The Trump administration has initiated actions aimed at restricting gender-affirming care for individuals under 18 years old, a move that has drawn opposition from numerous medical organizations and legal entities.
Federal Actions and Rationale
On Thursday, federal health officials announced measures to ban gender-affirming care for transgender youth, asserting that these actions were based on science and evidence. They referenced a November report from the Department of Health and Human Services (HHS) that concluded clinicians providing medical care for youth transitions had failed their patients, while emphasizing psychotherapy as an alternative.
During the announcement, officials made statements questioning the concept of transgender identity. Acting CDC Director Jim O'Neill stated, "Men are men. Men can never become women. Women are women. Women can never become men," and referred to "the blurring of the lines between sexes" as "a hatred for nature as God designed it." Health Secretary Robert F. Kennedy Jr. alleged that doctors and medical groups had "peddled the lie" regarding the benefits of these treatments for children, asserting that youth were "conditioned to believe that sex can be changed."
Opposition from Medical Community
Major medical organizations have challenged the administration's stance. The American Academy of Pediatrics (AAP), representing 67,000 pediatricians, issued a statement from President Dr. Susan J. Kressly, asserting that the policies "misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families." The AAP's official position, shared by organizations such as the American Medical Association and the Endocrine Society, is that gender-affirming care is safe and effective for appropriate young patients.
The American Psychological Association also expressed "deep concern about recent federal actions that not only challenge the scientific understanding of gender identity but also potentially jeopardize the human rights, psychological health, and well-being of transgender and nonbinary individuals."
Proposed Rules and Potential Impact
A significant proposal from HHS would revoke all Medicare and Medicaid funding from hospitals that provide gender-affirming care to individuals under 18. Matthew Cook, CEO of the Children's Hospital Association, stated that if finalized, this rule could establish a precedent allowing "all kinds of specialized health care treatments to be withheld based on government-mandated rules," potentially affecting "millions of families."
The proposed rules are subject to a 60-day public comment period before potential finalization and implementation.
Attorneys general in New York and California have indicated intentions to challenge these rules, and the ACLU has announced plans for legal action. Additional legal challenges are anticipated.
Demographics and Personal Accounts
According to a CDC survey, approximately 3% of teenagers aged 13-17, totaling around 700,000 individuals, identify as transgender. A KFF poll found that less than one-third of transgender individuals use medication related to their identity, and 16% have undergone surgery. For minors, common medical options include puberty blockers and hormones, with surgery being rare. Dr. Kade Goepferd, founder of Children's Minnesota Gender Health Program, described this care as individualized and evolving over time.
An unnamed 15-year-old transgender individual in California described concerns about potential restrictions, stating, "The decision to not start gender-affirming care is often just as permanent as a decision to start it." After six months on testosterone, the individual expressed worry about losing access to medication, stating, "It feels like someone's throwing me into the bush just off the path I'm on, and that's kind of terrifying."
Broader Context
Over half of U.S. states have already enacted laws banning gender-affirming care for young people since 2021. This week, Republicans in the House of Representatives advanced two federal bills that would further restrict access to care, including one that proposes up to ten years in prison for doctors providing such care. The prospects of these bills passing the Senate remain uncertain.
In states where gender-affirming care remains legal, healthcare providers are preparing for potential clinic closures if national restrictions are implemented. Dr. Goepferd noted the "deep moral distress" experienced by healthcare professionals when restricted from providing care they believe improves health outcomes, and the dilemma faced by hospitals in potentially limiting care for one population to maintain financial viability for other services.