2 days Ago By Kiley Koscinski
Salem B. was busy folding laundry and tidying their Regent Square home in mid-March, preparing a comfortable space to recover from their upcoming top surgery. The procedure to remove breast tissue and reconstruct the appearance of the chest is designed to create a more masculine appearance, which better aligns with Salem's gender identity.
“I was really excited to have the recovery done before summer,” Salem said, imagining what it would be like to go for a swim without an oversized t-shirt obscuring their body. A few days before the surgery, they got a call from UPMC canceling the appointment. “They called like three days before,” Salem said.
“And I was really upset.” Salem uses they/them pronouns, and WESA is not using their last name to respect their concerns about privacy. They said their doctor canceled the appointment to comply with an executive order that threatens medical institutions that provide gender-affirming care to people under the age of 19.
Salem is 18 years old. President Donald Trump signed the executive order in late January advising that the federal government would not fund or support gender-affirming care for people under the age of 19 and would demand the same from institutions that receive federal funding. Trump also vowed to “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.
” Some hospitals ceased providing care to young trans patients immediately after the order was issued. Others have yielded to the restrictions more recently, including UPMC. The change signifies unsteady waters for trans patients even in cities with progressive local leaders like those in Pittsburgh.
UPMC declined to answer questions about when it changed policies surrounding gender-affirming care for minors. Parents who spoke to WESA, however, said the health system is canceling surgeries and declining to take on new patients seeking puberty blockers or hormone therapy. “We continue to monitor directives coming from the federal government that affect the ability of our clinicians to provide specific types of care for patients under the age of 19,” a UPMC spokesperson said in a statement.
While UPMC is not the only provider of gender-affirming care in Pittsburgh, it is the primary source of care for trans people under 19. Allegheny Health Network’s Center for Inclusion Health treats far fewer minors. “AHN remains committed to supporting the comprehensive needs of these patients, including primary care, surgical care and mental health support, while complying with all applicable laws,” a spokesperson said.
Cori Fraser, Salem’s parent, said although the family was devastated by the cancellation of the surgery, they could empathize with the struggle UPMC faces, and they appreciated the doctor’s candor about the policy change. “The executive order that preceded all of this does threaten ..
. funding if they provide gender-affirming care to [people] under 19,” Fraser said, adding that they were nonetheless disappointed that UPMC is “capitulating” to the order. As hospital systems endeavor to understand rapidly changing requirements for federal funding, patients like Salem have had their care caught up in the confusion.
While banning surgeries and hormone therapy for minors has been an objective of the Trump Republican party, Salem wonders why, at 18, they aren’t considered an adult who can make this decision for themself. “I can sign up to go die in the military if I wanted to, but it’s like, ‘Boobs off?’ No. No.
No,” Salem said. “I bet if I wanted to, I could probably get them bigger.” That’s true.
There is no legal age limit for breast augmentation, though medical providers typically recommend waiting until a patient is 18 to have such a procedure. Salem turns 19 in June and plans to have the surgery rescheduled for the summer. But they worry about what limits could be placed on gender-affirming care in the meantime.
“Am I actually going to be able to get it in three months? Or am I just screwed?” they wondered. Also facing an uncertain path forward is Marco Linnabary, a Delmont teen whose plan to start testosterone therapy is now up in the air. The 16-year-old hasn’t had an appointment canceled, but he and his mother Christie Linnabary have had difficulty getting in touch with Marco’s doctor.
The Linabarrys typically communicate with the doctor through UPMC’s patient app, but they said responses that used to take one to two days are now taking one to two weeks. Marco has been receiving birth control shots to stop his period as well as therapy to cope with navigating his teen years and body dysmorphia. The next step in his care is to begin hormone therapy to receive testosterone.
But Christie said she feels like she’s getting the runaround from UPMC about when Marco can start testosterone. She said she feels “really angry at UPMC for not standing up for what's right because everybody deserves health care.” “He's got the blood work ready to go.
Both of his parents are willing to support this. The psychiatrist is on board. And so he was ready,” Christie said.
Not knowing when or if he’ll be able to start hormone therapy has taken an emotional toll on Marco. “There [are] so many things I wish I could change about myself, but I just can't without hormonal treatments,” Marco said. “It makes it hard for me to get out of bed and get dressed, look at myself in the mirror; it's really hard.
” Other parents who have spoken privately to WESA said they worried UPMC would stop administering hormones to their children. Some said they were exploring switching their kids’ injections to an implant that could outlast President Trump’s term in office. The consideration mirrors the uptick in requests for long-term birth control options at OB-GYN offices after Trump was elected to a second term.
One parent worried that their child’s care plan would be stopped short, potentially keeping them on hormones longer than imagined. Long-term hormone replacement therapy can come with additional side effects . “We empathize with the patients and families who are directly affected by these ongoing changes,” a spokesperson for UPMC said.
“We continue to offer necessary behavioral health and other support within the bounds of the law.” Hospital funding threatened The executive order demands that institutions receiving federal research or education grants end what it calls “the chemical and surgical mutilation of children.” Among youth ages 13 to 17 in the U.
S., 1.4% identify as transgender, which amounts to roughly 300,000, according to the UCLA Law think tank Williams Institute .
In February, a federal judge blocked enforcement of the order after the American Civil Liberties Union, Lambda Legal and other groups sued on behalf of patients who had their care disrupted. But despite court action, health systems in several states have canceled surgeries, paused prescriptions and tightened restrictions on gender-affirming care for minors. Many of those health systems receive federal funding.
UPMC declined to answer questions about whether changes to the gender-affirming care it provides to minors were a precaution to ensure federal funding keeps flowing. Though they are legally separate entities, UPMC has close ties with the University of Pittsburgh, which relies on government support for its medical research initiatives. Pitt received the sixth-highest amount of grant funding from the National Institutes of Health last year, totaling more than $660 million.
The university has taken drastic measures amid uncertainty over future federal grant support: after pausing its Ph.D. admissions, Pitt ordered a hiring freeze , expense reductions and an executive review of “overall spending patterns.
” And while the NIH research grants made to the University of Pittsburgh have gotten the most attention, UPMC has also been the recipient of federal assistance. In 2024, Magee-Womens Hospital received more than $14 million from the NIH. Also last year, a federal database shows UPMC received $16.
7 million from the Department of Health and Human Services, including nearly $13 million to cover education costs for training physicians at Children's Hospital last year. Attorneys general representing 15 states issued a statement in February vowing to protect gender-affirming care and warned they would fight “any unlawful effort by the Trump Administration to restrict access to it in our jurisdictions.” The AGs said the Trump administration cannot freeze funding already allocated by Congress including funds going to institutions that provide gender-affirming care.
Federal courts have blocked a spending freeze effort by the Trump administration, with one judge stating that such a freeze undermines the distinct roles of each branch of government. “This means that federal funding to institutions that provide gender-affirming care continues to be available, irrespective of President Trump’s recent Executive Order. If the federal administration takes additional action to impede this critical funding, we will not hesitate to take further legal action,” the statement reads.
Pennsylvania’s Attorney General Dave Sunday is not a party in the lawsuit, and a spokesperson for his office declined to comment on the matter. The office also declined to comment on whether new restrictions on gender-affirming care could violate Pennsylvania’s anti-discrimination laws. A long process Christie Linnabary said preparing Marco to start hormone therapy took months of therapy, paperwork and preparation; a lengthy process that she said gets lost in political rhetoric.
“There is a narrative that a kid says, ‘I don’t want to be a boy anymore’ or ‘I don’t want to be a girl anymore’ and then the parents suddenly take them in and get surgery. That’s not what happens,” she said. “This has been a long process.
” Before puberty, transition typically involves social changes such as a new name, pronouns and a change of clothes and hairstyle, according to the federal Office of Population Affairs . Some children seek psychiatric care to discuss their gender dysphoria with a doctor. During and after puberty, medical treatments such as hormone therapy may be recommended, but only after extensive consideration by the youth, their parents and their health care providers.
Marco said therapy has been “very important” to improving his mental health. The other pillar of his gender-affirming care has been stopping his menstrual cycle. He said his period came with excruciating cramps that kept him home from school.
And in addition to the physical pain, his menstrual cycle brought on gender dysphoria. “Having your period is just like a constant reminder that I’m trans,” Linnabary said. “Not having that period makes me feel a lot better about myself.
” In addition to feeling better in his skin, Marco said he has fewer suicidal thoughts, something he struggled with often before seeking care at UPMC. Christie winces when she talks about what it was like at home before. “If you had been talking to us two years ago, this would be a very different conversation,” she said.
“There were nights that I didn’t sleep, and I was pretty much sitting at the door of my child’s room.” “If I did not have the support that I had from doctors and my family ..
. I don't know if I would even be alive right now,” Marco added. According to The Trevor Project , an LGBTQ suicide-prevention nonprofit, 39% of LGBTQ youth seriously considered attempting suicide in 2024.
That number is even higher among transgender and nonbinary young people: 46% of those surveyed considered suicide and 14% attempted it. Salem has also struggled with suicidal ideation and self-harm; thoughts came to them like clockwork each month. But it took a while before they realized their pain was tied to their menstrual cycle.
They have made serious attempts at ending their life, including one incident when they had to be pulled from a river. But even during other weeks of the month, Salem struggles with their body. They hide parts of themselves that signify the gender they were assigned to at birth and shared that looking in the mirror can feel traumatic.
When top surgery to remove their breasts felt out of reach, intrusive and violent thoughts entered their mind. “Before, I had thought about cutting them off with hedge clippers,” Salem said. But after Salem was adopted by Fraser and began treatment at UPMC, they have been doing better.
It’s been nearly two years since Salem was last admitted to a psychiatric hospital. Pittsburgh politicians push back Parents of trans minors said they were shocked by UPMC’s policy changes, especially in Pittsburgh which has been deemed a “sanctuary city” for gender-affirming care by local lawmakers. “Pittsburgh was considered a safe haven for trans people,” Christie said.
“What is happening?” Also surprised was City Councilor Barb Warwick, who sponsored the legislation to protect gender-affirming care providers in Pittsburgh. Warwick’s bill was designed to shield providers from outside investigations based in states where there are more restrictions on care. She said she never expected the providers themselves to restrict access.
“I understand that care providers are in uncharted territory at the moment,” she said. “But it seems to me that the way to have gone about this would have been to meet with the community and elected leaders and strategize around what to do about this situation rather than proactively and seemingly suddenly just canceling care that people were expecting.” Warwick spoke with UPMC representatives last week about how to move forward, but she said she left the conversation with more questions than answers.
She called for a post-agenda meeting in City Council chambers where city leaders can hear from the trans community about barriers to care in the coming weeks. In a statement, Mayor Ed Gainey acknowledged the limited authority he has to pressure UPMC to reverse its decision. “While UPMC’s apparent decision to discontinue gender-affirming care is deeply unfortunate and merits immediate reconsideration and reversal, it is not clearly within the scope of the city’s powers to order them to do so,” Gainey’s office said.
Still, Gainey said the city would “join with anyone who wants to challenge the Trump administration’s cruel and egregious orders which threaten our trans neighbors.” The mayor also affirmed his commitment to do what he can to shield health providers like UPMC from outside threats. “If UPMC makes the right choice and reverses this dangerous and inhumane decision to discontinue care to our trans community, the City of Pittsburgh stands prepared to protect its providers and patients to the full extent of our ability," he said.
A protest featuring Gainey and trans community organizations is scheduled for Thursday outside of UPMC’s headquarters downtown. In the meantime, families like the Linnabarys say they’re stuck in limbo, hoping to get the care Marco needs. “I guess we just wait for something to change [and] maybe do our best to participate in trying to help the change,” Marco said.
“But I feel like there's nothing really that we can do.” His mother Christie hopes to see more parents speak up for their children and protect their care “before it’s too late.” “As a parent, I'm mortified and I'm scared,” she said.
“I don't ever want him to go back to that dark place. I don't want to go back to sitting outside his room, watching him [where] he can't have the doors closed. I don't want to go back to that.
”.
