On Tuesday, President Donald Trump signed an executive order aimed at ending federal funding for medical procedures related to altering sex or gender for individuals under the age of 19. This includes procedures involving surgery, puberty blockers, or sex hormones.
The executive order states: “Accordingly, it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”
As part of the order, the Secretary of Health and Human Services (HHS) is instructed to take necessary actions to halt the use of gender-affirming care for minors, which may involve changes to Medicare, Medicaid, and the Affordable Care Act. HHS is also directed to retract its guidance on gender-affirming care and patient privacy.
While gender-affirming care can involve medical and surgical interventions, such practices are generally reserved for adults. International guidelines advise against medical or surgical intervention for transgender children before they reach puberty. Even for older teens and adults, surgical procedures are relatively uncommon.
Gender-affirming care can include counseling for individuals and families, aimed at supporting those who identify as transgender or gender-diverse—those whose gender expression does not conform to societal expectations. This multidisciplinary approach is based on scientific evidence and is considered medically necessary for helping individuals transition from the gender assigned to them at birth to the gender they identify with.
For children, the American Academy of Pediatrics defines gender-affirming care as developmentally appropriate and nonjudgmental treatment in a safe clinical environment. The care is tailored to the individual and based on peer-reviewed scientific studies that demonstrate its effectiveness.
Currently, 26 states have passed laws banning gender-affirming health care for transgender children and teenagers, according to the Movement Advancement Project, a nonprofit organization advocating for LGBTQ rights.
In the UK, a controversial research review has raised doubts about the use of puberty-delaying medications, arguing that the justification for early puberty suppression is “unclear” and that the evidence supporting its benefits for mental health is “weak.” The review, known as the Cass Review, has led some UK providers to reduce the use of this treatment. However, the review's methodology has been criticized by some experts in the field.
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