Originally published by our partners at NEXTpittsburgh on November 17, 2025.
After UPMC announced its decision to end gender-affirming care for queer youth this year, everything changed for 15-year-old transfemme Juno and her family.
Suddenly, the care Juno had been getting for years was cut off, and her parents are facing a difficult decision for the future: uproot the family and move to a state or country where Juno can continue gender-affirming care or risk losing their daughter entirely.
“We want our daughter to live, and unfortunately if she can’t get the medication I don’t think that’s going to happen,” said Debby, Juno’s mother.
Juno has struggled with her mental health for years, and losing access to gender-affirming care has only worsened that struggle. She came out to her parents when she was about 7. At first, she identified as nonbinary. Now, she uses the label transfemme or agender.
“We kind of just went ‘Yup, we’re not surprised,’” Debby said. “She was always very, very femme growing up.”
Shortly after Juno came out, her older sibling Ronnie also came out as nonbinary and began puberty blockers and testosterone through UPMC. Juno followed suit, beginning her medical transition with puberty blockers in 2022 and estrogen in 2023.
Juno has always had gender dysphoria, or feelings of distress when a person’s physical body doesn’t match their gender identity.
“It feels like the phrase ‘I’m in the wrong body’ is a cliche, but it’s true. It feels like there’s just a constant, pervasive sense of, there are traits in my body that do not belong to me,” she said.
Not all transgender or nonbinary people medically transition, but some do. While surgery – typically to remove breasts or alter genitals to fit the individual’s preferred gender – is an option, gender-affirming care spans a wide range of medical procedures and interventions.
That includes puberty blockers, which temporarily halt the production of sex hormones to delay puberty. For trans youth like Juno, puberty blockers can be lifesaving.
“The idea of not being able to continue puberty blockers and going through male puberty is one of the most distressing things I can think of,” Juno said. “’I’m already constantly uncomfortable in my own body, and the idea of going through male puberty and further masculinizing would just alienate me from my own body to a point that it’s like, there isn’t much point in living.”
On June 30, UPMC ended gender-affirming care for any patient under 19. A UPMC spokesperson provided a statement in response to questions from NEXTpittsburgh.
“UPMC remains steadfast in our commitment to providing exceptional care for all patients. As we continue to monitor any executive branch memos, directives, subpoenas and other guidance from the Trump administration, these actions have made it abundantly clear that our clinicians can no longer provide certain types of gender-affirming care without risk of criminal prosecution,” the statement read.
For Ciora Thomas, founder and executive director of trans advocacy nonprofit SisTers PGH, the impact on trans youth – particularly 18-year-olds who are otherwise legal adults – is devastating. Thomas began her own medical transition when she was 14.
“That’s not fair for any adult or doctor or anyone to be making that decision for them. This is a decision that should be made from our young folks and from the families that are supporting our young folks in their transition,” she said. “They’re already needing behavioral health services and therapy services, and that’s just going to exacerbate with the young folks that are not able to take their HRT who are under 19.”
UPMC did not respond to a follow-up request asking for additional information on why 18-year-olds seeking gender-affirming care were included in the decision.
“We will continue to provide essential behavioral health support and other necessary care within the bounds of the law while seeking to protect the confidentiality of the physician/patient relationship. We empathize deeply with the patients and families affected by these ongoing changes,” the statement provided to NEXTpittsburgh read.
UPMC’s decision comes after President Donald Trump signed an executive order in January calling gender-affirming care “dangerous,” and adding that “it is the policy of the United States that it will not fund, sponsor, promote, assist or support” gender-affirming care.
In September, the Women’s Law Project and Philadelphia law firm Berger Montague filed a complaint with the Pennsylvania Human Relations Commission on behalf of young trans patients and their parents alleging that UPMC is discriminating against trans patients under 19 based on their sex.
If the commission does not take action to resolve the issue within a year, it could be taken to court, a Women’s Law Project attorney told TribLIVE.
And in July, just a month after UPMC’s decision, the Department of Justice subpoenaed UPMC for years of records relating to gender-affirming care for those under 19.
Dena Stanley, executive director of TransYOUniting – a nonprofit dedicated to improving conditions for the trans community – had a quick answer to what UPMC’s decision means for trans youth: “Death, simple as that.”
“Now there’s no access to affirming spaces for health care for folks who are different and that actually means death,” she said. “This looks like death for many trans youth and a lot of stress on the family.
For Juno’s family, it has meant scrambling to find alternative ways to get care. After the election, Juno feared gender-affirming care would become harder to access, so she started rationing out her estrogen in May.
Now, the family is hoping it will last long enough for them to start getting care from QueerMed, which provides gender-affirming care via telemedicine.
For 16-year-old Jay, transitioning changed his outlook on life. Family members have told him he’s easier to talk to – less angry and more happy – than before his transition.
“I wanted to kill myself every time I woke up. I didn’t like waking up. I hated going to school. I didn’t feel like I was living. I felt like I was in a coma,” he said. “[Gender-affirming care] made me feel like I was somebody. And then they went and took it away, and I was just pissed off.”
Transitioning has given Jay, who realized he was trans around 12 years old, a newfound confidence.
“Before I medically transitioned, I was really anxious. I had horrible paranoia about not passing in public, and especially in bathrooms, and I had a horrible self-perception of myself, and then I got on [testosterone],” Jay said. “It made me feel so much better about myself, and made me feel like I was actually me, and I could live my life the way I wanted to live it and not the way other people told me I had to.”
He started puberty blockers at 14 and testosterone at 15. Testosterone has made a big impact on his life in the year since he started.
“I’ve noticed my voice getting deeper, and I’ve noticed my facial features becoming more masculine, and just in general, a lot of changes to my body and my appetite,” Jay said. “It’s what I decided for myself and both my parents, they supported it, and it’s what I wanted to do. And also, I wanted to keep up with the other guys in my grade. I didn’t want to be lagging behind my whole life and be stuck.”
Now, he can’t get testosterone from UPMC anymore. Jay is quick to point to research and statistics showing low regret rates for transitioning – lower than 1% for surgery – or that a 16-year-old can legally drive a dangerous vehicle but isn’t allowed to make the medical decision that, for someone like Jay, could save their life.
He plans to continue medically transitioning after he becomes an adult. Before he heads off to college in 2027, he wants to travel to get top surgery.
“I’m a very opinionated person, and I’m very loud and outspoken about what I want and who I am, and I know exactly who I am, and I don’t need anyone telling me who I am,” Jay said. “If I want to live my life the way I want, I’m going to and whether people like it or not, it’s going to happen.”
If you are a young trans person dealing with suicidal thoughts, call or text 988 for the National Suicide Prevention Hotline. For The Trevor Project’s queer crisis hotline, call 1-866-488-7386 or text START to 678-678. See below for a list of local and national resources.
TransYOUniting
TransYOUniting collects donations for a health fund established to restore gender-affirming care for youth after UPMC’s decision to end it. It also has a mutual aid fund that helps in financial emergencies.
525 E. Ohio St.
412-346-1324
info@transyounitingpgh.org
Hugh Lane Wellness Foundation
The Hugh Lane Wellness Foundation offers a plethora of services for young people, including community groups and events. The foundation also offers legal aid, support for caregivers of queer children and access to essentials like food and hygiene products.
925 Brighton Road
412-626-3812
info@hughlane.org
SisTers PGH
SisTers PGH helps trans individuals get access to gender-affirming care, housing, employment, legal aid and other essential resources. It also offers drop-in services and behavioral health sessions in its Stonewall Inn location in downtown Pittsburgh.
Stonewall Inn, 213 Smithfield St.
412-297-0548
info@sisterspgh.org
QueerMed
QueerMed is a national gender-affirming care provider with telehealth appointments.
404-445-0350
info@queermed.com
