At the Medical University of South Carolina (MUSC), a noxious combination of political ambition, billionaire privilege, and bureaucratic cowardice led the academic hospital to cut off gender-affirming care to minor patients, including patients younger than what the institution’s right-wing detractors had demanded.

In September 2022, opponents of gender-affirming care in South Carolina latched onto a parenthetical included in a medical student’s graduate research at MUSC. The parenthetical comment described the youngest transgender patient to visit the hospital’s pediatric endocrinology clinic, just 4 years old, according to a report from ProPublica.

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That fact morphed into fiction as far-right critics inaccurately claimed that children that young were prescribed hormones as part of gender transition therapy at the hospital.

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None other than gender-critical transphobe and X owner Elon Musk amplified the false claim, posting, “Is it really true that four-year-olds are receiving hormone treatment?” His post led federal and state lawmakers to interrogate hospital leaders about whether the public hospital was, in fact, helping young children medically transition.

The truth was that the hospital didn’t offer surgery to minors as part of their gender-affirming care offerings, nor did any patients receive hormone therapy before puberty.

The facts, however, didn’t matter.

“If MUSC is mutilating or castrating children, I won’t stop until they are stripped of public funding,” Republican state Rep. Thomas Beach of South Carolina’s Freedom Caucus, threatened in an X post.

The South Carolina legislature had already banned the state’s flagship medical university from using public money to provide any treatment “furthering the gender transition” of children under 16, and hospital leaders assured lawmakers they didn’t use state money to care for trans patients.  

But over the next several months, hospital administrators went even further in an effort to evade scrutiny from lawmakers, the press, and the far-right outrage machine. MUSC cut off all gender-affirming care for anyone under 18, while abandoning all previous patients with no explanation or advice for their continued care.

That autumn — as pressure mounted on the hospital from state lawmakers and those anxious to exploit the culturally divisive issue for political gain — U.S. Rep. Nancy Mace (R-SC) was locked in a contentious race against her Democratic opponent Annie Andrews, a pediatrician at MUSC who wasn’t connected to the endocrinology clinic. Mace exploited the connection, and placed trans kids at the center of the controversy.

In a tabloid-style video from Mace, text scrolled over a photo of Andrews: “Sex change surgery, puberty blockers, gender changing hormones for children?! That’s not protection. That’s child abuse.”

Hospital administrators dissuaded pediatric residents who wanted to publish a letter defending Andrews against Mace’s political attacks, for fear it would invite more scrutiny.

“They left me out on a limb,” said Andrews, who has since resigned from the hospital. 

The state’s far-right Freedom Caucus also reveled in their charge to strip MUSC of funding because of the hospital’s perceived pro-LGBTQ+ bias.

After MUSC leaders agreed in December to cut off access to hormones for gender transition for minors of all ages — including 16- and 17-year-olds — state Rep. Beach crowed on Facebook, “I went after the Medical Center of South Carolina with 19 other of my door-kicking, rock-ribbed, and South Carolina’s most Conservative legislator friends. It feels good to be a gangster.”