We Thought We Were Safe Here: What Fenway’s Decision Reveals About Bureaucratic Fear
The emails started coming within hours of Fenway’s announcement—parents panicked, heartbroken, and unsure where to turn. They’re asking how to refill prescriptions, where to find affirming providers, and what to tell their kids who suddenly feel unsafe again. Colleagues at other gender-affirming care clinics tell me their phones haven’t stopped ringing. Wait times are growing, and every unanswered call represents another family caught in the crosshairs of policy decisions made far from their daily lives.
We didn’t think this would happen here. For years, Massachusetts has been the place families point to when they say, “at least we’re safe here.” But on October 13th, Fenway Health, one of the most trusted names in LGBTQ+ care, announced it could no longer provide medical gender-affirming care for anyone under nineteen.
Just a month earlier, I’d stood at the podium at Fenway Health for the launch of my book, Raising Trans Kids. The room was overflowing with celebration and relief. For one night, it felt like proof that care and community could still endure here. Before I spoke, Fenway’s leadership reaffirmed their commitment to providing gender-affirming care, to standing firm amid federal pressure, and to ensuring continuity for trans youth and their families.
It was one of those rare moments that made you believe that maybe, just maybe, we really were safe here — that Massachusetts could remain a haven while the rest of the country grew more hostile.
The Illusion of Safety
The danger isn’t always in the laws that are passed; it’s in the policies quietly rewritten behind the scenes, the kind that can upend care in the blink of a portal notification.
No legislation was passed outlawing gender-affirming care for minors. No state policy reversed course. Yet, as federal directives, executive orders, and funding threats began reshaping the national landscape, the pressure was enough to reach even the places that once felt, at least somewhat, untouchable.
Fenway’s public statement on October 13th made that reality clear. They explained that “due to a change in federal requirements that went into effect October 1, Fenway Health is unable to provide medical gender-affirming care (hormones and puberty blockers) for patients under the age of 19.” The statement framed this decision as a response to “a shifting federal landscape that requires us to adapt in order to remain compliant, sustainable, and able to provide healthcare, support, and services to all our patients and the community.”
In other words, nothing in Massachusetts law forced this change, federal pressure did. The decision reflects how bureaucratic threats can move faster than legislation, reshaping care not through bans but through coercion.
Bureaucratic fear doesn’t shut the doors; it convinces institutions to lock them themselves. All it has to do is remind them, you could lose everything if you don’t comply.
When Compliance Becomes Containment
I don’t believe Fenway wanted to make this decision. They acted under constraint—trying to keep their doors open, their staff employed, and their broader community cared for.
That’s what makes this moment so gutwrenching.
What’s happening isn’t defiance of the law. It’s pre-compliance in anticipation of it. No legislation in Massachusetts has changed. But under new federal directives and the threat of losing essential funding, federally qualified health centers like Fenway are being pushed to act as if those laws already exist.
Their public statement, echoed in recent news coverage, makes that plain. This was a move to remain “compliant, sustainable, and able to provide healthcare to all patients.” The words sound administrative, but the impact is deeply human.
This is what bureaucratic containment looks like: policies that never have to say no because they’ve made yes impossible to sustain. When compliance is demanded at the expense of care, institutions are cornered into moral dilemmas they never asked for. And the result is that the most vulnerable lose first.
Massachusetts law explicitly protects access to gender-affirming care. Recent updates to the state’s Shield Law reaffirm that licensed providers cannot be disciplined or penalized for offering care that is legal in Massachusetts. Federal law also provides protections: Section 1557 of the Affordable Care Act prohibits discrimination “on the basis of sex,” which the Department of Health and Human Services has interpreted to include gender identity. On paper, both state and federal frameworks should safeguard this care.
No legislation has changed to outlaw treatment for trans youth. Yet despite those protections, bureaucratic fear has done what legislation could not—it has silenced care through coercion and compliance pressure.
The Cost of Compliance
Advocates have called out the danger of this capitulation. Journalist Erin Reed noted, “Fenway could try to fight federal attacks on funding … Instead, Fenway chose to comply in advance,” emphasizing that the organization still had legal ground to resist. Legal scholar Alejandra Caraballo went further, describing the decision as “a fundamental betrayal to the core mission of serving the community,” and in a post on BlueSky said, “This was cowardly capitulation sacrificing trans youth.” Their words underscore that this wasn’t a legal inevitability but a bureaucratic one: a choice shaped by fear, not law.
As Nico Lang reported for The Queer Agenda, the announcement left families “shocked and scrambling.” Nico Lang’s reporting mirrors what I’ve been seeing and hearing from colleagues in the last 36 hours — families blindsided, children suddenly without care, and providers left feeling confused, betrayed, and forced to explain decisions they didn’t make. Trans adults are watching this unfold with fear, wondering if they’ll be next.
Still, this isn’t a story about one organization’s failure; it’s a warning about how quickly fear can outpace the law itself. And if that can happen here, in one of the most protected states in the country, it’s a reminder that safety anywhere is more fragile than many of us want to believe.
A Wake-Up Call for Massachusetts
Many of us believed Massachusetts was the safest place in the country for trans people. It is a state with strong protections, supportive leadership, and a long record of doing what is right even when it is unpopular. And in many ways, it still is.
But safety is not static. It requires vigilance. We have to notice the early signs of erosion: the policy shifts, the funding anxieties, the legal gray areas, before they become cliffs.
If an organization as established and well-resourced as Fenway Health can be pushed to this point, safety cannot be something we assume. It has to be something we build together through coordination, advocacy, and accountability.
That also means looking to our state leaders to act. Massachusetts Attorney General Andrea Campbell has already joined multistate efforts to defend gender-affirming care, and her office has the power to intervene here as well. Following Michigan’s example, where Attorney General Dana Nessel reissued guidance reminding providers that state anti-discrimination laws protect access to care even when federal funding is at risk, Campbell’s office could take similar action now to clarify that Massachusetts law still stands.
If you are a Massachusetts resident, you can contact the Attorney General’s office to urge an immediate public statement and formal guidance reaffirming that state law protects access to gender-affirming care.
Safety in this moment means more than holding the line. It means creating conditions where care cannot be taken away, where state protections, public funding, and community pressure make retreat impossible.
What This Moment Teaches Us
This isn’t an isolated story. It’s part of a national pattern where systems designed to protect care are being repurposed to contain it.
It’s about how easily we can mistake relative privilege for permanent safety.
We can’t afford to sit comfortably in the illusion that Massachusetts, or any blue state, is immune to the consequences of federal intimidation. What we can do is remain connected, coordinated, and clear about what’s at stake.
Holding Onto Each Other
I keep thinking about my launch event; the applause, the laughter, the way people exhaled when they heard that Fenway “wasn’t backing down.”
That hope wasn’t naïve; it was human.
We needed to believe that care could outlast politics.
Maybe this is the moment we remember that safety is relative and uncertain. It is built and rebuilt in community every time fear and intimidation tactics try to undo it.
Safety was never promised, even here, but it can be protected through care that acts before it’s permitted and through solidarity that refuses to disappear.
If your family has been affected by these changes, you’re not alone. Fenway is working to coordinate continuity of care, and there are still affirming providers across Massachusetts who can help. Our team at Prism Therapy Collective can offer guidance or referrals as families navigate this transition.
