The Trump administration announced a series of sweeping regulatory actions Thursday to ban hospitals from offering gender-affirming care to minors.
Under the proposals, unveiled by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. at a press conference Thursday morning, hospitals that provide gender-affirming care to minors will be cut off from federal insurance funding.
The Centers for Medicare & Medicaid Services (CMS) will release draft rulemaking proposing to bar hospitals from providing gender-affirming care to children under age 18 or performing surgical interventions on transgender children as a condition of participation in Medicare and Medicaid programs. That would essentially block all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.
"Nearly all U.S. hospitals participate in Medicare and Medicaid and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children," HHS officials said in a press release issued Thursday.
The Trump administration is targeting pharmaceutical interventions such as puberty blockers and cross-sex hormones and surgical operations such as mastectomies, vaginoplasties, and other procedures that it says "attempt to align a child’s physical appearance or body with an asserted identity different from their sex."
Such medical interventions are among a range of other social and behavioral services that make up gender-affirming care and are widely supported by major medical groups such as the American Academy of Pediatrics, the American Medical Association and the American Psychological Association when used in line with medical guidelines.
The CMS will also release an additional notice of proposed rulemaking to prohibit federal Medicaid funding from being used for gender-affirming care for minors.
The same prohibition would apply to federal Children’s Health Insurance Program (CHIP) funding for these procedures on individuals under age 19, HHS said. Currently, 27 states have enacted laws or policies limiting youth access to gender-affirming care, according to KFF data.
The proposals and rule changes will not go into effect immediately, as there will be a long rulemaking process starting with a 60-day comment period.
As part of the regulatory actions unveiled Thursday, the Food and Drug Administration (FDA) is issuing warning letters to 12 manufacturers and retailers that market breast binders to children for the purposes of treating gender dysphoria, FDA Commissioner Marty Makary, M.D., said during the press conference.
Breast binders are Class 1 medical devices used for purposes such as assistance in recovery from a cancer-related mastectomy.
The HHS' Office for Civil Rights will also propose a rule excluding gender dysphoria from the definition of a disability.
RFK Jr. signed a declaration that transgender care for children and adolescents "are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and, therefore, fails to meet professional recognized standards of health care."
Medical professionals or entities providing transgender care to minors are out of compliance with medical standards, RFK Jr. said.
"This declaration is a clear directive to providers to follow the science and the overwhelming body of evidence that these procedures hurt, not help, children," he said during the press conference.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” RFK Jr. said.
Assistant Secretary for Health and Head of the United States Public Health Service Commissioned Corps Admiral Brian Christine, M.D., also signed a public health message [PDF] stating that current evidence does not support claims that puberty blockers, cross-sex hormones and surgeries are safe and effective treatments for pediatric gender dysphoria.
Many medical organizations and transgender advocates decried the regulatory moves saying that the Trump administration's stance contradicts medical guidelines.
"Allowing the government to determine which patient groups deserve care sets a dangerous precedent, and children and families will bear the consequences," Susan Kressly, M.D., president of the American Academy of Pediatrics, said in a statement issued Thursday.
“Unprecedented actions and harmful rhetoric taking place today by U.S. Department of Health and Human Services (HHS) leaders mark a concerning departure from the longstanding principle that health care policy should be grounded in scientific evidence, clinical expertise, and the needs of children and families. These policies and proposals misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families,” Kressly said.
Kressly called the proposed federal rules 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. The government’s actions today make that task harder, if not impossible, for families of gender-diverse and transgender youth,” she said.
Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at the Trevor Project, an LGBTQ+ suicide prevention nonprofit, condemned the federal government's efforts to restrict healthcare for transgender youth.
“Everyone in this country should have access to the care they need to stay healthy, including transgender and nonbinary young people. Personal medical decisions ought to be made between patients, their doctors, and their families – not through a one-size-fits-all mandate from the federal government. The multitude of efforts we are seeing from federal legislators to strip transgender and nonbinary youth of the health care they need is deeply troubling," Heng-Lehtinen said in a statement.
“If implemented, these efforts will have detrimental impacts on transgender and nonbinary youth in particular. The Trevor Project’s research shows that access to this care is associated with significantly lower rates of depression and suicide risk among transgender and nonbinary young people who receive it. It’s no hyperbole to say that restricting this medically necessary care risks the lives of transgender and nonbinary youth in communities all across the U.S.," Heng-Lehtinen said.
In May, the HHS released a review of youth gender dysphoria research bolstering the administration’s stance against gender transition treatments such as hormones or surgery—and denouncing major medical associations for their opposing positions. RFK Jr. said Thursday that the report found that gender transition treatments for minors do not meet professionally recognized standards of healthcare.
The 400-page review described existing evidence on the outcomes of various treatments for gender dysphoria as low quality, which “indicates that the beneficial effects reported in the literature are likely to differ substantially from the true effects of the interventions,” according to the report.
At the same time, the review placed a substantial focus on the potential harms related to transition interventions—for which the evidence is “also sparse” but warrants caution, the review’s authors wrote.
Since his first day in office, President Donald Trump has taken a series of actions specifically targeting transgender people. Executive orders signed during his opening days made it the government’s official policy to recognize two sexes, male and female, as unchangeable, to discard gender ideology as a “false claim that males can identify as and thus become women and vice versa,” and recast hormone therapy and surgical procedures to affirm one’s gender identity as “chemical and surgical mutilation.”
Wednesday, the House of Representatives approved legislation that would criminalize gender transition treatments for minors, including surgery and supplying hormones, and would subject providers to up to 10 years in federal prison, The New York Times reported.
The bill was approved almost entirely along party lines on a vote of 216 to 211.
Research from the Harvard T.H. Chan School of Public Health, published in 2024, found that providers rarely perform gender-affirming surgeries on transgender youth. For teens ages 15 to 17, about 2 per 100,00 received gender-affirming surgical procedures in 2019, according to the study. Less than one child per 100,000 aged 13 to 14 years old had received a gender-affirming procedure and no children under 12 had received that care.
RFK Jr. told reporters Thursday that he was bracing for lawsuits challenging the changes, but he predicted the agency would win in court.