Washington D.C. – The U.S. Department of Health and Human Services unveiled sweeping regulatory actions on Thursday designed to effectively ban gender-affirming care for minors across the nation. The comprehensive proposals represent the most significant moves the Trump administration has taken to restrict access to puberty blockers, hormone therapy, and surgical interventions for transgender children, potentially affecting healthcare access in nearly two dozen states.
Federal Funding Restrictions Target Gender-Affirming Care
The proposed regulatory framework includes cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children. Additionally, the restrictions would prohibit federal Medicaid dollars from being used to fund such procedures entirely. These sweeping proposals would also extend to the State Children’s Health Insurance Program for individuals under age 19, according to federal notices posted Thursday morning.
Health Secretary Robert F. Kennedy Jr. defended the administration’s position during a news conference, declaring that gender-affirming care procedures on children constitute malpractice rather than legitimate medicine. “Sex-rejecting procedures rob children of their futures,” Kennedy stated, framing the regulatory actions as protective measures for minors.
Impact on Healthcare Providers and Access
Nearly all U.S. hospitals participate in the Medicare and Medicaid programs, which represent the federal government’s largest health plans covering seniors, disabled individuals, and low-income Americans. Losing access to these payments would create existential threats for most U.S. hospitals and medical providers, effectively forcing healthcare institutions to choose between providing gender-affirming care and maintaining crucial federal funding.
The proposed restrictions on gender-affirming care would imperil access in approximately two dozen states where drug treatments and surgical procedures remain legal and funded by Medicaid, which combines federal and state dollars. Currently, more than half of U.S. states already ban or restrict such care through state-level legislation.
Additional Regulatory Measures
Kennedy announced that the HHS Office of Civil Rights will propose a rule excluding gender dysphoria from the definition of a disability under federal law. This regulatory change would represent another significant shift in how the federal government recognizes and addresses transgender healthcare needs.
In a related action, 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 targeted include GenderBender LLC of Carson, California, and TomboyX of Seattle. The FDA letters assert that chest binders can only be legally marketed for FDA-approved medical uses, such as recovery after mastectomy surgery.
Medical Community Response to Gender-Affirming Care Restrictions
The administration’s approach contradicts recommendations from most major U.S. medical organizations, including the American Medical Association, which has urged states not to restrict gender-affirming care for individuals with gender dysphoria. Medical professionals and advocacy groups have strongly refuted the administration’s characterization of these treatments.
Dr. Jamila Perritt, a Washington-based OB/GYN and president and CEO of Physicians for Reproductive Health, criticized the regulations in a statement: “In an effort to strongarm hospitals into participating in the administration’s anti-LGBTQ agenda, the Trump Administration is forcing health care systems to choose between providing lifesaving care for LGBTQ young people and accepting crucial federal funding. This is a lose-lose situation where lives are inevitably on the line.”
Current State of Gender-Affirming Care
Young people who persistently identify as a gender differing from their sex assigned at birth typically undergo evaluation by a team of professionals. Some may initially try a social transition involving changes to hairstyle or pronouns. Others may later receive hormone-blocking drugs that delay puberty, followed by testosterone or estrogen to bring about desired physical changes. Surgical interventions remain rare for minors.
Medicaid programs in slightly less than half of states currently cover gender-affirming care. At least 27 states have already adopted laws restricting or banning such care. Federal judges have struck down bans in Arkansas and Montana as unconstitutional, though legal battles continue in those states.
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Regulatory Process and Legal Challenges
The proposals announced by Kennedy and his deputies are not final or legally binding. The federal government must complete a lengthy rulemaking process, including periods of public comment and document revisions, before restrictions become permanent. These regulations are also likely to face significant legal challenges from advocacy groups and affected families.
However, the proposed rules are already creating a chilling effect among healthcare providers. Many hospitals have ceased providing gender-affirming care to children in anticipation of federal action, even before final regulations take effect.
Broader Context of Transgender Rights Restrictions
These announcements build upon a wave of actions President Donald Trump, his administration, and congressional Republicans have taken to target transgender rights nationwide. On his first day in office, Trump signed an executive order declaring the federal government would recognize only two immutable sexes: male and female. He has also 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.
Congressional action has accompanied these executive measures. On Wednesday, legislation passed the U.S. House that would expose transgender healthcare providers to prison time if they treat patients under age 18. Another bill under House consideration aims to ban Medicaid coverage for gender-affirming care for children entirely.
Rodrigo Heng-Lehtinen, senior vice president at The Trevor Project, called the changes a “one-size-fits-all mandate from the federal government” on decisions that should remain between doctors and patients.
