WASHINGTON — On Thursday, the U.S. Department of Health and Human Services announced a series of regulatory measures aimed at restricting access to gender-affirming care for minors. This move aligns with broader efforts from the Trump administration to limit rights for transgender Americans.
The newly proposed regulations represent the most extensive attempt by the current administration to curtail the use of puberty blockers, hormone therapy, and surgical interventions for transgender youth. Key elements of the proposal include withdrawing federal Medicaid and Medicare funding from hospitals that provide gender-affirming treatments to minors and barring the use of federal Medicaid funds for these procedures.
During a press briefing, Health Secretary Robert F. Kennedy Jr. criticized gender-affirming procedures for children, stating, “This is not medicine; it is malpractice. These procedures rob children of their futures.”
The proposed changes threaten access to gender-affirming care in nearly two dozen states where such treatments are currently legal and supported by a combination of federal and state Medicaid funding.
These proposals go against the guidance of most leading U.S. medical organizations. Advocates for transgender youth have strongly opposed the administration’s stance, arguing that limiting access to gender-affirming care could endanger lives.
“The ongoing efforts by federal lawmakers to deny transgender and nonbinary youth the healthcare they require is deeply concerning,” said Rodrigo Heng-Lehtinen from The Trevor Project, an organization focused on suicide prevention among LGBTQ+ youth.
Proposed rules would threaten youth gender-affirming care in states where it remains legal
Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have adopted laws restricting or banning the care. The Supreme Court’s recent decision upholding Tennessee’s ban means most other state laws are likely to remain in place.
The proposals announced by Kennedy and his deputies are not final or legally binding. The federal government must go through a lengthy rulemaking process, including periods of public comment and document rewrites, before the restrictions become permanent. They are also likely to face legal challenges.
But the proposed rules will likely further intimidate health care providers from offering gender-affirming care to children and many hospitals have already ceased such care in anticipation of federal action.
Some patients will still be able to receive care via private clinics specializing in transgender medicine, which often don’t participate in Medicare and Medicaid.
But nearly all U.S. hospitals participate in the Medicare and Medicaid programs, the federal government’s largest health plans that cover seniors, people with disabilities and low-income Americans. Losing access to those payments would imperil most U.S. hospitals and medical providers.
The same funding restrictions would apply to a smaller health program, the State Children’s Health Insurance Program, when it comes to care for people under the age of 19, according to a federal notice posted Thursday morning.
“This sets a very dangerous precedent for all areas of health care, if the government can cherry-pick one area of medicine to use to withhold necessary funding from entire groups of people,” said Dr. Scott Leibowitz, a child and adolescent psychiatrist and board member for the World Professional Association for Transgender Health.
WPATH developed standards of care for transgender patients globally, including creating guardrails backed by medical evidence and noting the importance of including patients and their families in decision-making.
Kennedy also announced Thursday that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the definition of a disability. Gender dysphoria is a formal medical diagnosis that describes the distress felt when someone’s gender expression does not match their gender identity.
In a related move, the Food and Drug Administration issued warning letters to a dozen companies that market chest-binding vests and other equipment used by people with gender dysphoria. Manufacturers include GenderBender LLC of Carson, California and TomboyX of Seattle. The FDA letters state that chest binders can only be legally marketed for FDA-approved medical uses, such as recovery after mastectomy surgery.
Moves contradict advice from medical organizations and transgender advocates
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, on Thursday called transgender treatments “a Band-Aid on a much deeper pathology,” and suggested children with gender dysphoria are “confused, lost and need help.”
Polling shows many Americans agree with the administration’s view of the issue. An Associated Press-NORC Center for Public Affairs Research survey conducted in May found that about half of U.S. adults approved of how Trump was handling transgender issues.
Chloe Cole, a conservative activist known for speaking about her gender-transition reversal, spoke at the news conference to express appreciation. She said cries for help from her and others in her situation, “have finally been heard.”
But the approach contradicts the recommendations of most major U.S. medical organizations, including the American Medical Association, which has urged states not to restrict care for gender dysphoria. The American Academy of Pediatrics called on HHS to reverse course Thursday, saying “children and families will bear the consequences.”
“These rules are a baseless intrusion into the patient-physician relationship. Patients, their families, and their physicians-not politicians or government officials -should be the ones to make decisions together about what care is best for them,” said Dr. Susan Kressly, AAP president. “The government’s actions today make that task harder, if not impossible, for families of gender-diverse and transgender youth.”
Actions build on a larger effort to restrict transgender rights
The announcements build on a wave of actions President Donald Trump, his administration and Republicans in Congress have taken to target the rights of transgender people nationwide.
On his first day in office, Trump signed an executive order that declared the federal government would recognize only two immutable sexes: male and female. He also has signed orders aimed at cutting off federal support for gender transitions for people under age 19 and barring transgender athletes from participating in girls’ and women’s sports.
On Wednesday, a bill that would open transgender health care providers to prison time if they treat people under the age of 18 passed the U.S. House and heads to the Senate. Another bill under consideration in the House on Thursday aims to ban Medicaid coverage for gender-affirming care for children.
Young people who persistently identify as a gender that differs from their sex assigned at birth are first evaluated by a team of professionals. Some may try a social transition, involving changing a hairstyle or pronouns. Some may later also receive hormone-blocking drugs that delay puberty, followed by testosterone or estrogen to bring about the desired physical changes in patients. Surgery is rare for minors.
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