Federal Pressure on Transgender Care Reaches San Francisco Clinics

A sweeping federal campaign to curb gender-affirming care for minors is testing the limits of Washington's authority over medicine.

Mar. 16, 2026 at 6:07pm by Ben Kaplan

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A sweeping federal campaign to curb gender-affirming care for minors is testing the limits of Washington's authority over medicine and placing San Francisco clinics at the center of a national legal battle, leaving transgender adolescents uncertain about whether their treatment will continue. Federal policy debates about transgender health care are already affecting the San Francisco Community Health Center, even though new federal regulations have merely been proposed.

Why it matters

The federal government's efforts to restrict gender-affirming care for minors could have significant implications for transgender youth and the clinics that provide this care, particularly in progressive cities like San Francisco that have positioned themselves as leaders in LGBTQ+ healthcare. This issue highlights the tension between federal authority and local control over medical practices.

The details

The U.S. Department of Health and Human Services has proposed new federal policies that would bar hospitals receiving Medicare and Medicaid funding from providing gender-affirming care to minors. Critics say this could effectively function as a nationwide ban, as most hospitals rely heavily on federal funding. The San Francisco Community Health Center has already lost some federal funding due to its work serving transgender patients, and clinicians are being forced to weigh the needs of their patients against potential legal and financial consequences.

  • In December 2025, U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. announced new federal policy proposals.
  • Shortly after the administration took office in 2025, the San Francisco Community Health Center lost federal funding due to its work serving transgender patients.

The players

San Francisco Community Health Center

A community health center in San Francisco that provides care to transgender patients of all ages.

Dr. Tatyana Moaton-Santiago

The chief strategy and workforce officer at the San Francisco Community Health Center.

Lance Toma

The chief executive officer of the San Francisco Community Health Center.

Robert F. Kennedy Jr.

The U.S. Department of Health and Human Services Secretary who announced the new federal policy proposals.

Eric

A 15-year-old sophomore at Oakland High School who began hormone therapy after working with doctors, therapists, and his family.

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What they’re saying

“We're done with junk science driven by ideological pursuits, not the well-being of children.”

— Robert F. Kennedy Jr. (sfpublicpress.org)

“You don't have to ban something outright to restrict access to it. You just have to make people afraid — afraid to provide it, afraid to seek it, afraid to fund it.”

— Dr. Tatyana Moaton-Santiago, Chief Strategy and Workforce Officer, San Francisco Community Health Center (sfpublicpress.org)

“I do worry that the care could get cut off. Testosterone is a controlled substance. If my doctors aren't allowed to prescribe it to me anymore, then I have to find some way to get this thing that I really need to live my life.”

— Eric, 15-year-old Oakland High School Student (sfpublicpress.org)

What’s next

The federal proposals are still moving through the rulemaking process, and courts will likely decide whether the policy exceeds federal authority if the agency attempts to enforce the restrictions.

The takeaway

The federal government's efforts to restrict gender-affirming care for minors are creating significant uncertainty and anxiety for transgender youth and the clinics that provide this care, even in progressive cities like San Francisco that have positioned themselves as leaders in LGBTQ+ healthcare. This issue highlights the ongoing tension between federal and local control over medical practices.