An executive order by United States President Donald J. Trump on January 28, 2025, would withdraw federal funding and support for gender-affirming care for transgender youth, Human Rights Watch said today. The order, Protecting Children from Chemical and Surgical Mutilation, specifically targets access to puberty blockers, hormone therapies, and surgery for transgender youth, anyone under age 19.
This order is part of a sweeping rollback of transgender rights protections by the Trump administration. It instructs agencies to revoke funding for medical institutions that research or provide gender-affirming care for youth and to eliminate protections for transgender youth in federal healthcare programs such as Medicaid, TRICARE, and the Federal Employee Health Benefits Program. It also directs the Department of Justice to investigate and prosecute providers of gender-affirming care, citing laws against "female genital mutilation."
"Transgender youth, their families, and their doctors are being forced to make impossible choices, whether to risk legal consequences for accessing or providing care, or to suffer in silence," said Rasha Younes, interim lesbian, gay, bisexual, and transgender (LGBT) rights program director at Human Rights Watch.
Gender-affirming care for youth encompasses a range of practices, which may include medical intervention such as puberty blockers and hormone therapies delivered through a tailored, multidisciplinary approach. In the United States, transgender youth typically undergo months or years of rigorous evaluation before any medical interventions are initiated. Major medical organizations, including the American Medical Association, American Academy of Pediatrics, American Psychological Association, and the American Academy of Child and Adolescent Psychiatry, support access to this evidence-based, developmentally appropriate care.
Approximately 26 percent of US transgender and questioning students surveyed by the Centers for Disease Control and Prevention (CDC) in 2023 said that they had attempted suicide during the prior year alone. Research consistently shows that access to gender-affirming care can reduce this risk. A 2022 study published in the Journal of the American Medical Association (JAMA) found 73 percent lower odds of suicide attempts by children receiving this care over a 12-month period, underscoring the critical role of gender-affirming care in the mental health and well-being of transgender youth.
The order prohibits the use of certain drugs and interventions for transgender youth who wish to transition but not for cisgender youth who use them for other purposes, such as early puberty. It also instructs federal agencies to rescind policies relying on guidance from the World Professional Association for Transgender Health, a 45-year-old professional organization dedicated to advancing evidence-based care in transgender health, labeling its medical recommendations "junk science."
The order mandates the Department of Health and Human Services to review and rewrite federal standards on gender-affirming care and to roll back anti-discrimination protections. It also imposes stricter measures on what it characterizes as "deceptive" practices related to gender-affirming care, directing the Department of Justice (DOJ) to investigate allegations of fraud and consumer deception. The order instructs the DOJ to draft legislation enabling people to sue providers for alleged harm from gender-affirming care received as youth and states that the legislation should include a "lengthy" statute of limitations.
LGBT advocates and civil rights groups strongly condemned this executive order, highlighting its discriminatory and cruel nature, and vowed to take swift legal action in response. Omar Gonzalez-Pagan, senior counsel and health care strategist for Lambda Legal, a US-based civil rights organization focused on LGBT rights, condemned the order in a January 28 statement, calling it "an outrageous overreach of government power that reveals its cruel absolutism."
Currently, 26 US states restrict access to some form of gender-affirming care for youth. Human Rights Watch has documented the devastating effects of these restrictions on the well-being of transgender youth and their families. Medical providers and transgender advocates have reported increased harassment, threats, and targeting by state government officials and others.
In some jurisdictions, medical institutions and providers, including hospitals, clinics, labs, and pharmacies, have been found to "overcomply" with health care bans, preemptively halting gender-affirming services or ceasing more services than legally required, to reduce the risk of prosecution, violence, and harassment.
The executive order is expected to have a similar chilling effect on medical institutions and providers due to the threat of investigations and litigation. Faced with the risk of legal and financial consequences, institutions may feel compelled to choose between continuing other operations or providing gender-affirming care, ultimately endangering access to this care nationwide.
On January 29, 2025, Trump signed an executive order instructing various agencies to take action to withhold federal funding from primary and secondary schools that respect and affirm students' gender identity and to discourage faculty and staff from supporting transgender students.
On January 27, 2025, Trump signed an executive order instructing the Department of Defense to bar transgender people from serving in the military, reversing Biden-era policies that allowed open service. The following day, six active-duty trans service members and two trans people seeking to enlist filed a federal lawsuit challenging the order.
On January 20, 2025, Trump signed an executive order that states that the US government will recognize only two sexes, male and female, that are fixed at conception, and orders government agencies to end all reference to and consideration of a person's gender identity. This sweeping redefinition threatens federal programs used by transgender people and affects federal documentation such as passports, which can currently reflect the gender identity of transgender and nonbinary people.
The order further instructs agencies to house transgender people in detention according to their sex assigned at birth, putting them at extreme risk of physical and sexual violence, and to withhold gender-affirming care in prisons, which can amount to cruel, inhuman, and degrading treatment or punishment under international law.
If fully implemented, these orders targeting transgender people will lead to violations of their fundamental right to freedom from discrimination under the International Covenant on Civil and Political Rights (ICCPR), which prohibits discrimination on the basis of both sexual orientation and gender identity.
In 2023, the United Nations Human Rights Committee concluded a periodic review of the US government's performance relative to its obligations under the ICCPR. The Committee expressed particular concern about "the increase in the number of state laws that severely restrict people's rights on the basis of their sexual orientation or gender identity, such as laws that ban and, in some instances, criminalize gender-affirming health care for transgender people." President Trump's executive order on gender-affirming care essentially seeks to accelerate and nationalize those same, troubling state-level trends.
"This order highlights the Trump administration's systematic, dangerous effort to roll back fundamental protections for transgender people," Younes said. "Lawmakers should be focused on creating systems for young transgender people to navigate their identity with safety and support, not prohibiting them from accessing the care they need."
