What the Records Show: UW Health’s Pause on Gender-Affirming Care for Youth

The short version. In January 2026, UW Health stopped prescribing puberty blockers and hormone therapy to patients under 18. It pointed to federal pressure. The internal records behind that decision are now public, and they show no clinical reason, no board vote, and no paper trail for who actually made the call. UW Health also stopped months before any federal penalty could have reached it. In April 2026 a federal court struck down the federal order UW Health pointed to, in a case Wisconsin joined. UW Health still has not resumed care.

A Wisconsin public records request pried loose the internal records behind the decision. They are now published in full, and you can read every page yourself. Every claim below that comes from those records links to the document it came from, in the Gender-Affirming Care collection at Glass Government, a public records reading room.

A decision driven by federal pressure, not by care

Every record UW Health produced points in the same direction: the pause was a response to federal regulatory risk, not to any reassessment of patient care. No document offers a clinical reason, cites new evidence, or references a review of how patients were doing.

The internal announcement that carries the chief clinical officer’s byline puts the mechanism plainly. Hospitals must meet federal Conditions of Participation “not only to participate in the Medicare and Medicaid programs but also to operate as a hospital in Wisconsin,” and a December 2025 federal declaration “has already been used to refer several children’s hospitals across the country for investigation.” You can read that document here: Updates to Pediatric and Adolescent Gender Affirming Care.

The sentence that announces the decision names no one at all. It is written in the passive voice: “it was determined that UW Health will not provide hormone therapy and puberty blockers to patients under the age of 18 at this time.” Nothing in the records says who determined it. (See also the internal Statement on changes to gender-affirming care.)

They stopped months before any penalty could reach them

This is the sharpest thing in the file. On January 16, 2026, the same day the pause took effect, UW Health leadership circulated a bulletin from the Children’s Hospital Association. By that bulletin’s own account, the federal government had agreed not to take any action against providers until a court ruled on a challenge brought by 21 states, or until 30 days after oral argument set for March 19. In plain terms, no federal penalty was going to land in the near term.

UW Health stopped prescribing anyway, on January 16. The federal rules it pointed to were still only proposed, sitting in a public comment window, with no rule yet in force. You can read that circulated bulletin here: CHA Washington Update, January 16, 2026.

The same email thread shows leadership still working out the basics that morning, with one senior staffer asking who had even made the statement about immunity, the federal agency or the trade association.

And the penalty never came. On April 18, 2026, a federal court struck the federal order down (see “Where things stand” below).

No board reviewed it. No paper trail exists.

The request asked for anything presented to a board, committee, executive council, or leadership body. UW Health’s answer was flat: “no records were presented to, reviewed by or distributed to any UWH board, committee, executive council or leadership body.”

A decision to end a service line for a defined group of patients, at an institution created by state statute, generated no governance record at all. When the response tried to point the public toward open board meeting minutes, the address it gave for them was an email address, labeled as a website. As written, even that route does not work. See the public records response letter.

The decision-making itself is sealed

Everything about how the decision was actually reached, the legal memos, the risk assessments, the executive and legal communications, was withheld in full. UW Health claimed attorney-client privilege, the common-interest doctrine, attorney work product, and a state exclusion for drafts and notes. No privilege log was provided, so there is no public accounting of how much was withheld. One of the legal citations the response leans on cannot even be matched to a named case. The details are in the response letter.

What it means for patients

From the confidential talking points for care teams and the internal announcement, the records describe the effect this way:

  • New prescriptions of puberty blockers and hormone therapy for gender dysphoria in patients under 18 stopped.
  • Existing refills can still be filled.
  • Histrelin implants will not be replaced. A patient keeps the implant, but once it stops working it is not renewed.
  • Routine monitoring labs move to a patient’s “new provider” after January 16. The records assume patients will find another provider and describe no referral pathway to help them.
  • The PATH Clinic stays open, adult care is unaffected, and no staff lost their jobs.

Patients were told by direct phone calls, and the talking points braced care teams for “higher call volumes.”

A carefully managed message

The care-team script tells staff, in bold at the top of both pages, that it is “important to consistently share that UW Health is pausing prescribing.” Staff were given word-for-word scripting, a set phrase to document each conversation, and one route for any press question, straight to a single communications staffer.

That word, “pausing,” is doing a lot of work, and UW Health defends it again seven months later in its response letter. Yet the same script answers the obvious question this way: “How long will this change be in effect? There is no end date at this time.” By the date of the response, the “pause” had run six months with no endpoint. See the talking points and the patient relations reply template.

Where things stand now

This part goes beyond the records, and it is sourced to the courts and to news reporting, not to the UW Health file.

The federal order was struck down. On April 18, 2026, a federal judge in Oregon ruled against the Trump administration in a lawsuit brought by 21 states and the District of Columbia, including Wisconsin. The court vacated the December 2025 HHS declaration that UW Health’s records lean on, and issued a permanent injunction barring the government from enforcing it, or any materially similar policy, against hospitals in those states. The court found the administration had bypassed states’ authority to set the standard of care and skipped the rulemaking process the law requires. (KPTV, Becker’s Hospital Review)

The rule was not withdrawn, and it is not in force. Separately from the struck-down declaration, HHS has kept pursuing a formal rule. It sent a final version to White House budget-office review on June 16, 2026, and on July 15, 2026 it publicly rejected reporting that it planned to abandon the effort, saying it “has not withdrawn or reversed course” and intends to issue a final rule. As of now, that rule is not final and has not taken effect. (DistilINFO)

UW Health still has not resumed care. Even after the April ruling in Wisconsin’s favor, UW Health told The Advocate it does not plan to resume, saying that while it still believes this is evidence-based care, “the current risk is too great to resume this care.” (The Advocate, Wisconsin Public Radio)

Wisconsin has been asking loudly. In June 2026 the Dane County Board of Supervisors passed a resolution calling on UW Health to resume care. More than 65 Wisconsin organizations, faith communities, and businesses signed a coalition letter led by Fair Wisconsin and GSAFE. And the Transgender Resistance Action Committee has rallied in Madison and gathered more than 800 signatures on its own petition.

What we are still asking

The records answer some questions and raise others:

  • Who actually decided? Not one document names a decision-maker.
  • Where are the board minutes for late 2025 and early 2026? The pointer UW Health gave does not work, so they have to be requested directly.
  • What is the plan to resume? The federal order is blocked and Wisconsin was on the winning side. UW Health says the risk is still too great, but the records show no clinical reason it stopped and no criteria for when it would start again.

Add your name

If you want UW Health to restore this care, these Wisconsin campaigns are the place to start:

Read the records yourself

All six records are public, in full, at Glass Government:

Or browse the whole Gender-Affirming Care collection.

These records were obtained under Wisconsin’s public records law, Wis. Stat. sections 19.31 to 19.39. “UW Health” is a trade name for two entities, the University of Wisconsin Hospitals and Clinics Authority and the University of Wisconsin Medical Foundation. The response was issued on behalf of both.