Diversity Clinic for Children, Adolescents and Young Adults” that offers “pubertal blockade” and “cross-hormonal therapy” for minors. Young adults 18 and older can obtain referrals at the clinic for gender-affirming surgeries.
A spokeswoman for Hopkins told Spotlight on Maryland that “providers do not perform gender affirming surgery on minor patients.” Hopkins did not respond to questions about whether the clinic previously performed surgeries on minors.
The University of Maryland Medical System (UMMS) offers puberty blockers and “prescription treatments” to treat gender dysphoria at its Golisano Children’s Hospital, according to its website. A UMMS spokeswoman told Spotlight on Maryland that “we provide gender-affirming care that supports adolescents as they explore and define their gender experience,” while specifying that services never included gender-affirming surgeries.
Chase Brexton Health Care deleted its webpage titled “Gender Affirming Care,” which, according to an archived version from last year, listed “health care services for transgender and gender diverse children and adolescents.” The organization did not respond to questions about what treatments are currently offered for children with gender dysphoria. A July press release still published on its website touted a newly hired staff physician who listed “gender affirming care” as a “particular interest.”
Planned Parenthood Maryland’s website lists “gender affirming hormone therapy for individuals aged 16 and older,” but did not respond to a request for comment about what specific services this includes and whether there have been any recent changes.
The American Society of Plastic Surgeons issued a statement in February describing “insufficient evidence to determine the risk-benefit profile” of gender-related surgeries in adolescents, with a recommendation to delay procedures until adulthood. Other leading medical associations in the U.S., including the American Medical Association, continue to support access to puberty blockers and cross-sex hormones for minors, often citing positive results from observational research, though such studies frequently rely on patient-reported outcomes and have limited long-term follow-up and a lack of controlled data.
Government-led reviews in the United Kingdom, Sweden and Finland found limited evidence and uncertain long-term outcomes for puberty blockers and cross-sex hormones in minors, leading those countries to restrict their use to selected cases and clinical trials while shifting toward mental health care.
In the U.S., a 2025 HHS report described the evidence base for pediatric medical interventions as limited and highlighted potential risks, including effects on bone density, fertility, cardiovascular health, and sexual function.
Over the past year, dozens of hospitals in the U.S. stopped prescribing puberty blockers and cross-sex hormones, while others halted surgeries or stopped accepting new patients. Notable examples include Children’s National Hospital in Washington, D.C., and Michigan Medicine ending puberty blockers and cross-sex hormones for minors; Yale New Haven Health discontinuing new cross-sex hormones for patients under 19; and Children’s Hospital Los Angeles closing its youth program entirely.
Other major systems in states such as Illinois, Massachusetts, and Colorado have similarly reduced services, paused treatments, or reviewed their programs.
Johns Hopkins launched one of the nation’s first gender identity clinics around 1965, offering psychiatric evaluation, cross-sex hormones, and sex reassignment surgery. The program operated for more than a decade before being shut down in 1979 after a follow-up study found no clear improvement in broader psychosocial outcomes among patients who underwent surgery compared with those who did not.
Dr. Paul McHugh, who worked as the psychiatrist-in-chief at Hopkins from 1975 to 2001, reviewed those findings and was a leading voice in the decision to end the program, arguing at the time that the interventions did not adequately address underlying psychological issues. Hopkins reopened its gender clinic in 2017.
In an exclusive interview with Spotlight on Maryland, McHugh said he is “absolutely certain it was the right decision” to close the clinic in 1979 and described the expansion of gender-affirming medical interventions in children as a “huge mistake.”
“I think they should be closed,” McHugh said of gender clinics offering medical interventions for minors. “They should work with gender dysphoric people in other ways than with medical ways and see it as a psychological problem rather than a physical or biological one.”
McHugh said the rise in children with gender dysphoria is rooted in a “social movement” that needs to be more closely observed. The proven psychiatric approach, he asserted, is helping patients come to terms with who they are.
“We don’t do fat removal in an anorexic to make them thinner. We start talking about why they think they are fat even though they’re emaciated,” he said. “This is what psychiatrists do. They confront ideas that are misdirected, and they work with those ideas to find out where they come from, what’s influencing them, what’s giving them their strength, and what might be proposed in opposition. It’s standard psychotherapy.”
Over the past decade, the number of minors seeking treatment for gender dysphoria increased sharply, particularly in the United Kingdom, where centralized health data show annual referrals to the Gender Identity Development Service rose from less than 100 cases in 2009 to more than 5,000 by 2022. The increase was accompanied by specific demographic trends: by 2022, nearly 75% of patients were adolescent girls, according to the Cass Review.
A U.S. Centers for Disease Control and Prevention survey in 2023 found that 3.3% of high school students identified as transgender.
A growing number of former pediatric gender clinic patients, often referred to as detransitioners, have filed lawsuits against medical providers.
In January 2026, a New York jury awarded $2 million to a woman who underwent a double mastectomy at age 16.
Dozens of similar lawsuits are now pending nationwide, including cases involving puberty blockers and cross-sex hormones, with plaintiffs alleging inadequate screening, lack of informed consent, and failure to address underlying mental health conditions.
McHugh said Maryland may face a similar fate if public officials and medical leaders are unable to put politics aside and follow the science on gender dysphoria.
“We’re having two parties fighting with one another rather than having a proper argument,” he told Spotlight on Maryland. “A lot of this will be prompted by court decisions, and that is, I’m afraid, often how many psychiatric misadventures get resolved. It should be resolved in the clinic. Instead, they get resolved in courts.”
Stella O’Malley, a psychotherapist specializing in children with gender dysphoria, said the U.S. needs to follow Europe’s example of analyzing and adjusting to longitudinal data.
“It’s hit so many people, and when people have been hurt or harmed by medical transition, they live very difficult lives,” she told Spotlight on Maryland. “Clinicians became scared. They’re like, ‘Will we get sued?’ And they will get sued. And they’re nervous of getting sued. Honestly, I think it’s a safe move to close down.”
Soren Aldaco, 23, is one of those plaintiffs. She has a pending lawsuit against medical practitioners in Texas who gave her testosterone at 17 and performed a double mastectomy on her at 19—a process she now claims included poor screening and caused serious health problems.
“All the things that I brought up that would have been relevant to consider, and why I was coming to them with gender dysphoria, those weren’t really talked about,” Aldaco told Spotlight on Maryland. “I even disclosed a history of sexual abuse to the therapist who wrote my mastectomy letter, but she still wrote that letter without ever exploring that abuse.”
Aldaco said gender clinics in Maryland will likely face similar lawsuits from former pediatric patients.
“I do think it’s causing harm because it’s foreclosing them from being able to seek healthy options,” she told Spotlight on Maryland. “And when someone’s appearing with a fractured self, this idea of themselves in their head that doesn’t match their body, you would think to pause and to consider, okay, where did this go wrong? But instead, I think it’s being not only affirmed, but blindly affirmed, and affirming a discordance between mind and body instead of working to integrate that.”
Spotlight on Maryland is a joint venture by The Baltimore Sun, FOX45 News and WJLA in Washington, D.C. Have a news tip? Call 410-467-4670 or email SpotlightOnMaryland@sbgtv.com. Contact Patrick Hauf atpjhauf@sbgtv.comand @PatrickHauf.
Local Story
