Duke Health continues to offer gender-affirming care amid ongoing legal battles over the Trump administration's effort to upend federal funding of the practice.
President Donald Trump signed an executive order Jan. 28 titled “Protecting Children from Chemical and Surgical Mutilation.” The order threatened to revoke federal funding from institutions that provide gender-affirming care including puberty blockers, hormone therapy and surgeries to patients under the age of 19.
“It's real … and if you treat it, people get better,” said Greg Sawin, Duke Health vice chair for education and faculty development, regarding gender dysphoria and gender-affirming medicine. “It's life-saving treatment, period.”
Duke Health currently offers various types of gender-affirming care, including hormone therapy, gender-affirming voice coaching and top surgery.
U.S. District Court Judge Brendan Hurson initially issued a pause on the order Feb. 13 in response to a lawsuit from families with transgender or nonbinary children. He issued a preliminary injunction Tuesday to extend the pause, one day before the expiration of the initial restraining order.
So far, Duke Health has not changed its policies for gender-affirming care in response to the order. The executive order takes direct aim at guidance on gender-affirming care provided by the World Professional Association of Transgender Health, an organization of which many Duke Health providers are members.
Duke Health is currently abiding by North Carolina laws, passed in August 2023, which limit gender-affirming care for minors. According to Sawin, underage patients who were already under care at the time of that ban were allowed to continue treatment.
Now, the Trump administration seeks to restrict gender-affirming care specifically for 18-year-olds, Sawin said. As a result, he shared that some patients are “terrified” and “contemplating on whether they should leave the country,” depending on whether they would be able to continue receiving such care.
“Obviously, Duke can't break the law,” Sawin said. He noted that if a law passes that prevents gender-affirming care, he believes Duke Health would “publicly dissent,” but still “follow the law.”
He added that he is “confident” that Duke Health will not make any policy changes to stop treating such patients without a law in place.
However, he said that Duke must do a “delicate dance” of adhering to its values while not “waving a flag” amid National Institutes of Health funding cuts — adding that such cuts are “designed to attack research institutions [and] academic medical centers.”
“[Duke has] to be super careful in this chess game that they're playing because it's millions and millions of dollars and people's jobs,” Sawin said, adding that Duke Health has been wholly supportive of its employees who offer gender-affirming care and proactive about communicating any policy changes.
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Winston Qian is a Pratt sophomore and health/science editor for the news department.