President Donald Trump’s latest executive order makes good on his campaign rhetoric to crack down on government support for trans healthcare.
Signed late Tuesday, the order titled “Protecting Children from Chemical and Surgical Mutilation” forbids the federal government from funding, sponsoring, promoting, assisting or supporting “the so-called ‘transition’ of a child from one sex to another.” It applies to those younger than 19 years.
Alongside enforcement of laws blocking these services, the order authorizes the Department of Health and Human Services (HHS) to include such measures within the Medicare or Medicaid conditions of participation or conditions of coverage. It also pulls research grant funding from organizations providing those services and excludes coverage of the services from the Department of Defense and other federal health employees’ benefit programs.
The action addresses certain subsets of gender-affirming care services—a range of social, behavioral and medical interventions that affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth. These services are supported by major medical groups such as the American Academy of Pediatrics, the American Medical Association, the American Psychological Association and numerous others.
Specifically, the EO addresses the use of hormonal treatments and surgical procedures. The practices are defined in the Trump administration order as “chemical and surgical mutilation.”
Using inflammatory language to describe transition-related medical care, the EO states: “Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions."
The order states that these individuals' “medical bills may rise throughout their lifetimes, as they are often trapped with lifelong medical complications.”
Another section of the order mandates the government end a “reliance on junk science” that “cloaks [gender-affirming care] in medical necessity." The order points to guidance from the World Professional Association for Transgender Health, which the White House said “lacks scientific integrity,” and orders all agencies to pull or edit policies that rely on its care standards guidance. It does not reference guidance from other major medical groups that support gender-affirming care.
The order goes on to direct the HHS secretary to review conditions of participation and coverage, essential health benefits requirements, parts of the Patient Protection and Affordable Care Act and federal materials defining mental disorder diagnoses for potential regulatory actions to limit the services. The HHS secretary is also to withdraw a 2022 guidance document, “HHS Notice and Guidance on Gender Affirming Care, Civil Rights and Patient Privacy” and instead work with the attorney general to issue new guidance “protecting whistleblowers who take action related to ensuring compliance with this order.”
The Department of Justice (DOJ), meanwhile, is instructed to prioritize and coordinate with other state law enforcement on “protections against female genital mutilation” as well as to take action against organizations or states for specific actions in support of the practices.
"[The U.S.] will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” the order reads.
While broadly signaled along the campaign trail, Trump has made his administration’s ideological opposition to gender-affirming care apparent in speeches, opening-day EOs and when his DOJ dropped charges against a Texas surgeon accused of obtaining records on minors’ gender-transition-related treatments.
The order also suggests federal prosecutors will withdraw or remain hands-off on other cases challenging protections. The Biden administration had opposed state attorneys general who investigated or sought to prosecute providers offering the services.
Of note, a case addressing a Tennessee bill prohibiting gender-related medical treatments for minors is currently being considered by the Supreme Court.
The Human Rights Campaign, an LGBTQ+ civil rights organization, stressed that the care services have broad support across medical professional groups and said the “brazen” order stands in between patients and their doctors.
“It is deeply unfair to play politics with people’s lives and strip transgender young people, their families, and their providers of the freedom to make necessary healthcare decisions,” Kelley Robinson, the group’s president, said in a statement. “Questions about this care should be answered by doctors–not politicians–and decisions must rest with families, doctors, and the patient.”
Recent years have seen a slew of children’s hospitals and other providers harassed in online campaigns over their gender-affirming care policies, including through the use of unfounded bomb threats. Medical groups called on the Biden administration to take a harsh stance on those behind the harassment.