PHILADELPHIA — Penn Medicine will no longer provide gender-affirming surgery to patients under age 19, effective this week, citing new federal orders targeting such procedures among transgender minors.

President Donald Trump issued in January an executive order that bars federal funding for gender-affirming care, including hormone therapy, puberty blockers or surgeries for transgender patients under age 19. Such care helps patients to have a body that matches their gender identity and has wide acceptance within the medical community.

The order directed agencies to cease grants and other funding that could be used for gender-affirming care and instructed the U.S. Department of Health and Human Services to review the terms of publicly funded coverage under Medicare, Medicaid and the Affordable Care Act.

Penn is among a growing number of health systems across the country — including UPMC and Penn State Health — that have backed off gender-affirming care services for youth under threat of losing critical federal financial support.

The executive order is not legally binding. But it has had a chilling effect on health systems because it is unclear how far-reaching funding restrictions could be, and whether providers could be at risk of losing federal funding for any type of service if they continue to offer gender-affirming care.

Earlier this week, HHS sent a letter to state medical boards and healthcare providers urging them to comply with the department’s new guidance restricting hormone treatment therapy and surgery for transgender youth. The Centers for Medicare and Medicaid Services sent notices to select hospitals seeking information about gender-affirming care they provide.

Penn does not generally treat minors in its gender-affirming care program, but officials said the health system is in the process of notifying “a small number” of individuals affected by the policy change.

The change is specific to gender-affirming surgical procedures in plastic surgery, gynecology, urology, and otorhinolaryngology. Transgender individuals may seek surgery to make changes to their voice, facial features, chest and breasts or genitals.

Medication and hormone therapy, which are more common treatments among transgender youth, will remain available.

“This is a difficult decision that we know impacts patients and families who place their trust in our care teams,” PJ Brennan, Penn Medicine’s chief medical officer, said in a statement. “We remain deeply committed to ensuring a respectful and welcoming environment for all members of the communities we serve and providing comprehensive medical and behavioral healthcare and psychosocial support for LGBTQ+ individuals while complying with federal government requirements.”

The Trump administration has already paused $175 million in grant funding for University of Pennsylvania for allowing a trans athlete to compete on its women’s swimming team a few years ago — although there was no NCAA or federal ban on trans athletes at that time.

“It’s hard to say how it’s going to play out,” said Lindsey Dawson, director of LGBTQ health policy for KFF, a national health care policy research nonprofit.

Debate over gender-affirming care

Gender-affirming care broadly refers to medical services intended for people whose gender identity does not match the sex they were assigned at birth, a condition known as gender dysphoria. Care could range from voice coaching and hair removal to hormone therapy and surgery.

Conservative lawmakers have pushed for bans on such services, particularly among children, arguing that some therapies are irreversible and could have significant side effects.

In his letter to states and providers, HHS Secretary Robert F. Kennedy Jr. told providers and states that he expects them “to update your treatment protocols and training to ensure that our nation’s children are protected from harm.”

He indicated that the department is considering new policies “to hold providers that harm children accountable.”

The American Academy of Pediatrics and other major medical organizations have said that gender-affirming care may be medically appropriate for children. They cite research showing young people with gender dysphoria experience higher rates of suicide, self-harm, depression and anxiety.

The number of children between ages 6 and 17 diagnosed with gender dysphoria more than doubled between 2017 and 2021, according to research by Reuters and Komodo Health, a health care technology company. Use of puberty blockers and hormone therapy is also on the rise, according to a 2022 investigation by Reuters.

But surgery remains rare. About two out of every 100,000 teenagers aged 15 to 17 has received a gender-affirming surgery, according to a study by Harvard researchers. Breast reductions accounted for the greatest share of gender-affirming surgeries, according to the study.

Talk therapy, puberty blockers and hormone therapy are more common treatments for transgender youth, said Ellen Kahn, a senior vice president with the Human Rights Campaign, which advocates for LGBTQ issues.

The Penn Medicine Program for LGBTQ Health provides a range of basic and specialized health services, in addition to surgery. Services include hormone replacement therapy, fertility support, mental health services, gastroenterology and dermatology.

Doctors may recommend surgery for transgender teenagers stable in their identity and seeking to complete surgeries before beginning a new life chapter, such as going to college, she said.

“It’s an important milestone for some — but not all — to get those things behind them when they’re starting a new chapter,” Kahn said.

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(Inquirer staff writer Abraham Gutman contributed to this story.)

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