Senators clash over whether parents or politicians should decide on trans youth care

A Senate hearing on gender-affirming care for minors on Wednesday became a fight over who gets to make decisions for transgender children, whether politicians should override doctors and parents, and whether the Trump administration’s escalating campaign against gender-affirming care is rooted in concern for children or hostility toward transgender people.

The hearing, convened by Republican Sen. Bill Cassidy of Louisiana, chairman of the Senate Health, Education, Labor and Pensions Committee, came as the administration has intensified efforts to restrict care, including Justice Department subpoenas seeking records from providers that treat transgender minors. The committee listed three witnesses, including Dr. Kurt Miceli, chief medical officer of anti-trans and anti-diversity activist group Do No Harm; Chloe Cole, an anti-trans advocate who received gender-affirming care as a minor and who regretted that care; and Shannon Minter, legal director of the National Center for LGBTQ Rights.

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Opening the hearing, Cassidy argued that children are increasingly being pushed toward medical transition by schools, social media, and what he described as ideologically driven medical institutions.

“Gender ideology is being pushed to convince children and parents that cross-sex hormones and irreversible sex change operations are acceptable solutions to gender dysphoria,” Cassidy, who is a gastroenterologist, said.

But gender-affirming care for minors is not a single treatment, nor does it typically begin with medication or surgery. According to the Endocrine Society, its clinical guideline recommends no medical intervention before puberty, puberty delaying medications that are “generally reversible” once puberty has begun, consideration of hormone therapy as adolescents grow older and can provide informed consent, and waiting until adulthood for genital surgery.

Most major U.S. medical groups, including the American Medical Association and the American Academy of Pediatrics, endorse gender-affirming care as evidence-based, safe, and effective treatment for gender dysphoria. Major medical groups have continued to oppose blanket government bans. The AMA has called restrictions on medically necessary gender-affirming care for minors “a dangerous intrusion into the practice of medicine,” and the Endocrine Society said in 2024 that transgender and gender-diverse patients, parents, and physicians should be able to determine appropriate treatment.

Related: Federal judge blocks FTC probes into trans medicine groups, citing ‘extensive evidence of animus’

A 2025 JAMA Pediatrics study found that less than 0.1 percent of privately insured U.S. minors received puberty blockers or gender-affirming hormones, and no transgender or gender-diverse patients under 12 received gender-affirming hormones.

Surgery for minors is rarer still. A JAMA Network Open study found no gender-affirming surgeries performed on transgender or gender-diverse youth 12 or younger in 2019; among teens 15 to 17, the rate was 2.1 per 100,000, and most were chest procedures. Most chest-related procedures for minors in the U.S. include corrective surgery for gynecomastia, when a cisgender boy grows unwanted breast tissue, and breast reduction or augmentation procedures for teenage cisgender girls.

Republicans centered much of their case on Cole, who medically transitioned as a teenager before later reversing course. Cole told senators that she and her parents were not fully informed about the long-term consequences of medical transition, including infertility, loss of sexual function, and other permanent effects.

“If you’re giving parents an ultimatum of transition or your child is going to kill themselves, they’re going to take what seems like the better of those two options,” Cole testified.

Asked by Cassidy whether Congress should enact a nationwide ban on puberty blockers, hormone therapy, and surgeries for minors diagnosed with gender dysphoria, Cole answered, “We absolutely need federal legislation on this,” adding, “This is medical abuse.”

Related: Trans teen pleads with SCOTUS to strike down Tennessee’s gender-affirming care ban ahead of landmark hearing

Democrats countered that stories like Cole’s, while important, do not justify government interference in other families' decisions.

Minter argued that care for transgender adolescents is governed by standards requiring evaluation, informed consent, and parental involvement. He repeatedly emphasized that parents are central participants in every stage of treatment.

“Parents, not politicians, know their children best,” Minter testified.

Research on regret among minors remains limited, but available data does not support claims that regret is common. A 2024 JAMA Pediatrics study of 220 youths who had received puberty blockers or hormones found that 97 percent continued gender-affirming medical care and that 9 participants, or 4 percent, expressed regret about at least one treatment. Four had stopped all gender-affirming medical care.

Minter also accused the Trump administration of launching an unprecedented campaign against providers and families seeking care, citing efforts to obtain medical records and to investigate providers. The Justice Department announced in July 2025 that it had sent more than 20 civil subpoenas to doctors and clinics involved in gender-affirming procedures for minors. More recently, federal prosecutors issued a grand jury subpoena to NYU Langone Health and other medical centers seeking information about minors who received gender-affirming care.

Sen. Tammy Baldwin of Wisconsin argued that Republicans were devoting committee time to transgender youth while Americans face rising health care costs and other pressing concerns.

“Healthcare decisions should be left to patients, their parents, and their healthcare providers and doctors, not politicians,” Baldwin said.

The hearing’s most striking exchange came from Sen. Tim Kaine of Virginia, who delivered one of the strongest defenses of transgender young people. Kaine began by acknowledging Cole’s testimony. “Your story is tragic,” he told her. “It is a classic case, as you tell it, of medical malpractice.”

He said allegations that doctors failed to adequately explain risks or pressured families deserved serious attention and could be addressed through malpractice lawsuits, professional standards, and medical oversight rather than a federal ban. “This hearing is in a context of intense hostility against trans people,” he said.

Related: More than 160 Democrats urge Supreme Court to support transgender people’s rights to health care

Kaine pointed to recent political attacks involving transgender people, including efforts to falsely label Texas Democratic Senate nominee James Talarico as transgender and campaign messaging portraying support for transgender rights as politically dangerous. He also criticized the administration’s efforts to remove transgender service members from the military. Kaine said that the reason Republicans are attacking transgender people is that it's easy to target a marginalized group.

Kaine also drew a historical parallel, arguing that politicians have repeatedly sought to gain power by targeting vulnerable minority groups. Pointing to Virginia’s history, he said the state spent much of its post-Founding political history focused on "kicking around marginalized oppressed people" — particularly African Americans — and warned that transgender people are increasingly being cast in a similar role in modern politics.

"Who can we kick around? Who can we direct hate towards?" Kaine said, describing what he viewed as a recurring pattern in American political life. He argued that recent attacks on transgender people resembled earlier efforts to use marginalized groups as political scapegoats. "Attacking trans people is sort of like the new version of kicking around vulnerable communities for political gain," Kaine said.

His remarks came two days after a federal appeals court said the Pentagon could not, for now, remove currently serving transgender troops while litigation continues, though it allowed restrictions on new enlistment to remain in place during the case.

Kaine highlighted reports that some transgender troops forced from service had initially been classified as national security risks rather than retirees.

“You’ve served this country honorably. You’re a national security risk because you’re transgender,” he said.

Cassidy pushed back.“This Republican senator emphatically rejects the idea that we’re trying to make a certain group of people an example,” Cassidy said. “I actually take offense at that.”

After the hearing, Minter told The Advocate that Kaine's remarks were among the most significant moments of the day.

"I thought Senator Kaine was so powerful," Minter said. "I thought that was perhaps the single most powerful moment on the Democratic side."

Minter said senators succeeded in placing the hearing within what he described as the broader context of the Trump administration's actions targeting transgender people.

"They did a really good job of contextualizing today in the context of this administration's larger attack on transgender people," he said. "They made it so clear that this is not a genuine concern about healthcare, that it's part of a larger pattern of dehumanizing and harassing a vulnerable minority group."

In one exchange, Republican Sen. Jim Banks of Indiana repeatedly pressed Minter about Pride flags in classrooms, whether teachers should discuss sexuality with children, and whether Pride symbols represent political statements. Minter declined to engage, instead returning to health care and parental decision-making.

He similarly dismissed suggestions that organizations such as the American Academy of Pediatrics and Endocrine Society are driven by ideology rather than medicine.

"It sounds like a conspiracy theory," Minter said. "They're asking people to believe that all of these longstanding professional organizations have somehow sold out."

Vermont Sen. Bernie Sanders argued that Republicans were devoting extensive attention to an issue affecting a small percentage of young people while ignoring poverty, healthcare access, and other crises facing American families.

“This hearing is not about healthcare,” Sanders said. “It is about base politics.”

By the hearing’s conclusion, Republicans remained adamant that Congress should intervene to prevent what they described as harmful and irreversible medical treatments for minors. Democrats insisted those decisions belong to families, patients, and physicians — not politicians.

But amid hours of debate over studies, standards of care, parental rights, and federal authority, one question lingered beyond the hearing room: What message are transgender young people hearing as lawmakers continue to argue over their lives?

“If you’re a trans kid watching this hearing, if you have friends who are trans kids, if you have family who are trans kids,” he said, “there is some intentional effort to make you feel bad about yourself.”

He added, “You’re a beautiful, precious person. You've got a lot of people who love and care about you.”