Months before his first class at Carlow University, Lee, a 17-year-old in Pennsylvania, found himself without a provider. On a summer day, Lee sat waiting in a doctor’s office, playing GamePigeon on his phone, telling family stories with his mom and deciding where to get dinner. It seemed like an ordinary afternoon, yet the reason for Lee’s appointment was far from ordinary. Lee, 17, was there because the UPMC health system, headquartered in Pittsburgh, had cut off the gender-affirming care he’d been receiving for two years — a change driven by a federal executive order. A pharmacy mix-up meant his...