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On Tuesday, President Donald Trump signed an executive order that halts federal support for medical procedures aimed at altering sex or gender for minors under 19. The order explicitly prohibits the funding, sponsorship, or promotion of treatments such as surgical interventions, puberty blockers, and sex hormones for children and teenagers.
The order stresses that the United States will no longer support the “transition” of minors from one sex to another, stating that it will “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”
Implications for Gender-Affirming Care
The order instructs the U.S. Secretary of Health and Human Services (HHS) to take necessary actions to end the use of gender-affirming care for minors. This includes potential impacts on Medicare, Medicaid, and the Affordable Care Act, which may be restricted in terms of funding or coverage for gender-affirming services. Additionally, the order mandates the withdrawal of previous guidance on gender-affirming care and patient privacy issued by HHS.
Gender-affirming care includes a range of medical and therapeutic interventions, with surgery and hormone therapy generally reserved for adults. International guidelines typically recommend avoiding medical or surgical interventions for children until after puberty, focusing instead on supportive care, such as counseling, to help individuals identify and express their gender.
The Controversy Surrounding Gender-Affirming Care
While medical organizations such as the American Medical Association and the American Academy of Pediatrics recognize gender-affirming care as a critical, evidence-based practice, President Trump’s executive order sharply criticizes it. The order accuses medical professionals of “maiming and sterilizing” children under a “radical and false claim” that children’s sex can be changed through irreversible medical procedures.
Despite these criticisms, major medical organizations continue to support gender-affirming care, asserting that it can be a life-saving approach for children and adults. Studies have shown that such care can help individuals align with their affirmed gender, enhancing their well-being and mental health.
The executive order demands several significant policy changes. It directs federal agencies to withdraw their policies based on the World Professional Association for Transgender Health (WPATH) guidelines, which the order describes as lacking scientific credibility. WPATH is recognized globally as the gold standard for transgender health care, but the order challenges its validity.
In addition, the director of the Office of Personnel Management is ordered to exclude gender-affirming care for minors from the 2026 plan year for Federal Employee Health Benefits and Postal Service Health Benefits. The Secretary of Defense is also directed to initiate steps to exclude coverage for gender-affirming medical interventions for minors under TRICARE, the military’s health program.
State-Level Bans and National Debate
Currently, 26 states have implemented bans on gender-affirming health care for transgender minors. The debate over these treatments continues to divide the nation, with critics highlighting concerns over the long-term effects and the potential for children to undergo irreversible procedures at too young an age.
This development comes on the heels of the controversial “Cass Review” in the UK, which questioned the effectiveness of puberty-blocking medications for children, especially in terms of mental health benefits. Critics of the review, however, argue that its methodology was flawed, and the review has sparked widespread debate about the role of gender-affirming care.
The executive order signed by President Trump marks a significant shift in U.S. policy regarding gender-affirming care for minors. While it has been met with strong opposition from medical professionals and LGBTQ+ advocates, it has garnered support from those who argue that minors should not undergo irreversible medical procedures before reaching adulthood. This order reflects the ongoing, highly polarized debate over transgender rights and medical interventions in the United States.
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