Trump seeks to ban federal funding for youth gender-affirming care

Dive Brief:

• President Donald Trump signed an executive order on Tuesday seeking to ban federal funding and support of youth gender-affirming medical treatments, such as puberty blockers, hormone therapies and surgeries.
• The executive order would exclude treatments related to transition services for minors from coverage under federally run insurance programs, and end federal grants dedicated to researching the treatments. The president also tasked the HHS with publishing a literature review on best practices for treating minors with gender dysphoria within 90 days.
• The directive will almost certainly be challenged in court. The American Hospital Association declined to comment on the new policy. However several health systems, including Providence, UNC Health and Mass General Brigham said they were evaluating the order to determine what impact it might have on care.

Dive Insight:

Since taking office, Trump has issued an outsized number of executive orders focused on transgender Americans relative to their prevalence in the population.

Fewer than 1% of American adults identified as transgender as of March, according to a survey from Gallup. Some studies suggest that slightly more young people might identify as transgender or might question their gender identity, while other studies find similar rates between the populations.

Despite transgender policies impacting just a sliver of the public, Trump has thus far sought to ban transgender people from serving in the military and remove nonbinary ‘X’ gender indicators from official documents like passports.

The latest action takes aim at transgender individuals’ healthcare access by seeking to reduce gender-affirming medical services for those under the age of 19. 

Such care is supported by nearly every major medical group, including the American Medical Association, American Psychological Association and the American Academy of Pediatrics. However, Trump claims the industry’s support for transition care will be looked upon unfavorably in the future.

“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 executive order said. “This dangerous trend will be a stain on our Nation's history, and it must end.” 

To that effect, the president also ordered the HHS to compile evidence about best treatment practices for those with gender dysphoria and “use all available methods to increase the quality of data to guide practices” for those seeking care.

The executive order comes as states increasingly curtail minors’ access to gender-affirming care. As of August, 26 states had passed laws limiting or banning gender-affirming care for minors, according to a tracker maintained by the Human Rights Campaign.

Families, physicians and patient advocate groups have sued in an attempt to block the bans. The organizations are likely to take a similar stand against the new executive order.

Lambda Legal, a civil rights organization serving LGBTQ+ communities, has already pledged to take action. “We fought previous attempts by the first Trump administration to restrict health care and we won,” Omar Gonzalez-Pagan, senior counsel and healthcare strategist for Lambda Legal, said in a statement Wednesday. “We stand ready to fight back against this even more pernicious effort to deny medically necessary health care to our youth.”

To date, plaintiffs have found limited success in court.

Last year, challenges to Tennessee’s policy — which blocks minors from receiving hormone treatments or surgeries for gender dysphoria — made it all the way to the U.S. Supreme Court as United States v. Skrmetti. 

Patient advocates claimed the ban violated access to care on the basis of sex and constituted medically necessary care under physician guidelines. However, attorneys for Tennessee testified to the alleged medical risks of gender-affirming care procedures for minors, including possible long term harms associated with “de-transitioners.”

Tennessee’s legal team argued the medical community had not fully coalesced around guidance for treating children with gender dysphoria, saying it was new and still developing — despite multiple medical organizations stating the treatments were safe.

Justices have yet to rule on the case. However, when they heard oral arguments in December they appeared swayed by Tennessee’s arguments and likely to uphold the policy, according to an analysis published on SCOTUS Blog.

Specifically, Chief Justice John Roberts said the court was not equipped to review “evolving” medical standards pertaining to gender-affirming care.

Trump’s executive order will likely add fuel to such arguments. The executive order says that research performed by the World Professional Association for Transgender Health — which is cited by plaintiffs challenging both Tennessee and Idaho’s bans on gender-affirming care for minors — “lacks scientific integrity.”

The administration has ordered agencies to immediately rescind guidance based on WPATH recommendations.