The U.S. Department of Health and Human Services (HHS) announced on October 26, 2023, a series of regulatory actions aimed at restricting access to gender-affirming care for minors. This initiative builds on existing policies from the Trump administration that target transgender individuals. The new proposals represent significant efforts to limit the availability of puberty blockers, hormone therapy, and surgical procedures for transgender youth, particularly affecting those under 18.
The proposed regulations would cut off federal funding from Medicaid and Medicare to hospitals providing gender-affirming care to children. HHS Secretary Robert F. Kennedy Jr. described these procedures as “malpractice,” stating during a news conference, “Sex-rejecting procedures rob children of their futures.” If implemented, these changes would jeopardize access to care in nearly two dozen states where such treatments are currently legal and funded by Medicaid.
These proposals contradict recommendations from major medical organizations, including the American Medical Association and the American Academy of Pediatrics, which advocate for the continuation of gender-affirming care. Advocates for transgender youth expressed serious concerns, emphasizing that the administration’s actions could endanger lives. Rodrigo Heng-Lehtinen of The Trevor Project, a nonprofit organization focused on LGBTQ+ youth, stated, “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.”
Implications of the Proposed Regulations
According to the latest data, approximately 27 states have enacted laws restricting or banning gender-affirming care. The recent ruling by the U.S. Supreme Court that upheld Tennessee’s ban suggests that similar state laws are likely to remain in effect. The proposals from HHS are not yet finalized; they will undergo a lengthy rulemaking process, which includes public comment periods and potential legal challenges.
Despite the uncertainty surrounding the finalization of these rules, many healthcare providers are already hesitant to offer gender-affirming care due to anticipated federal restrictions. Most U.S. hospitals participate in Medicare and Medicaid, which cover services for seniors, people with disabilities, and low-income individuals. Loss of funding from these programs would significantly impact their ability to provide care.
Some patients may still access gender-affirming services through private clinics that do not participate in federal programs. However, the majority of hospitals rely on federal funding, and the proposed restrictions could deter them from providing necessary treatments.
Broader Context of Transgender Rights Limitations
The recent announcements are part of a broader movement by the Trump administration to limit transgender rights nationwide. Since taking office, President Donald Trump has signed executive orders that define gender strictly as male or female and sought to restrict federal support for gender transitions for individuals under 19. A bill currently progressing through Congress would impose prison sentences on healthcare providers who treat individuals under 18 for gender dysphoria.
Medical professionals typically evaluate young patients who identify as a gender different from their sex assigned at birth. Initial steps may include social transitions, such as changing pronouns or hairstyles. Some may later receive hormone-blocking treatments, while surgical interventions remain rare among minors.
The proposed changes are generating significant backlash within the medical community. Dr. Scott Leibowitz, a child and adolescent psychiatrist, warned that the government’s selective approach to funding could set a dangerous precedent for healthcare access overall.
Dr. Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, expressed a controversial view on transgender treatments, suggesting they are a temporary solution to deeper issues. Despite such views, many Americans, according to a May survey by the Associated Press-NORC Center for Public Affairs Research, appear divided on the topic, with about half approving of the administration’s approach to transgender issues.
The controversy has drawn attention from various quarters, including conservative activists like Chloe Cole, who spoke at the news conference, expressing gratitude for the administration’s actions. Cole highlighted her own experiences and claimed that her calls for help have been acknowledged.
As the debate over gender-affirming care for minors continues, the implications of these proposed regulations remain contentious, with significant consequences for the health and wellbeing of transgender youth across the United States.
