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New York City Council
Oversight - Access to Gender-Affirming Care and Associated Mental Health Outcomes for Transgender and Nonbinary Youth
Read summaries and jump into the video at the segment start.
Staff announces the joint hearing with Mental Health and Substance Use, Women and Gender Equity, and Hospitals committees. Staff asks everyone to silence devices and tells the chair they are ready to begin.
Council Member Tiffany Cabán states her pronouns and role as chair of the Committee on Mental Health and Substance Use. She thanks Chairs Narcisse and Farías and recognizes Public Advocate Jumaane Williams and other members joining.
Cabán says transgender and nonbinary New Yorkers face federal threats and institutional capitulation. She cites research linking affirming care to roughly 60% lower odds of moderate to severe depression and over 70% lower odds of suicidality.
Cabán describes Intro 949 from Council Member Shulman, Resolution 208 from Council Member Hanif, and her own Resolution 547. She thanks committee and personal staff and passes the mic to Council Member Narcisse.
Council Member Mercedes Narcisse introduces herself as chair of the Hospitals Committee and names the co-chairs. She defines gender-affirming care and describes higher anxiety, depression, and suicidality among transgender and nonbinary youth.
Narcisse says the federal government is limiting access and creating challenges for H&H and DOHMH. As a registered nurse and hospital chair, she commits to pushing back and says the hearing will examine services and legislation.
Narcisse thanks senior legislative counsel, policy analyst, legislative analyst, and her staff for preparing the hearing. She recognizes joined members and turns the mic to Chair Farías.
Council Member Amanda Farías introduces herself as chair of Women and Gender Equity. She cites Human Rights Campaign analysis that 27 states plus Puerto Rico passed bans affecting 48% of transgender youth, and a survey showing 87% of trans youth using hormones feared losing access.
Farías says transgender and nonbinary youth experience higher anxiety and depression. She cites a 2025 Trevor Project survey finding youth unable to access wanted hormones were nearly twice as likely to attempt suicide, and notes major medical associations support affirming care.
Cabán turns to Public Advocate Jumaane Williams. Williams thanks the chairs and calls for expanding affirming care through public hospitals, school-based health centers, and community organizations, citing Local Laws 126 and 127 on patient rights and training.
Williams says LGBTQ+ individuals face higher chronic disease, mental distress, and substance use, worsened by stress. He criticizes medical education for failing to train clinicians in sexual orientation and gender identity care, forcing patients to educate providers or avoid care.
Williams says he has been public about his journey and speaks to parents who love their children. He warns against using surgery restrictions to take away broader access, compares it to abortion restrictions, and calls for protecting trans youth.
Cabán thanks Williams and asks committee counsel to swear in administration witnesses. Staff administers the affirmation to tell the truth and respond honestly to Council questions.
Taylor Brown gives her pronouns and role as inaugural director of the Mayor's Office of LGBTQIA+ Affairs. She thanks the committees and states the administration opposes federal attacks and is alarmed by private providers caving to pressure.
Brown describes gender-affirming care as interdisciplinary services for gender dysphoria, citing WPATH Standards of Care 8 and Endocrine Society guidance. She explains individualized treatment including social transition, puberty blockers, and hormone therapy based on age and clinical criteria.
Brown says opponents falsely claim surgeries are performed on youth at high rates. She cites a 2024 Harvard study finding little to no utilization of gender-affirming surgeries by trans and nonbinary youth, and says mental health risks stem from stigma and lack of support.
Brown shares 2023 survey data showing suicidal ideation among trans 42%, nonbinary 38%, other gender identity 45%, and questioning 28% students versus 16% cisgender. Suicide attempts were trans 49%, nonbinary 29%, other 33%, questioning 61%, and cisgender 9%.
Brown describes federal executive orders, funding cuts, investigations, and regulatory actions. She says NYU Langone, Mount Sinai, and New York Presbyterian began ceasing youth gender-affirming care in early 2025, and Mount Sinai and NYU later entered DOJ settlements to end puberty blockers and hormone therapy.
Brown says the Mamdani administration announced a $15 million, three-year investment. It includes a direct care access fund, a confidential health department call and chat line, research on access gaps, gender marker change support, and coordination and evaluation.
Brown cites the Trans Rights or Human Rights campaign and a forthcoming rights and resource guide. She says H&H and DOHMH continue providing age-appropriate care, supports Intro 949, and notes existing DOHMH LGBTQ health pages, the Health Care Bill of Rights, and NYC Health Map. She then transitions to H&H testimony.
Dr. Andrew Wallach introduces himself as Ambulatory Care Chief Medical Officer at NYC Health and Hospitals, joined by Dr. Omar Fattal. He describes H&H's safety-net mission and history, including 2011 mandatory LGBTQ+ training and the 2014 Metropolitan Pride Health center.
Wallach says H&H treats each patient as a whole person and gender-affirming care is not one-size-fits-all. Providers use informed consent with patients and families, make behavioral health referrals, use correct pronouns, create safe spaces, and document in gender-affirming ways.
Wallach describes the Elmhurst Suicide Prevention and Youth Program, Trans Health Fest, and training referencing WPATH Standards of Care 8. He says all eligible H&H facilities have earned LGBTQ+ Healthcare Equality Leader designations and long-term care facilities earned equality leader recognition. He closes promising care without exceptions.
Cabán cites peer-reviewed studies and guidance from the American Academy of Pediatrics and Endocrine Society. Taylor Brown defers to DOHMH, whose staff are sworn in; Marnie Davidoff cites a 2022 study of 104 youth and a 2023 study of 300 youth showing lower depression, self-harm, and suicidality.
Cabán asks whether denial of puberty blockers or hormone therapy elevates suicide risk and whether DOHMH reflects affirming care in suicide prevention planning. Davidoff says yes, citing Trevor Project research and youth suicide prevention efforts focused on marginalized youth.
Cabán asks whether DOHMH has seen utilization changes since federal actions and how it monitors them. Davidoff says 988 counselors are trained on LGBTQ youth needs and referrals, but anonymous, time-limited crisis calls limit demographic tracking.
Cabán describes a secondary mental health crisis driven by fear and care disruption. Taylor Brown says untreated gender dysphoria worsens over time and cites a Nature study finding a 72% increase in suicide attempts in states with anti-trans laws.
Cabán shares her own experience with a chronic condition and asks about protective factors beyond medical care. Davidoff names family support and affirmation, caring adults, peers, teachers, youth development, and community safety as protective against depression, suicidality, and substance use.
Cabán asks Davidoff to flesh out the idea of connectedness. Davidoff says it means being seen and affirmed in gender identity and pronouns, and that affirmation and support are central to connectedness.
Cabán cites research that family acceptance reduces suicide risk and asks about programming for parents. Davidoff describes Family Youth Peer Support Alliances in each borough and the Strong Families and Communities Training Center, with Queens and Staten Island alliances doing focused work.
Narcisse frames the hearing around fairness, support, and access to care. She asks what H&H clinical experience shows; Omar Fattal says research and evidence show affirming care lowers depression and suicidality and improves overall mental well-being.
Narcisse asks about clinician capacity for TGNB patients. Fattal says H&H child and adolescent behavioral services have capacity across boroughs, patients can be referred internally or call 1-844-NYC4NYC, and Narcisse praises H&H for not turning people away.
Narcisse asks about the value of coordinating mental health support with affirming care. Wallach cites his 29 years at H&H and integrated physical and behavioral health programs; Fattal says H&H connects patients internally between primary care and behavioral health.
Narcisse says she works for H&H as a nurse and believes in the care provided, and mentions Elmhurst never turning anyone away. Fattal jokes that H&H does not mind her being biased.
Narcisse asks whether staff have observed increased anxiety among patients and families. Wallach says H&H is hearing rumblings from patients and aims to reassure through updated public websites, social media, patient emails, and exam-room communication.
Narcisse asks how H&H involves and supports parents and caregivers, given family acceptance's protective role. Fattal says child and adolescent behavioral services include families and caregivers, H&H works in 50 schools, and the same approach applies to LGBTQ patients.
Narcisse describes ER experience where family beliefs can obstruct care for young people. Fattal says H&H treats the whole person including family, while practicing within New York State OMH guidelines and regulations.
Narcisse notes Pride centers are mostly in Manhattan, the Bronx, and Brooklyn and asks about expansion as private hospitals pull back. Wallach cites telehealth, system-wide referrals, and lists Pride sites including Lincoln, Bellevue, Woodhull, Metropolitan, Elmhurst, Jacoby, Gotham Gouverneur, and Gotham Judson.
Narcisse thanks H&H for its support and advocates for keeping New York City health care available to all. She passes the mic back to Chair Cabán.
Farías asks whether the NYC Youth Risk Behavior Survey or other DOHMH surveys capture gender identity. Davidoff confirms the YRBS for high school and middle school public school students captures gender identity data.
Farías asks what the gender identity data show on depression, anxiety, self-harm, and suicide. Davidoff says disparities exist and cites 2023 suicidal ideation rates: trans 42%, nonbinary 38%, other gender identity 45%, questioning 28%, and cisgender 16%.
Farías asks what immediate support exists for a young person or family after care disruption, before a formal complaint. Brown discusses state inpatient discharge rights and professional continuity-of-care rules, but says there is no clear city analog and may follow up.
Staff swears in another witness who cites the $15 million investment's call and text line as a backstop linking New Yorkers to care. Farías asks for concrete steps and bilingual aftercare; Brown says city language access rules would require that.
Farías asks Brown to connect her litigation background to the office's current work. Brown describes prior roles at the NYS Attorney General's Civil Rights Bureau, ACLU, and Lambda Legal, doing impact litigation for transgender people, and says that experience informs using legal tools amid federal hostility.
Farías asks what legal developments Brown is watching and how the Council can help. Brown says she monitors the federal register, Supreme Court docket, and litigation, flags data as a key area likely needing legislative solutions, and wants to meet LGBTQI people in Council districts.
Cabán thanks Farías for asking about collaboration opportunities. She says the Council has passed TGNC and NBI protections and funding, and is ready to partner with the administration on innovation.
Cabán asks how the Mayor's Office of LGBTQ Affairs coordinates with other agencies and whether it will outreach hospitals about youth affirming care. Brown describes cooperation with CCHR, the Law Department, OCH, DOHMH, and H&H, plus planning around H.R. 1 and public awareness.
Carl Wilson asks how the city assesses capacity and mental health impacts when major hospital systems stop youth affirming care. Wallach says H&H monitors demand and capacity and stands ready to support all patients; Fattal says mental health capacity exists and gives the contact center number.
Wilson asks about system-wide safeguards during policy uncertainty. Wallach says H&H has not changed its scope of practice for gender-affirming care.
Wilson asks whether H&H will notify the Council of significant policy changes affecting equitable access without unnecessary clinical detail. Wallach emphasizes HIPAA, patient rights, annual compliance training, and following law on release of information.
Cabán notes the Health Map's LGBTQ health services portal and asks how often provider information is verified. Andrea Howard is sworn in and says the section launched in 2018, participation is voluntary, and DOHMH is reviewing and surveying providers, including updating Mount Sinai and NYU listings.
Cabán says DOHMH is relying on providers to report changes and asks about other ways to verify accuracy. Howard says a comprehensive survey is planned for the fall and asks the Council to flag inaccuracies; Cabán suggests proactive outreach to advocacy groups.
Cabán asks if the map indicates which providers offer gender-affirming care for youth separately from adults. Howard says users can filter by primary care, gender-affirming care, sexual health, and behavioral health, and by adult or youth services.
Cabán asks Council Member Epstein if he has questions; he does not. Cabán thanks the administration witnesses and ends the agency Q&A portion.
Cabán opens the hearing to public testimony and reminds attendees to observe decorum. She explains the witness table, limits on recording, appearance cards, three minutes to speak, and written testimony submission within 72 hours.
Cabán names the first panel: Maxima Rodas, Nat Moog, Filament Kind, and Asha Lyons. She gives mic instructions and wishes Asha well.
Nat Moguet of the New York Transgender Advocacy Group describes cost, housing, transportation, food insecurity, and lack of culturally competent providers. Moguet cites 17.3% of trans New Yorkers reporting cost barriers and 36.2% reporting transportation or housing insecurity, and supports Intro 949, Res 208, and Res 547.
Maxima Rodas, a NYTAG program participant, describes being misgendered despite ID changes and clinics not training front desk staff to relay affirming information. She notes overlooked conditions like diabetes, cancer, and heart disease, and barriers for immigrants and undocumented people; she supports Intro 949. Cabán thanks her and notes Council Member Gutierrez joined.
Filament Kind describes past hospitalizations for self-injury and finding care at Callen Lorde, now two years on testosterone. Kind says word-of-mouth access creates gaps and Intro 949 would help others find life-saving care; supports Intro 949, Res 208, and Res 547. Cabán thanks the advocates and youth submitting written testimony.
Cabán names the second panel: Ocean D. Waves, Cygnus Pavo, Zev Frank, and Ellis Jablansky. She gives instructions on using microphones.
Ocean D. Waves, a 20-year-old Afro-Latino transgender man, describes homelessness and daily testosterone as essential care. He describes biochemical dysphoria and says Intro 949 would expand access to gender-affirming, dental, primary, reproductive, and mental health care; supports all three measures.
Zev Frank, a Youth Advocacy Fellow at NYTAG, says even supportive parents were lost trying to help with hormone replacement therapy. He describes misinformation and fear when searching for trans health care and says city-verified resources through Intro 949 would reduce doubt; supports Intro 949, Res 208, and Res 547.
Ellis Jablonski says Mount Sinai called about handing over trans patient records to the federal administration, which he called a privacy violation. He also describes misgendering, deadnaming, and an unsolicited procedure pitch at an orthodontist; supports Intro 949, Res 208, and Res 547.
Cygnus Pavo, a Youth Advocate Fellow at NYTAG, says trans people struggle to find affordable, reputable, gender-affirming clinics. He describes friends refused hormone therapy at pharmacies and says a DOHMH LGBTQ+ health section would be a vital commitment; supports Intro 949, Res 208, and Res 547.
Cabán invites the panel to suggest additional city actions. Cygnus Pavo says the hardest part of receiving care is finding therapists or providers aware of transgender struggles and asks for improved mental health and psychiatric care access.
Ocean D. Waves says government should stop erasing trans and queer history, citing the removal of a Marsha P. Johnson monument. Cabán agrees and discusses increasing representation, monuments, and funding for queer and trans artists.
Zev Frank says trans people need safe practitioners for binding and other aspects of life, not only gender-affirming care. He says being visibly or openly trans can affect care even at a dentist or outside gender-affirming settings.
Ellis Jablonski says the Council listening to trans residents matters. He describes difficulty accessing a gender-neutral restroom at a public pool and urges positive, authentic media representation; Cabán thanks the panel and encourages follow-up.
Narcisse praises the witnesses' strength and leadership. She says their willingness to testify and speak with love will push back against hate and urges them to keep using their voices.
Cabán acknowledges that Council Member Pierina Sanchez joined. She thanks the panel and moves to the next speaker.
Cabán introduces Manhattan Borough President Brad Hoylman-Sigal. He thanks the Council, notes Stonewall, and says at least 27 states restrict gender-affirming care while New York is becoming a safe haven.
Hoylman-Sigal describes an expected federal Medicaid and CHIP reimbursement rule, DOJ subpoenas for patient records, and SHIELD Law 2.0 notification protections. He says Lambda Legal, ACLU, and NYLPI won an injunction, and that NYU Langone and Mount Sinai settlements ended youth gender-affirming medical care.
Hoylman-Sigal calls the settlements federal overreach and quotes a parent saying New York protects its children. He urges passage of Intro 949 and the resolutions, but says the city's $15 million commitment will not cover the impending loss of Medicaid dollars.
Cabán thanks Hoylman-Sigal for his testimony. She announces the next panel: Judith Goldner, Brie Farron, Tatiana Cruz, Alexia Sol, and Ronan Tuggle.
Judith Goldner of the Legal Aid Society says Legal Aid was lead counsel in Cruz v. Zucker and is committed to gender-affirming care. She says Mount Sinai and NYU are dumping patients without continuity, supports Res 547, and is mostly supportive of Intro 949 but warns the map could lead to harassment and threats.
Tatiana Cruz of Make the Road New York and the NYC Trans and Queer Coalition says she fled Florida for safety and care. She says affirming care improved her emotional well-being and helped her overcome substance abuse, and describes 17-year-old Jade losing care; supports Res 547 and Res 208.
Alexia Sol describes lacking hormone therapy, surgeries, and emotional support as a young trans woman and having two suicide attempts. She urges New York City to invest in gender-affirming care and community health and supports Res 547 and Res 208; Cabán reads the English translation.
Brie Farron, a nurse practitioner at Planned Parenthood of Greater New York, says PPGNY conducted over 3,100 gender-affirming hormone therapy visits for over 1,500 people in 2025. She supports Intro 949, Res 208, and Res 547 and asks that Res 208 include nursing, pharmacy, and allied health students.
Ronan Tuggle of the NYCLU says the organization has seen more intakes from trans New Yorkers and supportive parents seeking care, plus anecdotal reports of increased suicides. He supports Res 547 but wants the state definition of gender-affirming care expanded to mental health and other affirming care while excluding non-consensual intersex surgeries; supports Intro 949 with map safety concerns.
Cabán notes she has been working on Spanish with Council Member Gutierrez. She calls the next panel: Jan Ousting, Bianca Garcia, Reina Bien, Wren Galloway, and Kristen Clifford.
Wren Galloway of the Ali Forney Center says gender-affirming care and mental health care cannot be separated. He describes barriers compounded by homelessness, immigration status, and unstable coverage, asks how the city measures access and protects privacy, and supports Intro 949 with updates and safeguards.
Biana Garcia of Make the Road New York and the NYC Trans and Queer Coalition says she injected hormones bought on the street at 17. She says many trans people still buy hormones and silicone on the black market and supports Intro 949, Res 208, and Res 547.
Raina Bien, board chair of Transformative Schools and parent of a nonbinary seventh grader, says her 12-year-old was kicked out of NYU, lost their doctor, and had records tied up in a lawsuit. She describes families driving hours or paying out of pocket for puberty blockers and asks the city to expand ages, train providers, and consider a city-run pediatric clinic.
Kristen Clifford, mother of two trans kids, says NYU Langone ended health care for her teenager due to political pressure. She says DOJ requested their private records, NYU paid over $8 million and stopped medically necessary care, and puberty blocker implants are hard to access due to insurance coding; she urges the city to attract and support affirming practitioners.
Cabán thanks the panel, especially the parents, and asks if they want to expand on how the city can support their families. Kristen Clifford says their kids are lucky to have them, but the city must support kids who do not have supportive parents.
Cabán asks if there is another panel and then calls Kimberly Blair, Annabelle Ruggiero, Rae Blazin, JJ Cleo Mizrahi, and Andy Bowen. She apologizes in advance for mispronunciations.
JJ Cleo Mizrahi says trans people are dehumanized and stigmatized, causing fear around taking hormones and facing harassment. Mizrahi says gender care includes support groups, counseling, and social services, describes discrimination in a union and a psych ward, and supports the resource map.
Annabelle Ruggiero says she helped organize the Mount Sinai protest and thanks Director Brown for attending. She supports Intro 949 but says such steps should have happened earlier, blames collective inaction, and demands public consequences for Mount Sinai and NYU, financial support for institutions that stand by patients, and taxing the rich to offset federal health care cuts.
Rae Blazin, a public health professional testifying personally, says an LGBTQ resource map already exists at DOHMH. Blazin says Intro 949 would codify and protect it and allow greater provider granularity, and describes needing word-of-mouth after a provider left NYU; supports the map with provider safety and an implementation timeline.
Kimberly Blair of Girls for Gender Equity says about 1 in 5 TGNCNBI youth report attempting suicide and nearly 50% seriously consider it. She says anti-trans laws increased suicide attempts by as much as 72% in restrictive states, and Intro 949 would relieve community organizations of updating resource lists; supports all three bills.
Cabán appreciates Mizrahi's comments about faith and saving a life. Mizrahi describes growing up in the Orthodox Jewish community, family rejection, internalized negative messages, and says the trans community remains on guard and fearful until Trumpism ends.
Cabán says this is the last in-person panel and calls Angelica Jadanandan and Mohamed Irtaza, then also calls Andy Bowen. She apologizes for any mispronunciations and gives mic instructions.
Angelica Jadunandan, mother of an eight-year-old transgender daughter, says her family moved from Florida to Brooklyn for legal protections. She describes learning that trans kids do best when loved and supported, hopes affirming care remains available if needed, and urges New York City to remain a beacon.
Andy Bowen of the Queer Budget Center and an H&H patient says the Trump administration loses when challenged and that the city should align the Law Department, chief counsel, and corporation counsel to protect affirming care under the Human Rights Act. Bowen says city contracts with hospital systems give leverage to compel continuity of care and supports the bills.
Cabán asks whether there are other things the city should do. Angelica Jadunandan asks for LGBTQ+ representation in mandated curricula and school-level family support; Andy Bowen declines to elaborate but offers to follow up. Cabán thanks them.
Cabán says the hearing will move to Zoom and calls Suheili Mendez. Staff tells the witness she may begin.
Suhali Méndez of New York Lawyers for the Public Interest describes the UndocuCare TGNCI+ program serving transgender, gender nonconforming, and intersex immigrants. She says immigrant youth face trauma, language barriers, misinformation, and fear of government institutions; supports Intro 949, Res 208, and Res 547 and will submit detailed testimony.
Cabán thanks everyone who testified and asks if anyone else wishes to speak; no one does. She notes written testimony may be submitted within 72 hours to testimony@council.nyc.gov and thanks Director Brown for staying for the entire public testimony.
Cabán says she wants every trans child to grow up to be a trans elder, able to play, make friends, engage in sports, build a family, and enjoy New York City. She thanks everyone for the shared commitment and closes the hearing.