The United States government is currently engaged in a multifaceted effort to investigate the administration of gender-affirming care to minors, involving both legislative inquiries into federal funding and executive attempts to acquire patient data.

美國政府目前正採取多方面行動，調查對未成年人提供性別肯定醫療服務的情況，包括對聯邦資金的立法調查以及行政部門嘗試獲取病人數據。

Legislative scrutiny has been initiated by Senator Bill Cassidy, Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee. This inquiry focuses on whether federally funded entities, specifically community health centers such as Thundermist Health Center and Hasbro Children’s Hospital in Rhode Island, have utilized taxpayer resources to provide puberty blockers, cross-sex hormones, or surgical referrals to patients under 19. A primary concern cited by Senator Cassidy is the federal liability framework under the Federal Tort Claims Act (FTCA), which may necessitate that the Department of Justice (DOJ) defend providers against malpractice claims, thereby shifting the financial burden of litigation to the federal government.

聯邦參議院健康、教育、勞工與退休金委員會（HELP Committee）主席比爾·卡西迪（Bill Cassidy）參議員已發起立法審查。此次調查重點在於聯邦資助的機構，特別是如羅德島州的 Thundermist 健康中心和 Hasbro 兒童醫院等社區健康中心，是否利用納稅人的資源為 19 歲以下的患者提供青春期阻斷劑、跨性別激素或手術轉介。卡西迪參議員提到的一個主要擔憂是根據《聯邦侵權理賠法》（FTCA）的聯邦責任框架，這可能導致司法部（DOJ）必須為醫療提供者辯護以對抗醫療過失指控，從而將訴訟的財務負擔轉移至聯邦政府。

Parallel to these legislative efforts, the executive branch has sought to obtain confidential patient records through civil subpoenas. The DOJ has asserted that these measures are necessary to investigate potential fraud and the 'misbranding' of FDA-approved drugs, specifically alleging that pharmaceutical companies may be providing financial incentives to clinicians for off-label prescriptions. However, this strategy has encountered significant judicial resistance. U.S. District Judge Mary McElroy recently voided a subpoena directed at Rhode Island's largest provider of gender-affirming care, citing a lack of trust in the DOJ's impartial exercise of prosecutorial discretion. This ruling aligns with at least seven other federal courts that have limited similar subpoenas.

與這些立法努力平行地，行政部門試圖透過民事傳票獲取機密患者紀錄。司法部主張這些措施對於調查潛在的詐欺及 FDA 核准藥物的「標示錯誤」至關重要，特別是指控製藥公司可能向臨床醫生提供財務誘因以開立適應症外處方。然而，這一策略遭遇了顯著的司法抵制。美國地方法院法官 Mary McElroy 最近撤銷了一份針對羅德島州最大性別肯定醫療提供者的傳票，理由是不信任司法部能公正地行使起訴酌情權。此項裁決與至少其他七個限制類似傳票的聯邦法院一致。

Institutional responses to these pressures vary. While some providers have established protocols for adolescent gender-affirming care contingent upon parental consent, others, such as NYU Langone, have publicly acknowledged receipt of grand jury subpoenas from the Northern District of Texas. Simultaneously, a class-action lawsuit has been filed in Maryland by eleven families to prevent the disclosure of patient records. This legal volatility exists within a broader national landscape where 27 states have implemented restrictions on pediatric gender-affirming care, while other jurisdictions have enacted protections to ensure continued access.

機構對這些壓力的反應不一。部分醫療提供者已建立相關協定，規定青少年性別肯定醫療需以父母同意為前提；而其他機構（如紐約大學朗格尼醫療中心 NYU Langone）則公開承認收到德州北區大陪審團的傳票。與此同時，馬里蘭州的 11 個家庭提起集體訴訟，以防止患者紀錄被披露。這種法律波動存在於更廣泛的國家格局中：全美已有 27 個州對兒童性別肯定醫療實施限制，而其他司法管區則制定了保護措施以確保持續獲取服務。

The current situation is characterized by a tension between federal oversight efforts and judicial protections of patient confidentiality, alongside a fragmented state-level regulatory environment.

目前的情況是以聯邦監督努力與司法對患者保密性的保護之間存在緊張關係，以及碎片化的州級監管環境為特徵。