On January 28, President Trump issued an executive order aimed at restricting access to gender-affirming health care for transgender minors. The order calls for a complete reversal of federal support for gender-affirming care for youth under age 19. This policy brief explores the scope of the executive order and the potential impact on transgender and intersex youth.
Gender-Affirming Health Care
Gender-affirming care commonly refers to health services that support a person in living in alignment with their gender identity when their gender identity differs from their sex assigned at birth. This care may include the use of hormones to delay puberty in adolescents and to promote the development of secondary sex characteristics that are consistent with a person’s gender identity or, in some cases, various surgical interventions. Such treatments are considered evidence-based and typically follow standardized practice protocols, which have been reviewed and
refined over the course of over 40 years. Although President Trump’s executive order describes gender-affirming care as “junk science,” access to gender-affirming care for transgender youth is supported by a consensus of major medical associations in the U.S. The order does not acknowledge any benefits of gender-affirming care, instead making unsubstantiated statements of widespread harm and disregarding decades of science that form the foundation of the services that are currently available to transgender youth.
Implementation of Presidential Executive Orders and Policies
A key function of executive orders is political messaging. Executive orders can have practical impacts, but there are limits on what a president can do through this medium. Most importantly, an executive order must be supported by authority the president derives from the Constitution or through an express delegation from Congress by statute. Additionally, implementation is often not immediate. This is because an executive order often takes the form of a directive to federal agencies or offices under the executive branch, each of which would have to conduct internal assessments and consider actions such as rulemaking. Here, President Trump’s order largely takes this approach. However, executive orders may also have a more immediate impact in instances where formal rulemaking is not required or by taking actions that may encounter fewer procedural constraints. For example, this executive order directs the Department of Health and Human Services to rescind a Biden administration guidance document supporting access to gender-affirming care, which could be done more quickly than formal rulemaking. Additionally, it is possible that the Department of Justice may move quickly in response to the executive order.
Scope and Reach of the Executive Order on Gender-Affirming Care
The primary function of this executive order is to prohibit federal support for the provision of gender-affirming care to minors, who are defined, in the order, as youth under 19 years of age. The order does this through several interrelated actions:
- First, the order redefines gender-affirming care using harmful and inaccurate terms (“chemical and surgical mutilation”). The order then directs federal agencies to stop relying on the guidelines developed over decades by experts in gender-affirming care. Instead, the order directs the Department of Health and Human Services (“HHS”) to publish a summary of research findings related to providing care for children who, as described by the order, “assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion.” Notably, rapid-onset gender dysphoria is not a formal diagnosis and is not supported by credible research. In fact, the vast majority of research on gender-affirming care refutes the administration’s characterization and supports access to care; therefore, the order appears to direct the Department to produce a tailored literature review prioritizing research that has been deemed by national experts in the treatment of gender dysphoria to be inaccurate and unreliable. The executive order also directs HHS to further its goals by taking action (ambiguously) with respect to diagnostic manuals that received federal funding, including the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
- Next, the order prohibits federal agencies from engaging in activities that would support access to care. HHS is directed to “take all appropriate action” to end access to gender-affirming care, including “regulatory and sub-regulatory action.” The executive order directs attention to several program areas, including Medicaid, Medicare, nondiscrimination, quality, safety, and essential health benefits guidance. The order directs the Department of Defense to issue regulations excluding coverage under the Military’s TRICARE program, which already excludes gender-affirming care up to age 17 under the 2024 National Defense Authorization Act. Furthermore, all agencies are directed to ensure that medical institutions receiving research and education grants do not provide gender-affirming care. Additionally, coverage for such care is excluded under federal employee benefits programs.
- The order also directs the Department of Justice to “prioritize enforcement of protections against female genital mutilation” (appearing to erroneously conflate gender-affirming treatments with female genital mutilation), convene state attorneys general and work with them to enforce related state laws, work with Congress to enact a law providing a cause of action against doctors prescribing gender-affirming care for minors “with a lengthy statute of limitations,” and to “take appropriate action to end child-abusive practices by so-called sanctuary States that facilitate stripping custody from parents who support the healthy development of their own children.”
Some of the actions requested of the Department of Justice may take effect quickly. However, as noted above, implementing the full agenda in this order will likely take time. Due to the various powers and responsibilities of Congress and courts regarding civil rights and medical interventions, the president may not be able to sustain all of the actions described in the order indefinitely. Furthermore, the legal landscape for gender-affirming care is quite complex, implicating both federal and state laws, and there is extensive litigation around access to the care, as described below. Additionally, many of the actions contained in this order will likely be challenged in court.
However, the president’s order will likely at least limit the availability of gender-affirming care or make it more difficult to access in the short term and could increase risk for both providers and recipients of the care. Additionally, gender-affirming care for minors has been a persistent subject of legislation in Congress in recent years. Both houses of the previous Congress considered federal bans on gender-affirming care for minors, and the 119th Congress is likely to consider a broader federal ban on gender-affirming care in 2025.
Impact on Transgender People
Approximately 1.6 million individuals, or 0.6% of the U.S. population aged 13 and older, identify as transgender. An estimated 300,100 youth between the ages of 13 and 17 identify as transgender. While it is difficult to estimate the total number of transgender minors who receive a form of gender-affirming care, available data suggest that the number is low. For example:
- A study conducted by Reuters and Komodo Health Inc. using health insurance claims for about 330 million U.S. patients from 2017 through 2021, including both private plans and public plans like Medicaid, found that of those aged 6 to 17 with a prior gender dysphoria diagnosis, 14,726 patients began gender-affirming hormone therapy and 4,780 patients had started puberty-blocking medications during that time.
- A separate analysis published in 2025 using private insurance claims concluded that receipt of gender-affirming hormone therapy and puberty-blocking medications among transgender youth aged 8 to 17 was rare.
- Another study using medical claims data from nearly 23,000,000 insured minors found that gender-affirming surgeries among transgender and “gender-diverse” minors were rare.
- In the 2015 U.S. Transgender Survey, 1% of all adult respondents had received puberty-blocking medications (typically used between the ages of 9 and 16).
The executive order most directly impacts transgender minors in states that don’t already ban the care, transgender dependents of military service members under 19, and youth under 19 enrolled in Medicaid, Medicare, and other health assistance programs subject to federal funding restrictions. Below, we provide more information about these populations.
- Transgender Minors. As noted above, there are approximately 300,100 transgender youth aged 13 to 17 living in the U.S. Currently, over 180,000 of those youth live in states where access to gender-affirming care is permitted, most of whom (149,100) are in states with “shield” laws that protect access to gender-affirming care in various ways, and an additional 8,000 live in states where surgery is banned for minors but other gender-affirming treatments remain available. Transgender minors in these states are likely to be the most directly affected by a federal ban on gender-affirming care.
- An additional 110,300 transgender youth live in one of 24 states with an existing ban on gender-affirming hormone therapy and surgeries. Many transgender youth living in these states are currently prohibited from accessing these forms of gender-affirming care. However, in several states, there are court challenges to the bans, as described below.
- Furthermore, the executive order limits access to care for transgender people up to and including youth aged 18. Most state-level bans restrict care for minors aged 17 and younger and do not impact access to care for adults. The order will likely impact access to care for some 18-year-old transgender people who are currently able to access care even in states with bans.
- Transgender Dependents of Military Service Members. Congress has already enacted legislation that prohibits funding under TRICARE for gender-affirming treatments for the minor dependents of service members. The President’s executive order extends this prohibition to youth aged 18 and directs the Department of Defense to issue regulations and subregulatory actions regarding the exclusion.
- Medicaid. Medicaid programs are operated by states in partnership with the federal government, providing health care to low-income individuals. Limitations in data sources make it difficult to know how many transgender youth under age 19 are enrolled in Medicaid. However, we estimate that approximately 276,000 transgender adults are enrolled in Medicaid nationally. Existing coverage for gender-affirming care under these programs varies from state to state, with some states already excluding coverage. Additionally, several jurisdictions have court decisions that may currently prevent a state from denying gender-affirming care. A federal ban on coverage for gender-affirming care that applies to these plans could result in a loss of care for transgender youth who rely on these benefit plans. The impact would be most directly experienced by youth who currently have access to care under state Medicaid policy.
- Medicare. Although the executive order only addresses care for transgender youth 19 and under, it references the Medicare program. Medicare is a federal health care program predominantly for people 65 and older but does apply to some individuals with disabilities, which could include minors under 19. Due to limitations in data, we cannot estimate with certainty how many Medicare beneficiaries may be under age 19.
Current Legal Landscape
Access to gender-affirming care is subject to a complicated patchwork of state bans, state protections, and other federal and state laws. As described above, this includes categorical prohibitions for youth and restrictions on funding and insurance coverage, including for dependents of military service members. This also includes restrictions on gender-affirming care in some state government settings, such as prisons and in the military. No state has banned access to gender-affirming care for adults, but one state, Florida, has imposed restrictions on the ways that adults can access gender-affirming care. At the same time, many states offer state-level protections for providers and recipients of care.
Restrictions and bans on gender-affirming care have been extensively litigated. In December 2024, the Supreme Court heard oral arguments in a case challenging Tennessee’s ban on gender-affirming care for minors, in which we submitted an amicus brief outlining some of the data provided above. The case deals with the question of whether Tennessee’s law is a form of sex discrimination or transgender discrimination that violates the Equal Protection Clause of the U.S. Constitution. A decision in the case is expected in 2025 and has the potential to dispositively impact the landscape of gender-affirming care—in particular, it has the potential to uphold or presumptively invalidate state bans on gender-affirming care, and depending on the scope of the decision could also have impact on the viability of the proposed federal ban.
Conclusion
President Trump has directed federal agencies to prohibit access to gender-affirming care for transgender youth and take additional steps to discourage access to the care. Some aspects of this executive order will have an immediate impact, such as the rescission of President Biden’s support for gender-affirming care and possible early enforcement attempts from the Department of Justice. However, other aspects of this order will likely take time to implement, and the president will need to go through formal channels, such as the formal rulemaking process. A long-term ban on gender-affirming care, if it requires a statutory change, would have to go through Congress. Furthermore, the extensive landscape of state laws and court precedent surrounding gender-affirming care means that most of the actions outlined in the executive order will likely have to contend with immediate and potentially long-lasting litigation.