The Trump administration has lost in court every single time it has tried to strip federal funding from hospitals providing gender-affirming care to minors. The score is zero wins from seven attempts, with federal judges issuing blocking orders, preliminary injunctions, and stinging 53-page decisions ruling the policy unconstitutional. By any conventional measure of legal strategy, this is a catastrophic failure. And yet the policy is working – not through courts, but around them.
Losing Every Case Is Not Losing the War
As of February 2026, at least 42 hospitals nationwide have paused or stopped providing gender-affirming care to transgender minors, according to STAT News. At least nine hospitals have stopped providing hormones and puberty blockers entirely. Rady Children’s Health in California – the state’s largest children’s hospital system – discontinued hormone therapy for nearly 1,500 patients. NYU Langone Health in New York City abruptly shuttered its entire Transgender Youth Health Program, leaving hundreds of patients without care and, in at least one documented case, a 17-year-old with a surgically implanted puberty blocker and no guidance on removal.
None of this happened because the Trump administration won a court case. It happened because hospitals decided the risk of being “made the example to enforce the rule on day one” – the phrase used by Harvard Law School’s Carmel Shachar – was not worth the fight. This is what a chilling effect looks like in practice.
The Mechanism: Threat Without Enforcement
The administration’s toolkit here is straightforward: a January 2025 executive order, proposed Centers for Medicare and Medicaid Services rules threatening to bar hospitals from federal funding, and referrals for investigation by HHS’s Office of Inspector General. The executive order has been repeatedly blocked. The CMS rules are not final. The investigations have not resulted in any hospital losing funding.
But Medicare and Medicaid represent roughly half the revenue for most major hospital systems. The Centers for Medicare and Medicaid Services told hospitals that roughly 75 percent would need to change their policies to comply. You do not need to actually cut funding to reshape hospital policy – you only need hospitals to believe you might. As NYU Law Review research on chilling effects notes, compliance arises from “ambiguity and uncertainty” more than from actual legal risk. The administration created maximum ambiguity deliberately.
The result, as The Guardian reported, was that NYU Langone and Mount Sinai in New York – institutions in one of the most aggressively Democratic cities in the United States – both cited “the current regulatory environment” when shutting down their programs. Blue-state hospitals, operating under blue-state laws with blue-state attorneys general threatening legal action against them for complying, still complied. USA Today reported in February 2026 that Trump’s attacks on trans rights had “infected blue states” – not through legislation, not through court wins, but through institutional fear.
What the Medical Establishment Did Next
The chilling effect was not limited to hospital administrators doing risk calculations. In February 2026, the American Society of Plastic Surgeons and the American Medical Association both shifted their positions to oppose gender-affirming surgeries for patients under 19 – exactly matching the age threshold in Trump’s executive order, and explicitly citing the contested Cass Review as justification. Medical organizations that had previously backed gender-affirming care as evidence-based practice reversed course without a single court ordering them to do so.
This is how durable policy change actually gets made. You do not need to win in the Supreme Court if you can make the American Medical Association flinch first. The institutions that were supposed to defend evidence-based practice became vectors for the administration’s preferred outcome. The patients who lost access to care that federal judges described as “life-saving” did not get it back when those same judges blocked the executive orders.
What This Actually Means
Courts blocking the Trump administration’s gender care orders is not the same as those orders failing. The administration has demonstrated something important: in a system where hospitals depend on federal funding and institutions depend on regulatory stability, you do not need to win legal battles to win policy battles. You only need to create enough fear of consequences that institutions self-censor before any enforcement action is taken.
The 0-for-7 court record is a narrative of legal resistance. The 42 hospitals that stopped providing care are the narrative of practical outcomes. The second number is what matters, and it is not going down.
Background
What is gender-affirming care for minors? Gender-affirming care for transgender youth includes puberty blockers (medications that pause puberty), hormone therapy (estrogen or testosterone to align the body with gender identity), and in some cases surgery. Major medical associations including the American Academy of Pediatrics and the Endocrine Society have classified this care as evidence-based and medically necessary. The Trump administration’s executive orders frame these treatments as “chemical and surgical mutilation,” a characterization that federal judges and most major medical bodies reject.
Sources
STAT News | NBC News | The Guardian | USA Today | NPR | Washington Square News