President Donald Trump’s all-out effort to block federal funding for “transgender lunacy” has the potential to upend the clinical research industry, with one specific clause in one specific executive order already causing hospitals across the country to scramble their plans.
Trump’s order directs federal agencies to work with the Office of Management and Budget to “take appropriate steps” to withhold educational and research grants from medical institutions that do not commit to ending gender transition treatments, referring to it as “the chemical and surgical mutilation of children.” (The order defines “children” as any person younger than 19 years old).
NOTUS examined research project grants given by the National Institutes of Health in 2024 to over 80 medical institutions — both hospitals and schools — that offer gender-affirming care to evaluate what types of projects would be impacted by Trump’s executive order.
The order itself does not immediately withdraw funds from medical institutions that provide gender-affirming care to trans patients under 19, since such an action would need to come directly from the agencies that provide the funds, but some hospitals have nevertheless responded to the order by cancelling appointments for trans youth — even if they are located in states where gender-affirming care is not banned.
One pediatric pharmacist whose employer halted gender-affirming care for patients under 19, who was granted anonymity to speak frankly, said that while her employer was “quietly supportive” of providers doing what they could to work around the executive order, her team was still scrambling to figure out ways to do so without getting into hot water legally.
“They’re trying to toe the line because if we are found violating the executive order and we lost federal funding, we go under,” the pharmacist told NOTUS.
Sinéad Murano-Kinney, a health policy analyst for Advocates for Trans Equality, told NOTUS that the executive order is a “threat” to “the financial stability” of medical institutions across the country.
“Based on our current understanding of the administration’s executive orders, these funds need not be directly applied to the provision of gender-affirming care in order to be subject to these restrictions,” Murano-Kinney added. “Hospitals that support a wide range of clinical research investigations may be particularly vulnerable.”
Gender-affirming care is endorsed by leading medical organizations like the American Medical Association, the American Academy of Pediatrics and the Endocrine Society, which say that this type of care “saves lives.” Since 2021, more than half of U.S. states have enacted policies to restrict gender-affirming care for trans youth in their states. Trump’s order attempts to take that further.
Trans rights advocates immediately denounced the order. “It is deeply unfair to play politics with people’s lives and strip transgender young people, their families, and their providers of the freedom to make necessary health care decisions,” said Kelley Robinson, president of the Human Rights Campaign.
The order is “already having its intended effect — preventing children from being maimed and sterilized by adults perpetuating a radical, false claim that they can somehow change a child’s sex. Hospitals around the country are taking action to downsize or eliminate their so-called ‘gender-affirming care’ programs,” the White House said following reports on how hospitals were responding to the directive. (The White House did not respond to NOTUS’ request for comment).
Children’s Hospital Colorado told NOTUS in a statement that it would be modifying “our model of care for providing puberty blockers and other hormone-based gender-affirming care treatments.” The University of Colorado School of Medicine, which includes Children’s Hospital Colorado doctors, received over $200,000,000 in NIH research grants in 2024. The funding went to research on cancer, diabetes, HIV, Alzheimer’s disease and other areas.
“The executive order threatens Children’s Hospital Colorado’s ability to receive federal health care funds that support the care of hundreds of thousands of patients,” the hospital said.
Denver Health, which received over $408,000 in research grants from NIH in 2024, reportedly paused some gender-affirming care days after the order was issued.
The order “includes criminal and financial consequences for those who do not comply, including placing participation in federal programs including Medicare, Medicaid and other programs administered by HHS at risk. These programs represent a significant portion of Denver Health’s funding, and the executive order specifically states that should we not comply, our participation in these programs is at risk,” Denver Health said in a statement. “The loss of this funding would critically impair our ability to provide care for the Denver community.”
Virginia Attorney General Jason Miyares sent a letter to VCU Health and UVA Health, two of the state’s largest hospital systems, telling them to stop providing gender-affirming care to patients younger than 19. Miyares called the letter “legal advice to enable the Commonwealth — including its agencies — to protect itself from significant legal risk and substantial financial exposure.”
The University of Virginia’s school of medicine received nearly $150,000,000 in NIH research funding in 2024, and Virginia Commonwealth University received more than $60,000,000. The research areas included cancer, autism, genetics and cardiovascular disease.
Other institutions in states without bans told NOTUS they weren’t pausing care, but were reviewing the order.
Rutgers University’s medical school, which received over $117,000,000 in NIH research grants last year, said “our patient care is unchanged” but that the “university continues to monitor the impact and legal implications of all of the federal executive orders that may affect our university community.”
Similarly, a spokesperson for Michigan Medicine said the “University of Michigan Health teams are assessing the potential impact of this executive order on our healthcare services and the communities we serve.” The university’s medical school received over $384,000,000 in NIH research grants.
And a spokesperson for the Oregon Health and Science University told NOTUS: “[OHSU] has a process in place for monitoring, evaluating and responding to any federal actions or legislation that may directly impact our programs and services. We know the executive order on gender-affirming care is very scary for patients and their families. We are continuing to provide this care.” The university received over $277,000,000 in NIH grants for research on obesity, Alzheimer’s disease, heart disease, cancer, Parkinson’s disease and others.
Days after Trump issued the executive order, the American Civil Liberties Union filed a lawsuit on behalf of several trans patients who had appointments cancelled by hospitals. Joshua Block, an ACLU attorney, told reporters that Trump’s move “undermines the basic structure of checks and balances.”
Block said that, ideally, the lawsuit would provide some cover for hospitals worried about the potential impact to their federal funding if they choose to ignore the executive order for now.
“Hopefully as soon as we have a [temporary restraining order], the hospitals and their lawyers will feel sufficiently protected to begin resuming the care that they’re required to provide under state and federal law already. But we certainly welcome them providing it now,” he said.
A federal court in Maryland on Thursday will hear oral arguments for the case on whether to temporarily block the executive order. The judge could issue a decision from the bench, which would take effect as soon as the hearing concludes.
Trump’s second term has already been marked by attempts to change how federal funds are distributed, including by unexpectedly freezing all federal financial assistance. The president’s multiple anti-trans executive orders have threatened to withhold funds from educational programs that allow trans women to participate in women’s and girls’ sports and directed all federal agencies to “assess grant conditions and grantee preferences and ensure grant funds do not promote gender ideology.”
The ACLU’s lawsuit, which argues that Congress, not Trump, has the authority to decide how these funds are used, says the patients involved in the legal challenge had care paused in VCU Health, UVA Health, Denver Health, Children’s National Hospital in Washington, D.C., (which received over $26,000,000 in research funding from the NIH in 2024), NYU Langone Health (New York University’s medical school received over $430,000,000 in NIH research grants) and Boston Children’s Hospital, which established the country’s first pediatric and teen trans health program (the hospital received nearly $200,000,000 in NIH research grants).
All of these hospitals are located in places without policies banning gender-affirming care.
But Trump’s order against gender-affirming care is also impacting care in states where gender-affirming care for trans minors is already banned by considering 18-year-olds minors.
Akron Children’s Hospital in Ohio, for example, told NOTUS in a statement they “updated our policies and procedures to comply with the Trump administration’s new Executive Order from January 28, 2025, related to gender affirming care which extends the restrictions from age 18 to 19.” The hospital did not explain if it was specifically cancelling care that had already been scheduled for 18-year-old trans patients.
The Ohio hospital received over $434,000 in NIH funding on research looking to improve “home-based pediatric hospice and palliative care.”
Even if hospital systems choose to continue gender-affirming care for trans patients under 19, the effects of the executive order will still be felt at the individual provider level, said Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ+ Equality. The organization is a plaintiff in the ACLU’s lawsuit.
“Our members are experiencing an unbearable level of scrutiny,” Sheldon said on a press call. “There’s a palpable fear of lawsuits, fear of losing medical licenses, fear of political retribution from an administration determined to criminalize care that has been very well established.”
The pediatric pharmacist said she was hopeful that her institution would be able to find a solution for all of its patients without jeopardizing needed federal money.
“Our legal teams are working really hard to help us figure out where the line is,” said the pharmacist. “Like any other large institution, what they’re releasing to the public is different from what they’re saying to our leadership, and what they’re saying to their leadership is different from what we’re quietly doing in our teams.”
—
Oriana González is a reporter at NOTUS. Margaret Manto is a NOTUS reporter and an Allbritton Journalism Institute fellow.