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 transgender minors. This move builds on previous efforts by the Trump administration to limit the rights of transgender individuals, particularly youth. The proposed regulations represent a significant shift in federal policy regarding treatments such as puberty blockers, hormone therapy, and surgical interventions for minors.
Among the key measures outlined, the HHS plans to cut federal funding for hospitals that provide gender-affirming care to children through programs like Medicare and Medicaid. This could effectively eliminate access to these vital services in nearly two dozen states where such treatments are currently legal and funded. HHS Secretary Robert F. Kennedy Jr. criticized gender-affirming procedures, stating, “This is not medicine, it is malpractice,” during a news conference.
The changes proposed by the administration contradict recommendations from major medical organizations, which advocate for gender-affirming care as essential for the mental well-being of transgender youth. Advocates, including those from The Trevor Project, expressed grave concerns about the potential consequences of these actions. Rodrigo Heng-Lehtinen, a representative of the organization, said the federal effort to restrict necessary health care for transgender youth is “deeply troubling.”
Impact on Access to Care
Currently, just under half of U.S. states have Medicaid programs that cover gender-affirming care. In contrast, at least 27 states have enacted laws restricting or outright banning such care. The recent Supreme Court ruling upholding a ban in Tennessee suggests that many of these state laws are likely to remain in place. Although the proposals are not legally binding at this stage, they initiate a lengthy rulemaking process that includes public comment periods, indicating they may eventually become formal regulations.
Health care providers are already feeling the effects of the administration’s stance. Many hospitals have begun to limit or cease offering gender-affirming care in anticipation of federal restrictions. While some patients may still access care through private clinics that do not participate in Medicaid or Medicare, the majority of U.S. hospitals rely on these federal programs for funding. Losing this support could threaten the viability of many healthcare facilities.
Dr. Scott Leibowitz, a child and adolescent psychiatrist, warned that the proposed funding restrictions could set a dangerous precedent for healthcare at large. He emphasized, “If the government can cherry-pick one area of medicine to use to withhold necessary funding from entire groups of people, it sets a very dangerous precedent.”
Broader Political Context
These regulatory moves are part of a broader agenda by the Trump administration to limit the rights of transgender individuals. On his first day in office, President Trump issued an executive order that recognized only two immutable sexes: male and female. Since then, various legislative efforts have emerged, including a recent bill that would criminalize healthcare providers who treat transgender individuals under the age of 18.
Polling indicates that a substantial portion of the American public supports the administration’s approach. An Associated Press-NORC Center for Public Affairs Research survey conducted in May revealed that about half of U.S. adults approved of Trump’s handling of transgender issues. Among those voicing support for the administration’s new direction was Chloe Cole, a conservative activist who has publicly discussed her experience with gender transition reversal. She expressed gratitude that her concerns were finally being addressed.
Despite this support, the majority of medical organizations, including the American Medical Association and the American Academy of Pediatrics, have urged the administration to reconsider its stance. Dr. Susan Kressly, president of the AAP, stated, “These rules are 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.”
In addition to the proposed funding cuts, the HHS also announced intentions to redefine gender dysphoria, a formal medical diagnosis, by excluding it from the definition of a disability. The Food and Drug Administration (FDA) has also taken action, issuing warning letters to companies that produce chest-binding equipment, stating that such products can only be legally marketed for FDA-approved medical uses.
As these developments unfold, the future of gender-affirming care for transgender youth hangs in the balance, with significant implications for healthcare policy and the rights of transgender individuals across the United States.
