Catholic leaders have formally banned their hospitals from providing gender-affirming care to transgender patients, following a Wednesday vote at the United States Conference of Catholic Bishops. 

Catholic health systems account for 1 in 6 acute care hospitals in the country — and in many rural areas, they are the only available hospital. The Catholic health ministry oversees more than 650 hospitals, according to numbers by the Catholic Health Association, plus another 1,600 health facilities, including those meant for long-term care. However, not all Catholic hospitals have explicitly disclosed their religious affiliation on their websites in the past, creating potential for confused patients seeking care that they cannot access. 

“Catholic providers will continue to welcome those who seek medical care from us and identify as transgender. We will continue to treat these individuals with dignity and respect, which is consistent with Catholic social teaching and our moral obligation to serve everyone, particularly those who are marginalized,” the Catholic Health Association said in a statement on Wednesday. 

The formal gender-affirming care ban follows 2023 guidelines issued by U.S. bishops that urged Catholic hospitals to not provide gender-affirming treatments, “whether surgical or chemical,” as part of a patient’s medical gender transition. Now, that policy is official. Similarly, reproductive health care is heavily restricted at Catholic hospitals due to the church’s opposition to contraception and abortion: birth control pills, IUDs and vasectomies are prohibited, as is abortion. These restrictions limit how doctors at Catholic hospitals can treat urgent pregnancy complications.

That does not always mean patients can’t get help. Some doctors find workarounds for their patients — and it’s been an open secret in Catholic hospitals for some time, said Debra B. Stulberg, chair of family medicine at the University of Chicago, secular institution. She has researched the church’s health care policies as they relate to reproductive health care and gender-affirming care. 

“People who want hormonal contraception — the clinicians are advised that you can’t provide these medicines for the purpose of contraception,” Stulberg said. “But if the patient has really painful periods or really bad acne, you can prescribe it for other reasons.” 

Well before this formal ban on gender-affirming went into effect, Stulberg was looking into instances of trans patients being denied treatment at Catholic health facilities. So far, she and her colleagues have spoken with at least 20 clinicians on the topic, including speech therapists and mental health providers. Several said they were blocked from providing gender-affirming care due to working at a Catholic medical institution. Preliminary results from their work were presented at the National LGBTQ Health Conference in August 2024. 

“The reason that I wanted to do this research is that I was worried that those constraints and confusion and frustration that we have known about from research on reproductive care are now going to affect a whole other area of care, which is access to high-quality care for gender transition,” Stulberg said.

Gender-affirming care has been broadly endorsed by the medical community for its effectiveness in treating gender dysphoria, which is a persistent distress felt when one’s body is out of sync with their identity. The Trump administration has greatly reduced the ability of trangsender youth to access this care and is expected to issue further restrictions through a proposal to prohibit federal Medicaid reimbursement for trans minors’ health care. 

Across the country, hospitals and clinics are continuing to roll back access to gender-affirming care for trans minors while closely tying those decisions to the Trump administration’s policies, said Lindsey Dawson, director of LGBTQ health policy at KFF. Increasingly, health providers are stuck between state laws that require gender-affirming care access and federal policy seeking to limit that care, she said. 

Although U.S. Catholic leadership had already discouraged its medical providers from prescribing gender-affirming care to patients, some doctors in states with protective LGBTQ+ policies have still been able to get around those views — until now.

Now, medical providers at Catholic hospitals will face a new bind: following the edict of the church and their own obligations to their patients. In states like California, Illinois, Wisconsin and Washington state, where large Catholic hospital systems serve much of the population, these choices will be even more difficult, Stulberg said. 

“The group that worries me the most are patients getting care from large Catholic systems in which, up until now, their LGBTQ health policy has been more liberal,” she said. “For those clinicians to now be told you can no longer provide gender-affirming care to trans people is going to affect care for a lot of people.” 

In red states’ rural areas, Catholic leaders’ new rule may not have such a stark impact, Stulberg said — because trans people have likely already needed to find other alternatives to obtain gender-affirming care. But in areas where Catholic health systems are dominant and trans health care is less restricted, this new rule will be a significant change, she said.