Yuri Gripas/Abaca/Sipa USA/AP
On Tuesday, President Donald Trump issued an executive order attempting to sharply curtail access to gender-affirming care for transgender youth, up to and including 18-year-olds.
The executive order does not impose an immediate ban on gender-affirming care. Instead, it directs federal agencies to begin taking steps to end gender-affirming treatments for children. By defining “children” as individuals under the age of 19—including 18-year-olds, who exceed the age of majority—the order goes further than recent laws banning gender-affirming care for minors in about half of the states.
Since taking office, Trump has carried out his anti-trans campaign promises with breathtaking speed and cruelty. On his first day, he declared that the federal government will no longer acknowledge trans people’s existence or protect them under anti-discrimination laws. He has also ordered them out of the military, claiming that being transgender “conflicts with a soldier’s commitment to an honorable, truthful, and disciplined lifestyle, even in one’s personal life.” And he ordered trans federal prisoners—who are at a heightened risk of violence—to be medically detransitioned and transferred to facilities that match their sex rather than their gender identity.
Tuesday’s order represents another crowning achievement for the coordinated anti-trans campaign carried out by influential religious-right organizations over the last several years. Some of those groups have long made clear that their ultimate goal is to end transgender medical care for everyone, not just children. Trump’s new order is a step in that direction.
“They’re distorting these issues to fit their own political narrative.”
The directive, if allowed to take effect, would devastate much of the remaining access to gender-affirming care for youth in the United States. Many families seeking treatment for their children receive it at specialized clinics, often housed at major hospitals and medical schools that rely on federal funding. Trump’s order takes aim at these clinics, directing agencies to ensure that “medical institutions, including medical schools and hospitals” that receive federal research and education money do not provide gender-affirming care to anyone under 19.
It also directs the secretary of Health and Human Services to cut off federal funding for such treatments. The move is expected to affect Medicaid and Medicare coverage as well as health insurance plans for federal employees. (Twenty-seven states cover gender-affirming care via Medicaid programs.) Robert F. Kennedy Jr, Trump’s HHS nominee, stated publicly last May that he believed gender-affirming care should be “deferred to adulthood.”
Trump’s order also instructs the Department of Justice to enforce laws that ban “female genital mutilation, ”consumer fraud, and “parental kidnapping,” which, given the context, suggests those laws will be applied against providers of gender-affirming care and states with sanctuary policies for trans youth. “This order is horrifying,” a mother of three children, one of whom is trans, told us. The mother, who requested that her name not be used, describes it as “a heavy handed attempt by the government to take crucial health care decisions away from individuals, parents, and doctors” and predicts it “will cause an almost indescribable amount of pain and suffering to innocent children and families.”
Shortly after the order was released, LGBTQ rights organizations vowed to defend trans young people’s access to care. Omar Gonzalez-Pagan, Senior Counsel and Health Care Strategist for Lambda Legal called the order “morally reprehensible and patently unlawful” in a statement.
“The federal government—particularly, this administration—has no right to insert itself into conversations and decision-making that rightly belongs only to parents, their adolescent children, and their medical providers,” Gonzalez-Pagan said. “We stand ready to fight back.”
Trump’s order, which follows on more than $200 million in Republican anti-trans political ad spending during the 2024 election cycle, targets an extremely small minority. Gender-affirming care is rare even among trans youth, as researchers at Harvard University and Folx Health recently made clear. According to an analysis of five years of insurance claims for more than 5 million US youth (ages 8 through 17), only about 0.05 percent received gender-affirming care and were coded as transgender. Among the trans youth, 5 percent were on puberty blockers and 11 percent on hormone therapy.
Leading US medical associations and LGBTQ rights organizations say gender-affirming medical treatments have potentially life-saving mental health benefits for trans youth, who were vulnerable to widespread bullying and discrimination even before Republican politicians made them a political scapegoat. As we’ve previously reported:
Both puberty blockers and hormone therapy have been associated with improved mental health, including fewer thoughts of suicide, for trans teens—which is why they’re supported by the American Academy of Pediatrics and other leading US and international medical associations. Puberty blockers, for instance, temporarily inhibit the development of secondary sex characteristics, like breasts and periods in those assigned female at birth, or facial hair and Adam’s apples in those assigned male at birth—physical changes that can cause clinical levels of distress for youth with gender dysphoria. As trans teens get older, hormone therapy is used to spur the development of secondary sex characteristics associated with the opposite biological sex.
Trump’s order, misleadingly titled “Protecting Children from Surgical and Genital Mutilation” characterizes medical treatments for young people with gender dysphoria as a “stain on the nation’s history” and “junk science.”
“This is some alternate reality that they’re trying to impose on the world that’s counter to the lived experience of not only transgender people, but other people who know and love us,” says Alaina Kupec, president and founder of the transgender advocacy organization GRACE. “It’s just dystopian how they’re distorting these issues to fit their own political narrative.”
Speaking directly to transgender youth, Kupec adds: “Don’t fall into despair and think that you’re not seen or heard and that you’re not valuable. You are and you’re living your authentic self, and you’re living your life with integrity, which is more than these politicians can say, who are knowingly spreading these falsehoods and propagating these false narratives.”
