Trump administration seeks to bar gender-affirming care for minors in hospitals nationwide

WASHINGTON — The Trump administration on Thursday moved to bar gender-affirming care for minors at hospitals that participate in Medicare and Medicaid, signaling a sweeping regulatory effort to restrict pediatric transgender treatment. The Department of Health and Human Services said the Centers for Medicare and Medicaid Services would publish a notice of proposed rulemaking that would bar hospitals from performing hormone therapies, puberty blockers, or gender-affirming surgeries on anyone under 18 if those facilities want to participate in the federal programs.

The department said the actions target procedures intended to align a child’s body with an asserted identity different from their sex at birth. It argued the policies could lead to permanent harm and that federal funding should not be used to support such care. HHS noted that 23 states already provide Medicaid coverage for gender-affirming interventions and said its rules would extend to all states.

HHS Secretary Robert F Kennedy Jr., who signed a declaration tied to the move, said the federal government must stop unsafe, irreversible practices that put children at risk and that the administration would act to safeguard younger Americans. The declaration frames the procedures as not meeting professional standards of care, according to HHS, and positions the rulemaking as a mechanism to enforce those standards across programs that rely on federal funding.

Separately, the department said the planned rule would also bar federal Medicaid and CHIP funding for gender-affirming care for minors, a move that would affect how states structure their own programs and reimbursement policies. CMS said the proposed rules aim to ensure that hospitals participating in federal programs adhere to health and safety standards that protect children, rather than expanding access to unproven interventions.

In a related development, the U.S. Food and Drug Administration announced enforcement actions regarding the marketing of breast binders to minors, classifying those devices as Class I medical devices and saying they should be used only by women recovering from mastectomy. The agency said it issued warning letters to 12 manufacturers and retailers for illegal marketing to young people, and it warned that further enforcement could include import alerts, seizures, and injunctions if the practice continues.

The Biden administration has signaled a shift away from earlier efforts to define gender dysphoria as a disability, with HHS indicating it is moving to reverse those measures while the current administration is in office. CMS administrator Dr. Mehmet Oz emphasized that the proposed rule aims to protect children and to ensure that federal program standards reflect the country’s responsibility to promote the health and safety of minors. He noted that the proposals have not yet been finalized and will undergo a public-comment process before any final rules are issued.

Adults and adolescents who seek gender-affirming care encompass a small portion of the patient population. A January study found that fewer than 0.1 percent of all U.S. adolescents receive gender-affirming medications or other related care. Transition-related surgeries for minors remain extremely rare and are typically decided on a case-by-case basis by multidisciplinary teams.

Medical organizations, including the American Academy of Pediatrics, the American Medical Association, and the American Psychological Association, continue to view gender-affirming care as a necessary option for the emotional and physical wellbeing of many transgender youth when delivered under appropriate clinical oversight. Proponents argue that timely access to puberty blockers, hormone therapy, and, in some cases, surgery can reduce distress and lower the risk of mood disorders and suicidality by addressing dysphoria as part of comprehensive care.

Evidence on outcomes remains complex and is the subject of ongoing study. Some analyses have found higher rates of mood and anxiety disorders among transgender youths with untreated gender dysphoria, while others caution that data on long-term outcomes of specific interventions in minors should be interpreted with care. Additionally, research from Yale University described higher risks of mental health challenges among youth diagnosed with gender dysphoria prior to any treatment, underscoring the broader context in which care decisions are made.

The proposed regulatory actions have not been finalized, and the administration indicated that the rules would proceed through the normal rulemaking process with opportunities for public comment before a final version is issued.