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Facing a federal ban and the potential loss of funding, Dartmouth-Hitchcock Medical Center has pledged to find a way to continue performing sex-change procedures on children in New Hampshire.

Health and Human Services Secretary Robert F. Kennedy Jr. announced a new rule Thursday banning hospitals from performing what he called “sex-rejection procedures” on children.

“Doctors assume a solemn obligation to protect children, yet doctors across the country now provide needless and irreversible sex-rejecting procedures that violate their sacred Hippocratic oath by endangering the very lives they are sworn to safeguard,” Kennedy said.

“They have betrayed the estimated 300,000 American youths ages 13 to 17, conditioned to believe that sex can be changed,” he added. “This is not medicine. It is malpractice.”

As part of the Trump administration’s efforts, the Centers for Medicare and Medicaid Services (CMS) will release a notice of proposed rulemaking to bar hospitals from performing sex-rejecting procedures on children younger than 18 as a condition of participation in Medicare and Medicaid programs.

At the news conference on Thursday, Dr. Mehmet Oz, who oversees CMS, outlined the risks to children from sex-rejecting treatments.

“Puberty blockers reduce bone density, alter brain development — which is a real problem when you’re 11, 12 or 13 — and can disrupt sexual function for the rest of your life,” Oz said. “Cross-sex hormones cause irreversible changes, including infertility, loss of sexual function, even cardiovascular issues, as well as long-term cardioendocrine problems. And of course, the surgical interventions, where you remove healthy organs — as despicable and reprehensible as that is — permanently alter appearances and destroy children’s lives.”

Polls show Granite Staters overwhelmingly agree with the Trump administration’s policy and oppose sex-change procedures for minor children. Gov. Kelly Ayotte, a Republican, signed a law banning the practice earlier this year.

A day earlier, the U.S. House passed legislation banning doctors from treating children for gender dysphoria with surgery or puberty blockers. Reps. Maggie Goodlander and Chris Pappas both voted against the ban.

Nevertheless, Dr. Keith Loud, physician in chief at Dartmouth Health Children’s, said leaders at New Hampshire’s largest hospital system are still trying to determine how to continue offering the treatments to minor children.

“We are dismayed by the announcement of proposed rules and yesterday’s U.S. House vote regarding gender-affirming health care for children and adolescents, which creates significant distress and uncertainty for the patients and families we serve,” Loud said. “While these actions were anticipated, we are actively engaged with coalitions to evaluate next steps, and we are reviewing the proposed rule carefully to understand its implications, particularly for families who rely on us for comprehensive, evidence-based care delivered by our medical experts.”

As support for performing those procedures on children has declined and more data has been released, raising questions about their medical efficacy, Dartmouth-Hitchcock has remained an aggressive advocate for the treatments.

Several Granite State political leaders, however, praised the Trump administration’s policy.

“There’s big money to be made in so-called gender-affirming care, which inflicts irreversible damage on children,” said state Rep. Jim Kofalt (R-Wilton), House speaker pro tempore and a member of the House Health and Human Services Committee.

“Hospitals that continue to perform these procedures should bear in mind that New Hampshire lawmakers have been crystal clear. We will not stand by idly as members of the medical profession violate a core premise of the Hippocratic oath: ‘First, do no harm.’ Providers who ignore state or federal safeguards or attempt to circumvent them should expect repercussions,” Kofalt said.

State Sen. Kevin Avard (R-Nashua) said so-called gender-affirming care “is dangerous and has ruined countless lives for young people, many of whom have testified in our State House that they regret their decision and have decided to detransition. These new policies are about protecting our youth, rather than capitulating to the radical activist left.”

The Republican Attorneys General Association released a statement supporting the policy, saying Thursday’s announcement “helps restore sanity to our nation’s health care system by protecting children from chemical castration and surgical mutilation procedures.”

Asked about the new policy, New Hampshire Attorney General John Formella told NHJournal, “New Hampshire has taken a clear position when it comes to protecting children from irreversible medical procedures, and our state law reflects that commitment. The Trump administration’s actions are consistent with the approach New Hampshire has already adopted and align with our goals of prioritizing the health, safety, and long-term well-being of children.”

The new restrictions will not prevent Dartmouth-Hitchcock from offering care to children who identify as transgender, but they will change the type of care offered, Loud said.

“While legal constraints may limit the scope of care we can provide in the future, our commitment to this patient population remains as steadfast as ever,” he said. “Our priority remains ensuring our patients receive compassionate, appropriate care while maintaining our ability to serve the broader community through vital Medicare and Medicaid programs.

Angry parents turned out at Weare Middle School on Tuesday night to protest the school’s decision to allow a biological male student to use the girls’ bathroom — over the objection of girls who are being forced to share the space.

The situation came to light when the girls started complaining to their parents about the boy, who just recently began “identifying” as a girl. Katie LeRoy was upset when her daughter told her about the situation last week. The male student had switched from using a single-person bathroom to the girl’s room.

“That does make me feel uncomfortable, and others (are uncomfortable) as well,” LeRoy said.

But school board Chair Christine Heath insisted they were following state law.

“As of today, it is the law in New Hampshire that discrimination is prohibited based on gender identity in regards to bathrooms,” Heath said at the start of the Weare School Board meeting.

School Board Chair Christine Heath, Board Member Sarah Button, and Board Member Daniel Recupero listen to parents Tuesday night upset that a biological boy is using the girl’s bathroom in Weare Middle School.

State Rep. Ross Berry (R-Weare) attended Tuesday’s meeting to support concerned parents. He told NHJournal Heath’s claim the school’s hands are tied is spin, not fact. It’s true the state has yet to pass a law explicitly giving schools and other institutions the right to protect women’s spaces from biological males. The school could choose to do so right now.

“They are interpreting the non-discrimination statute in a way that conveniently fits their worldview,” Berry said. “I have no doubt the school board would vote to allow boys in girls bathrooms if they were explicitly given a choice.”

Resident Nancy Brennan, a public school teacher in another community, told the meeting she supported allowing the male student in the girls’ bathroom. According to Brennan, biological sex is complicated. She cited people who are born intersex to explain that transgender people have always been part of human history.

“The idea there is only male and female is not scientifically correct,” Brennan said.

Being born intersex is an extremely rare medical condition affecting an estimated .05 percent of the population. It typically refers to people born with both male and female sexual characteristics, such as having both male and female sex organs.

Nobody has suggested that applies to the male student at Weare Middle School.

State Rep. Lisa Mazur (R-Weare) said parents and girls should be able to talk about their concerns without being labeled as bigots.

“Having this concern for girls does not make us transphobic, and we’re not bullies for speaking up,” Mazur said.

Parents have been reaching out to Mazur to tell her the girls are uncomfortable sharing their bathroom with a boy, and some of them are refusing to use the bathroom at the school. Mazur said the school should allow male students “identifying” as female to use single-person bathrooms or staff bathrooms, but not the girl’s bathroom.

A bill keeping biological males out of spaces for women and girls is making its way through the legislature. If it passes, Gov. Kelly Ayotte is expected to sign it.

Weare resident and Republican candidate for Congress Lily Tang Williams said the school’s policy to allow the biological male into the girls’ bathroom is damaging the school and will be costly for the community.

“You’re going to push more children to homeschooling and out-of-town schools. You need to reevaluate this policy,” Tang Williams said.

Berry reminded the board Weare’s schools are underperforming, according to data.

In the latest standardized tests, 32 percent of students were proficient in English, 24 percent in math, and 22 percent in science. The district is spending more than $21,000 a year per student. The district’s also seen a 28 percent decline in enrollment since 2016, Berry noted. Perhaps academic performance should be their priority.

One Weare father, who had been considering putting his homeschooled children into the public school, predicted even more students are likely to leave. Not because there is a transgender student, but because the handling of the situation raises questions about how the school will teach science and biology.

“That 28 percent will climb if this goes the wrong direction,” the dad said.

Milford High School students may not have urinals in their bathrooms much longer as board members look for a compromise in the fight over a proposed policy regarding bathroom and locker room use by transgender and non-binary students. 

“We talk about our responsibility as school board members on a divided issue, which is to compromise. This is the compromise,” said board member Noah Boudreault.

Dozens of students, teachers, parents, and community members spoke out Monday night, most opposed to the policy which would bar transgender students from most bathrooms and locker rooms. Nate Wheeler, board vice chair, proposed the new policy which would, for example, prohibit biological males who identify as female from using bathrooms and locker rooms for female students. Those students would instead be required to use separate facilities.

Wheeler did not address the controversy during the meeting, though Chair Judi Zaino expressed dismay about the proposal and indicated she would vote against it.

“I would be acting with malice to put a population in danger, and that is why I feel the way I do,” Zaino said. “I do feel there is a degree of malice here, and that concerns me greatly.”

Boudreault’s counterproposal is to limit bathroom use for everyone. Students would only be allowed to use stalls in the bathrooms and changing stalls in locker rooms, with no changing in common areas.

The overwhelming majority of people who spoke out Monday night were opposed to Wheeler’s proposal, telling board members it was born of hate. They predicted it would directly lead to an untold number of trans students committing suicide. One resident said it was anti-science, claiming there are now more than two recognized genders. 

State Rep. Maria Perez, D-Milford, said school board members who support the policy ought to be ashamed of themselves.

“What this school board is trying to pass, it doesn’t adhere to human rights. Let them be. They are not doing anything wrong to you,” Perez said.

But there is a problem with female students being harassed in the locker rooms by transgender students, according to Samaia DeMarco, who recently testified in Concord about the bullying and harassment female students are experiencing in Milford. Marco told the Monday night meeting the policy is meant to keep the girls safe. The opponents were engaged in a bullying attempt to silence girls and women, she said.

“They’re claiming discrimination while ignoring children’s voices,” Demarco said.

Demarco also accused Perez of laughing as a female student who also testified in Concord about being harassed by transgender students.

“Do you feel shame for laughing at the little girl who shared her testimony,” Demarco asked.

The issue of public safety when addressing transitioning students has emerged as a significant topic in the wake of a high-profile case in northern Virginia, where a transgender teenager was found guilty of sexually assaulting a female student in a bathroom. Parents were outraged when they learned the biological male was transferred to another school, where he allegedly forced a second victim into a classroom, nearly suffocated her, and sexually assaulted her.

The result for the school district has been a lawsuit, the firing of the superintendent, and criminal charges against school officials.

It is not clear if Boudreault’s compromise plan is workable. His plan would eventually put stalls in all the bathrooms and remove urinals. The costs could be in the tens of thousands of dollars, and there is no current plan in place to fund the bathroom renovations.

Additionally, school board members learned Monday night schools are legally required to provide a certain number of bathroom facilities based on population. Limiting the use to stalls would likely drop the number of bathrooms below the required limit. There are also logistical questions about getting students changed in time for gym class if the space is limited.