The national discussion around transgender issues has primarily focused on the push to limit access to gender-affirming care for minors. Generally, it’s agreed that adults have the autonomy to decide on undergoing hormone therapy and surgeries. However, with both federal and state governments implementing measures to prevent taxpayer funds from covering youth transgender procedures, some hospitals have begun shutting down these services to safeguard their Medicare and Medicaid financing. This move is also impacting the availability of adult transgender surgeries, which are less profitable.
Vanderbilt University Medical Center (VUMC) in Tennessee, the state’s only facility offering adult transition surgeries, has announced it will cease these operations, citing “operational limitations.” This marks a significant development as it’s the first instance of a hospital discontinuing adult gender-transition services, and it could signal a broader trend.
In a statement provided to the Nashville Scene, VUMC outlined its decision:
Over recent years, VUMC has gradually shifted its approach. The center stopped offering transgender surgeries and puberty blockers for minors back in 2022, following the Tennessee legislature’s passage of a transgender care ban, which was upheld after the Skrmetti decision. In 2025, VUMC also shut down its LGBTQ health clinic. These actions indicate a strategic move by VUMC, assessing that the potential liabilities of providing adult transition surgeries could outweigh the benefits.
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According to RedState, a 22-year-old named Fox Varian, who identified as male at 16 and underwent a mastectomy, successfully sued for $2 million against the surgeon and psychiatrist who facilitated her transition. Noted detransitioner Chloe Cole, who is pursuing her own legal battle against California doctors for transitioning her beginning at age 12, commented on Varian’s legal success:
VUMC has signaled this big change through a series of incremental ones. VUMC stopped its trans surgeries and puberty blockers for minors in 2022 when the TN legislature first passed its transgender ban, which held after the Skrmetti decision. In 2025, VUMC closed its LGBTQ health clinic. So, the handwriting was on the wall that VUMC was looking to the future and seeing that the potential risks of offering these surgeries to adults would outweigh any reward.
The VUMC health care system, which has been legally separate from Vanderbilt University since 2016, suspended gender-affirming surgeries for people under 18 in 2022 following a state ban on the treatment. That ban was upheld after reaching the U.S. Supreme Court. VUMC also turned over a list of transgender patients’ health records to Tennessee Attorney General Jonathan Skrmetti in 2023. Last year, VUMC gutted its specialized LGBTQ health clinic, a severe blow to transgender health. Conservative media and politicians, including Tennessee’s U.S. Sen. Marsha Blackburn, previously attacked VUMC for offering transgender health care.
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As RedState reported, 22-year-old Fox Varian, a female who identified as male when she was 16, then underwent a full mastectomy, successfully sued and won a two-million-dollar settlement against the surgeon who performed the surgery and the psychiatrist who convinced her and her parents that this was the right thing to do. Prominent detransitioner Chloe Cole, who suffered a similar fate as Varian and has her own lawsuit pending against California doctors who transitioned her starting at the age of 12, said this of Varian’s win:
Cole believes the new guidance and recent legal victory could lead to a wave of additional lawsuits.
“These lawsuits are going to flood the court system and make it so that these doctors realize that there is a huge liability to these procedures and give them no other sane choice but to stop doing this to children,” she said.
According to legal analysts, it won’t be just how the children are affected, but could open the door for adults who transition and then choose to detransition, as well as their families, to also mount lawsuits. There is even the possibility that victims of transgender killers like Audrey Hale could also find a path to liability. The legal landscape is often about testing precedents.
The ruling has quickly become part of broader public discussions about medical autonomy, youth healthcare, and the role of parents and clinicians in high-stakes decisions. Supporters of the verdict view it as accountability for providers who move too quickly. Others warn against drawing sweeping conclusions from a single case.
From a policy standpoint, the decision may be cited in legislative debates, insurance risk assessments, and regulatory discussions. However, it does not itself change medical guidelines or establish new laws.
Instead, it reflects how juries may evaluate similar claims in the future based on evidence presented at trial.
Just as we are seeing medical associations and hospitals changing their policies on transitioning minors, expect to see more hospitals also looking into the future and taking more definitive action on whether it is legally and operationally cost-effective to continue these transition practices for adults.
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