Stanford Medicine is no longer providing gender-affirming surgeries to LGBTQ+ patients under the age of 19, a move it says was influenced by the “latest actions and directives” from the Trump administration.

The move, which sparked dismay among transgender advocacy groups, marks a major shift for what had been the Bay Area’s top provider of such procedures.

“After careful review of the latest actions and directives from the federal government and following consultations with clinical leadership, including our multidisciplinary LGBTQ+ program and its providers, Stanford Medicine paused providing gender-related surgical procedures as part of our comprehensive range of medical services for LGBTQ+ patients under the age of 19,” the health care provider said in a statement to this news organization. The change was effective June 2.

Since President Donald Trump signed an executive order in January seeking to ban, defund and criminalize gender-affirming chemical and surgical care for all youth under 19, the administration has been trying to restrict access to care by threatening to withhold federal funding from providers that offer it. The care in question includes medical and mental health services to support a person’s gender identity, or their sense of feeling male, female, neither or some combination.

In Southern California, Children’s Hospital Los Angeles is closing its Center for Transyouth Health and Development on July 22. In a statement, the hospital said although it was proud to have provided “high-quality, evidence-based, medically essential care for transgender and gender-diverse youth, young adults and their families,” it has been left with “no viable path forward” other than to closure.

Stanford did not immediately respond to a question about how many young people the discontinuation will affect but the institution’s Lucile Packard Children’s Hospital was the leading provider of comprehensive gender-affirming care across Northern California. Stanford will continue to provide non-surgical care.

“We took this step to protect both our providers and patients,” Stanford said. “This was not a decision we made lightly, especially knowing how deeply this impacts the individuals and families who depend on our essential care and support. Even as circumstances change, we remain committed to providing high quality, thorough and compassionate medical services for every member of our community.”

But Jorge Reyes Salinas, director of communications at Equality California, the largest statewide LGBTQ+ civil rights organization, said the move is the opposite of protection for patients.

“Transgender health care is health care,” he said. “What we’re seeing is Children’s Hospital of Los Angeles and Stanford joining this anti-transgender rhetoric from the Trump administration, which is now going to fully harm, physically harm, the well-being of youth. We’re seeing these health care providers turn their backs against the most vulnerable youth in our community. And this goes against California law.”

California Attorney General Rob Bonta has maintained that there should be no change to health care services protected by the state’s laws, which includes gender-affirming surgery, including those from other states.

Stanford declined to comment on questions about its compliance with California law.

Stanford’s decision preceded a U.S. Supreme Court ruling upholding Tennessee’s ban on gender-affirming care. More than half of states, including Oklahoma, Texas and South Carolina, have passed bans on gender-affirming care for children or young adults.

Other major Bay Area health care providers, including Kaiser Permanente, Sutter Health and UCSF, did not respond to requests for comment on their own policies surrounding gender-affirming care.

According to the Williams Institute at the UCLA School of Law, roughly 49,000 children 13-17 and 25,500 youth 19-24 in California identify as transgender.

Rachel Dowd, a spokesperson for the institute, cautioned not all of these individuals are necessarily socially transitioning or seeking chemical or surgical gender-affirming care.

Gender-affirming surgery, such as operations to transform genitals and chests, is rarely offered to minors. A study published this year in JAMA Pediatrics found that fewer than one in 1,000 U.S. adolescents receive gender-affirming medications such as hormones.

Reyes Salinas said he understands the fear of losing federal funding and other pressures from the Trump administration, “but there are laws in California that ensure that this cannot happen, and now essential health care is on the line.”