President Trump issued an executive order Tuesday that aims to stop the use of puberty blockers, hormones and other forms of gender-affirming care for transgender youth, denouncing such medical treatment as a form of “chemical and surgical mutilation” and threatening to defund hospitals that provide it.
The executive order declares that it is the policy of the U.S. that it “will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”
It directs federal agencies that provide research or education grants to medical institutions to ensure that grant recipients do not provide puberty blockers, hormones or surgical procedures for gender transition to anyone under the age of 19.
The executive order also directs the Department of Health and Human Services to take other steps to prevent children and teens from receiving medical treatment for gender transition, which could include changing federal rules on which medical providers can access funding under Medicare or Medicaid — a crucial source of hospital funding.
In addition, the order issued Tuesday directs the Department of Defense to start working on federal rules to exclude gender-affirming care for youth from Tricare, the insurance program that covers military families.
Omar Gonzalez-Pagan, senior counsel and healthcare strategist for Lambda Legal, called the order an “outrageous overreach of government power” and a “pernicious effort to deny medically necessary healthcare to our youth” that the organization was prepared to fight.
Lindsey Dawson, director for LGBTQ health policy with the independent research organization KFF, said much remains unknown about whether the provisions spelled out in the executive order will be carried out and when and how it might happen.
Many steps “will take time and require agencies to take individual actions, and work through guidance and rulemaking processes. Those are typically not fast-moving, and, in addition, litigation will inevitably challenge implementation of policies detailed here,” Dawson said.
Mark Trammell, executive director and general counsel of the Center for American Liberty, a group founded by Trump’s nominee to run the civil rights division at the Department of Justice, praised the move as a way to protect children “while also withholding federal funding from institutions that chemically and surgically mutilate kids.”
The move comes a week after Trump ordered that the U.S. government recognize only two sexes that are “not changeable.” The executive order issued Tuesday also directs the U.S. attorney general to prioritize the enforcement of laws against “female genital mutilation,” as well as investigations into whether consumers might be misled about side effects of gender transition.
Alejandra Caraballo, clinical instructor at the Cyberlaw Clinic at Harvard Law School, called the order “a lawless attempt to ban best practice medical care, but one that comes with such an implicit threat of state action that many will capitulate to and effectively eliminate access for many people.”
The executive order also attacks the scientific integrity of the World Professional Assn. for Transgender Health, calls for federal agencies to stop relying on its guidance, and directs Health and Human Services to publish a review of the best practices for helping children with “identity-based confusion.”
The American Medical Assn. has expressed support for gender-affirming care and opposed “governmental intrusion into the practice of medicine that is detrimental to the health of transgender and gender-diverse children and adults.” The American Psychological Assn. has called bans on such care a “direct threat to the mental health and emotional well-being of transgender, gender-diverse, and nonbinary youth.”
An analysis recently published in JAMA Pediatrics found that among millions of minors with private insurance, less than 0.1% had been identified as transgender or gender-diverse and prescribed puberty blockers or hormone treatment.
