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CNN
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President Donald Trump signed an executive order Tuesday to end federal support for medical procedures aimed at altering sex or gender that involve surgical interventions or the use of puberty blockers or sex hormones in those under 19 years old.
“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,” the order states.
The order directs the secretary of health and human services to “take all appropriate actions” to end the use of gender-affirming care for minors, including actions that could involve Medicare, Medicaid and the Affordable Care Act. It also instructs HHS to withdraw its guidance on gender-affirming care and patient privacy.
Medicine and surgery can be used in the broader practice known as gender-affirming care, but such interventions are typically reserved for adults. International guidelines do not recommend medical or surgical intervention before transgender children reach puberty. Even for older teens and adults, surgery is relatively rare, research shows.
The broader practice of gender-affirming care can also include counseling for the individual and for the family at any age. It is meant to help people who are transgender, meaning they identify with a gender that is different than one assigned at birth, or people who identify as gender-diverse, with a gender expression that doesn’t strictly match society’s traditional ideas about gender.
This multidisciplinary approach is a medically necessary and scientific evidence-based practice that can help a person safely transition from their assigned gender — the one a clinician assigned them at birth, based mostly on anatomic characteristics — to their affirmed gender — the gender by which a person wants to be known.
For children, gender-affirming care is defined by the American Academy of Pediatrics as developmentally appropriate, nonjudgmental treatment that’s provided in a safe clinical space. The care is individualized and based on peer-reviewed scientific studies that show its effectiveness.
Major mainstream medical associations — including the American Medical Association, the American Psychiatric Association, the Endocrine Society, the American Psychological Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry — have affirmed the practice of gender-affirming care and agree that it’s clinically appropriate care that can provide lifesaving treatment for children and adults.
However, Monday’s order condemns gender-affirming care, saying, “Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions.”
The executive order directs federal agencies to withdraw policies based on World Professional Association for Transgender Health (WPATH) guidance, which the order claims lacks scientific credibility, although these guidelines are considered by experts in this practice of medicine to be the gold standard around the world.
The director of the Office of Personnel Management is also ordered to exclude coverage for gender-affirming care for minors from the 2026 plan year for Federal Employee Health Benefits and Postal Service Health Benefits. The executive order also directs the secretary of defense to begin regulatory steps to exclude coverage of the medical interventions for minors from TRICARE, the military’s health program.
The order also directs the Department of Justice to investigate states that protect access to the procedures and “review” the enforcement of the US legal code that criminalizes female genital mutilation on minors.
The order outlines measures for tracking the progress of these directives.
Twenty-six states have passed bans on gender-affirming health care for transgender children and teenagers, according to a CNN analysis of data from the Movement Advancement Project, a nonprofit think tank that advocates for LGBTQ rights.
Last year, an extensive but controversial research review in the UK called into question the use of puberty-delaying medications, saying that the rationale for early puberty suppression was “unclear” and that any benefit for mental health was supported by “weak evidence.” The review — known as the Cass Review for Dr. Hilary Cass, the pediatrician who conducted it — has prompted providers in the UK to scale back their use of the treatment. Cass had no experience with gender-affirming care, and the review’s methodology has come under sharp criticism from some scholars and practitioners.
CNN’s Jack Forrest contributed to this report.
