The Trump administration’s aggressive push to restrict gender-affirming care for minors isn’t just happening in red states anymore. It’s directly impacting San Francisco clinics and leaving trans youth across the Bay Area scrambling to figure out if they’ll still have access to the medical care they need.

Even though the feds haven’t officially issued new regulations yet, the damage is already real. San Francisco Community Health Center lost federal funding shortly after the administration took office in 2025 because of the clinic’s work serving transgender patients. The Centers for Disease Control and Prevention terminated funding specifically because of the clinic’s “trans focus”. At the same time, the Department of Justice is actively investigating providers who offer gender-affirming care and seeking their medical records.

Dr. Tatyana Moaton-Santiago, the health center’s chief strategy and workforce officer, put it bluntly: “You don’t have to ban something outright to restrict access to it. You just have to make people afraid , afraid to provide it, afraid to seek it, afraid to fund it”. That fear is real for clinicians who have to choose between providing necessary care to their patients and protecting themselves from legal and financial consequences.

HHS Secretary Robert F. Kennedy Jr. announced in December that new federal policy would bar hospitals receiving Medicare and Medicaid funding from providing gender-affirming care to minors. Since most hospitals depend on these federal programs, it could effectively function as a nationwide ban. The federal government commissioned a report claiming that treatments like puberty blockers and hormone therapy lack sufficient evidence of safety and effectiveness. But major medical organizations and researchers are pushing back hard, saying the report doesn’t meet scientific standards and appears designed to justify a policy decision that was already made.

For young people like Eric, a 15-year-old from Oakland who’s on hormone therapy, the stakes are terrifyingly personal. “I do worry that the care could get cut off”, he said. “Testosterone is a controlled substance. If my doctors aren’t allowed to prescribe it to me anymore, then I have to find some way to get this thing that I really need to live my life”. He’s also pointing out the hypocrisy: politicians claiming to want small government are trying to insert themselves into private medical decisions made between patients, their families, therapists, and doctors.

Here’s the thing though, San Francisco’s progressive politics won’t fully shield local clinics from federal policy shifts. Lance Toma, the health center’s CEO, explained that they operate in a “federally regulated ecosystem”. UCSF, one of the nation’s leading providers of gender-affirming care, is currently reviewing the federal proposals and assessing the implications.

Legal experts think courts will likely have the final say. Dale Melchert, a staff attorney for the Oakland-based Transgender Law Center, points out that federal agencies can’t act arbitrarily. If they’re going to drastically change regulations, they have to explain why. Plus, there’s a section of the Social Security Act that specifically says the Centers for Medicare & Medicaid Services isn’t authorized to control the practice of medicine. Any attempt to enforce these restrictions will probably end up in court.