The Trump administration has finalised a rule stripping Medicaid and the Children's Health Insurance Program from covering puberty blockers, hormone therapy, and surgery for trans young people, taking effect in October. It targets low-income families specifically. The report used to justify the ban has been criticised by the American Academy of Pediatrics for misrepresenting the medical consensus, which remains firmly in favour of this care.

What are we going to do?

That is the question I keep coming back to. Not as a rhetorical device, but as the actual words that thousands of families in the United States are asking each other right now, in kitchens and cars and late at night. What are we going to do?

Blair's mum already knows the shape of it. She wrote a public comment on a government website, pleading with the Department of Health and Human Services to leave her family alone. "I have learned that my original vision of what my child's life would look like is very different from reality," she wrote, "and yet, this version is just as beautiful, if not more so." She was not asking for permission to love her son. She was asking why that love, and his doctors, and the careful monitoring and the blood tests and the counselling, were suddenly the government's business to end.

She got her answer on Tuesday. The Centers for Medicare and Medicaid Services published a final rule banning Medicaid and CHIP from paying for puberty blockers, hormone therapy, or surgery for trans young people. For those already on hormone therapy, there is a six-month tapering window. After that, coverage stops. The rule takes effect in October.

Who this actually hits

Medicaid exists for people who cannot afford private healthcare. That is not incidental to this story. It is the story. The families losing coverage on Tuesday are not the families who can quietly switch to a private provider or fly to another state. They are the families for whom that option does not exist, the ones who have already watched hospitals in both Republican and Democrat-led states withdraw care preemptively, who have already calculated what it would cost to relocate and concluded that they cannot. The attack on trans youth healthcare was already hitting poorer families hardest, as the Mother Jones report put it plainly. This rule does not change that pattern. It finalises it.

For a teenager in the middle of a medically supervised hormone protocol, losing that care is not an administrative inconvenience. Their body does not pause while a legal challenge works through the courts. Puberty does not wait. Every month of the wrong one is a permanent physical change that no future treatment fully undoes. Blair's mum understood that when she wrote about worrying not just about the medication itself, but about losing the whole team around her son: the monitoring, the side-effect checks, the relationship built over time with clinicians who knew him. That team, and the insurance that made it possible, is what this rule removes.

What the rule actually rests on

Mehmet Oz, the CMS administrator, told Fox News that the administration was "following the science." He described gender-affirming care as offering "no proven benefits" and posing "serious risks." Every major US medical association disagrees with him. The American Academy of Pediatrics, the American Medical Association, the Endocrine Society, the American Academy of Child and Adolescent Psychiatry: all of them support this care. The Trevor Project has published research showing that access to gender-affirming care is associated with significantly lower rates of depression and suicide risk in trans and non-binary young people.

The report the final rule leans on heavily was commissioned by the Trump administration itself, spearheaded by Leor Sapir of the Manhattan Institute, and authored by people who were already on record opposing this care before they were asked to review it. The American Academy of Pediatrics said publicly that it "misrepresents the current medical consensus and fails to reflect the realities of pediatric care." That is the evidence base Oz cited on Fox News as justification for stripping healthcare from tens of thousands of young people.

This is not a cautious government pausing on uncertain science. This is a political administration citing a politically motivated report to override the medical consensus and remove care from children whose families cannot afford to replace it. Calling it "following the science" does not make it so.

The system has been designed to make the answer impossible

Another parent wrote in the public comment period: "Every decision I have made as a parent is to keep my kid healthy and safe. In an emerging culture where parents' choice is so important to school and child development policies, why is my choice to consult with my child's medical team and make informed decisions being taken away?" That contradiction is deliberate. The same political movement that uses parental rights as a rallying cry in education is removing those rights the moment parents choose to affirm their trans child.

Over 35,000 public comments were submitted on this rule. More than 90 percent opposed it. The administration published the final rule anyway.

Twenty-six states have banned gender-affirming care for minors. Dozens of hospitals have withdrawn it preemptively. Medicaid was the remaining route for low-income families. There is also a second rule in preparation, described in the reporting as a "nuclear weapon," designed to force every hospital in the country to stop providing this care or lose all Medicaid and Medicare funding for all of their patients. That rule is scheduled to be finalised by December.

So when Blair's mum asks what they are going to do, the honest answer is that the system around her has been methodically closed off, route by route, option by option, and is continuing to close. LGBTQ legal organisations have said they will challenge Tuesday's rule in court, and I hope they succeed. The Trevor Project is right that nothing changes overnight. But for a teenager whose body is moving right now, and whose family cannot pay for private care, the courts moving slowly is not a comfort.

What remains

Blair is beautiful. That version of his life, the one his mum did not expect and has come to treasure, is worth protecting. So is every other trans young person facing uncertainty this week, whose family has been told by their government that the care keeping them well is now off the table.

If you are outside the US and looking for a path to gender-affirming medical care, GenderGP can help: a doctor there can look at where you actually are and what is available to you. If you are in the US and trying to understand your options, talk to Sammy here and we will think through it together.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a Gender Specialist, Medical Educator, writer, and advocate, and the founder of GenderGP.