Renowned NYC medical center caves to Trump on trans youth care just as DOJ loses in court

Mount Sinai Health System has agreed to stop providing gender-affirming medical care to minors under a settlement with the Trump administration, making one of New York’s largest hospital systems the latest provider to retreat as federal officials use investigations, subpoenas, and funding pressure to reshape transgender people’s access to health care nationwide.

The Justice Department announced Friday that Mount Sinai will cease providing puberty blockers, hormone therapy, and other transition-related care to minors. The hospital will also pay an unspecified monetary penjalty and dedicate $2 million to free medical care for people who say they suffered harmful consequences from gender-affirming treatment received as children.

DOJ acknowledged that its claims are allegations, that no determination of liability has been made, and that Mount Sinai denies wrongdoing.

Related: Mount Sinai Hospital drops gender-affirming care for trans teens, leaving New York families worried

Mount Sinai offered a different explanation for the deal. It says it was trying to protect transgender patients’ medical records.

“Mount Sinai was subpoenaed by a grand jury in the Northern District of Texas to produce, among other documents, the medical records of some of our patients who received gender-affirming care,” a spokesperson said in a statement to reporters. The hospital said it settled with DOJ and the Department of Health and Human Services so it would not be forced to provide those records.

The hospital said the dispute could ultimately reach the U.S. Supreme Court and that continuing the fight might eventually require disclosure. It also rejected suggestions that settling meant Mount Sinai believed providing gender-affirming care was wrong, noting that the agreement expressly denies wrongdoing.

But there is a complication to that defense. When Mount Sinai settled, its patients were already protected by a federal court order.

In June, U.S. District Judge Katherine Polk Failla blocked the Justice Department from obtaining identifying and sensitive medical information about people who received gender-affirming care as minors at New York City providers, including Mount Sinai and NYU Langone.

And on August 27, barely a week before DOJ announced the settlement, the 2nd U.S. Circuit Court of Appeals refused the administration’s request to suspend those protections while the government appeals.

Chris Geidner, the legal journalist behind Law Dork, highlighted the timing on Bluesky. He noted that litigation arising from a subpoena to NYU Langone had produced protections extending to other New York City providers and their patients, with Mount Sinai among the principal beneficiaries.

“This was literally the least sensible moment for Mount Sinai to fold,” Geidner wrote.

Related: NYC leaders denounce hospital for handing over trans patient records to Trump administration

Geidner also noted that Mount Sinai’s statement focuses on protecting patients and clinicians but does not directly address DOJ’s central announcement that the institution agreed to stop providing gender-affirming care to minors.

The Christopher Street Project, a national political organization that supports pro-trans causes, had a scathing response.

“Mount Sinai's decision to capitulate to the Trump administration's attacks is a surrender that leaves transgender young people without essential care,” founder and Executive Director Tyler Hack said in a statement provided to The Advocate. “This should outrage every single American who cares about their access to quality healthcare.”

Hack also condemned Mount Sinai’s $2 million commitment to provide free medical services to people who say they were harmed by gender-affirming care.

Related: Hospitals dodge questions on restoring trans youth care despite judge ruling they can keep providing it

“This is a slap in the face to the thousands of patients struggling to afford standard care,” Hack said. “Mount Sinai’s decision to put politics over their own patients will have reprehensible outcomes — it will kill kids.”

Hack said the settlement reflected a broader strategy about which they had previously warned The Advocate.

“Mount Sinai is not the first hospital to fold, and it won't be the last,” Hack said. “The Trump Administration is trying to scare institutions into a false choice.”

PFLAG NYC also issued a statement critical of the agreement.

“While Mount Sinai says the choice to settle was made to avoid handing over patient records to a grand jury, all we see is cowardice in the face of intimidation,” PFLAG NYC Executive Director Clark Wolff Hamel said. Hamel called for institutions willing to “hold the line for transgender youth” rather than “buckle under pressure.”

The settlement formalizes a retreat that began months ago. In February, The Advocate reported that families were being told their transgender teenagers could no longer receive gender-affirming care through Mount Sinai and that its youth program was no longer accepting new patients.

NYU Langone had ended its transgender youth program days earlier amid federal funding threats. Then, in June, parents said Mount Sinai had told them their children’s medical information could be provided to federal authorities, prompting condemnation from LGBTQ+ elected officials.

Mount Sinai is now the fourth major hospital system to reach a formal agreement with DOJ over transgender youth care, after Texas Children’s Hospital, Cleveland Clinic Foundation, and Connecticut Children’s Medical Center.

Texas Children’s agreed to end care and, through agreements with federal and Texas officials, pay more than $10 million and establish a clinic for people seeking to detransition. Cleveland Clinic also agreed to restrict care, while Connecticut Children’s agreed last month to stop providing puberty blockers, hormones, and surgeries to minors.

Other hospitals have withdrawn without formal settlements. Children’s National Hospital in Washington, Stanford Medicine in California, the University of Michigan, and providers in Massachusetts are among those that have restricted or ended services amid federal pressure.

The result is a national contraction in care without Congress having enacted a national prohibition.

Related: Families sue Southern California hospital system for withholding care from transgender youth

In New York, however, state officials are moving in the opposite direction.

Attorney General Letitia James joined 20 other attorneys general and Pennsylvania Gov. Josh Shapiro on Wednesday in suing the Trump administration over a new federal rule restricting Medicaid and Children’s Health Insurance Program funding for gender-affirming care. The rule, scheduled to take effect on October 13, bars federal Medicaid reimbursement for such care for patients under 18 and imposes similar restrictions on CHIP for patients under 19. States could continue paying for the care without federal reimbursement.

“The federal government does not have the authority to dictate what medically necessary care New York provides to its residents,” James said in a statement. “This unlawful rule threatens access to health care for transgender young people and undermines states’ ability to administer our own Medicaid programs.”

James reiterated that position Sunday, writing on social media, “I want transgender youth and all New Yorkers to know I’ve got your back. I will fight to stop the federal government from taking away the care New Yorkers rely on.”

The state Department of Health has also said it is “closely monitoring the chilling effect federal actions are having on gender-affirming care in New York,” Gothamist reports.