U.S. agencies announce sweeping measures that would restrict trans health care

The Trump administration ramped up its assault on transgender health care Thursday, with top health officials announcing a slate of proposals aimed at stymieing gender-affirming care for trans youth.

Those measures include seeking to bar hospitals that receive Medicare and Medicaid funds — in other words, almost all hospitals — from providing gender-affirming care for kids; prohibiting Medicaid funding for gender-affirming care for trans minors; and reversing the Biden administration’s characterization of gender dysphoria as a disability under federal law.

The Food and Drug Administration, housed within the Department of Health and Human Services, will also issue warning letters to a dozen manufacturers of chest binders, which transgender and nonbinary people sometimes use to combat gender dysphoria.

Federal officials cast the measures as efforts to protect children from making what they allege are long-term health care decisions that they said many trans kids come to regret — despite ample evidence to the contrary.

“The Trump administration will not stand by while ideology, misinformation and propaganda push vulnerable young people into decisions they cannot fully understand and that they can never reverse,” HHS Secretary Robert F. Kennedy Jr. said.

“Pushing transgender ideology in children is predatory, it’s wrong, and it needs to stop,” FDA Commissioner Marty Makary said.

The Medicaid and Medicare funding bans would target procedures ranging from the prescription of reversible puberty blockers and hormones to surgeries. Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said officials estimate that at least $250 million in Medicaid and Medicare funding went to these procedures over the past decade.

Research, however, has shown that only a tiny fraction of transgender minors on private insurance — less than half of 1% — receive gender-affirming medications, and that gender-affirming surgeries in particular are almost nonexistent among young people. The most recent national survey on the mental health of LGBTQ young people conducted by the Trevor Project, an advocacy organization that works to combat suicide in LGBTQ youth, showed that 13% of transgender and nonbinary young people reported being on gender-affirming hormones, and only 2% reported taking puberty blockers.

Approximately 185,000 trans adults are on Medicaid, according to the Williams Institute at the UCLA School of Law.

Leading medical organizations, including the American Medical Association and the American Psychiatric Association, support access to gender-affirming care, including for minors, and oppose efforts to restrict it.

The proposed Medicaid rules will have at least a 60-day public comment period before the final rules are published in the Federal Register and enacted. The proposed rule to exclude gender dysphoria from the federal definition of “disability” will have a 30-day public comment period before being finalized.

Advocacy groups supporting transgender rights slammed the policies.

Kelley Robinson, president of the Human Rights Campaign, said in a statement that the new rules “would put Donald Trump and RFK Jr. in those doctor’s offices, ripping health care decisions from the hands of families and putting it in the grips of the anti-LGBTQ+ fringe.”

Rodrigo Heng-Lehtinen, a senior vice president at the Trevor Project, said in a statement: “If implemented, these efforts will have detrimental impacts on transgender and nonbinary youth in particular.”

Heng-Lehtinen noted that the Trevor Project’s research, published in the Journal of Adolescent Health in 2022, shows that transgender and nonbinary young people’s access to gender-affirming hormone therapy was associated with lower odds of depression and attempted suicide.

“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.,” he continued.

On Thursday, federal officials relied on talking points that are largely unsupported by evidence but favored by many who are hostile to transgender rights. The officials alleged that trans kids are merely confused and may come to regret their transitions; that teachers try to secretly push them to transition in school; and that doctors providing trans health care are motivated by profit.

Oz slammed what he called “the dangerous progressive ideology that treats children like lab mice.”

This is not the first time the Trump administration has sought to discredit the body of evidence that supports gender-affirming care for young people. Last month, HHS self-published what it said was a peer-reviewed report — authored by many outspoken critics of gender-affirming care — reviewing the body of literature on trans health care for young people. The authors critiqued the current approach to gender-affirming care and called for greater use of psychotherapy.

Experts in trans health care and advocates dismissed the findings as predetermined and political.

Thursday’s moves by the federal agencies are part of a late-year push by Republicans to attack trans health care, an effort that began when Donald Trump was sworn in as president. On his first day back in office, Trump signed an executive order effectively denying the existence of trans people. A week later, he signed another executive order directing Kennedy to end gender-affirming care for minors, which the order called “the chemical and surgical mutilation of children.”

On Wednesday, the House passed a bill introduced by Rep. Marjorie Taylor Greene, R-Ga., that would make it a felony, punishable by up to a decade in prison, for doctors to provide gender-affirming care for minors or for parents to consent to or facilitate such care for their kids. That includes reversible puberty blockers, hormone therapy and surgeries.

The bill passed, 216 to 211. Three Democrats — Donald Davis of North Carolina and Henry Cuellar and Vicente Gonzalez of Texas — joined Republicans to vote in favor of the bill. And four Republicans — Mike Lawler of New York, Mike Kennedy of Utah, Brian Fitzpatrick of Pennsylvania and Gabe Evans of Colorado — bucked their party to vote against the bill. It is unlikely to pass the Senate, given that it would require Democrats’ support to get over the finish line.

Another bill that the House is slated to consider Thursday, introduced by Rep. Dan Crenshaw, R-Texas, and co-sponsored by Greene, would ban federal Medicaid from funding gender-affirming care for minors. The fate of that bill is now unclear in light of the HHS announcements seeking to do the same thing.

Three states already ban state Medicaid funding from going to trans-related health care for minors, while another 11 ban it for all ages, according to the Movement Advancement Project, an inclusivity-focused think tank. More than two dozen states ban gender-affirming care for young people more broadly.

Speaking on the steps of the Capitol on Wednesday, Rep. Sarah McBride, D-Del. — the first openly transgender member of Congress — slammed Republicans as being “obsessed with trans people.”

“They are trying to politicize a misunderstood community and misunderstood care,” McBride said of Republicans. “No one’s health care should be politicized.”