President Trump’s clampdown on the medical provision of “gender transition” drugs and surgeries for minor children is already causing significant reverberations in the nation’s medical community.

The Jan. 28 Protecting Children from Chemical and Surgical Mutilation executive order primarily affects states where transgender procedures for minors are currently permitted. The provision of hormones, puberty blockers and surgical procedures for this purpose is completely banned by 24 states, while two others, New Hampshire and Arizona, ban surgeries but allow the use of hormones and puberty blockers.

Facing the threat of federal defunding if they defy Trump’s executive order, a number of hospitals in states without bans have moved quickly to halt provision of the controversial and frequently irreversible procedures, which seek to modify a personal’s physical appearance so that it resembles the opposite sex to his or her biological sexual identity. According to news reports, these institutions include Children’s National Hospital in Washington, D.C.; Virginia Commonwealth University Health, University of Virginia Health and the Children’s Hospital of Richmond; and Denver Health and the University of Colorado Health.

And on Feb. 3, The New York Times reported that NYU Langone Health in New York was suspending transgender treatments for minors, although it had not publicly announced the policy shift. According to the Times, several hundred people protested the decision outside of NYU Langone’s Tisch Hospital in Manhattan during a rally organized by local chapters of the Democratic Socialists of America.

California is another major state that, like New York, has been in the forefront of offering transgender medical services. “Some medical providers are starting to preemptively cancel appointments with transgender youth because they’re afraid of losing their license or funding,” Dannie Ceseña, director of the California LGBTQ Health & Human Services Network, told the online news source CalMatters. “I’m hearing it across the state from a variety of partners.” 

On Feb. 4, CNN reported that Children’s Hospital Los Angeles had advised it was “pausing the initiation of hormonal therapies for all gender affirming care patients under the age of 19.” 

The Trump administration has applauded the reports of hospitals walking back the provision of transgender procedures for minors because of its executive order.

“It’s already having its intended effect — preventing children from being maimed and sterilized by adults perpetuating a radical, false claim that they can somehow change a child’s sex,” the White House said in a Feb. 3 news release. 

Earlier, the U.S. Conference of Catholic Bishops issued a statement in support of the executive order.

“I welcome the President’s Executive Order prohibiting the promotion and federal funding of procedures that, based on a false understanding of human nature, attempt to change a child’s sex,” Bishop Robert Barron, chairman of the USCCB’s Committee on Laity, Marriage, Family Life and Youth, said in the Jan. 29 statement.

“So many young people who have been victims of this ideological crusade have profound regrets over its life altering consequences, such as infertility and lifelong dependence on costly hormone therapies that have significant side effects.”

Pushback

In an apparent response to NYU Langone’s move to cancel appointments for some children seeking transgender procedures, New York State Attorney General Letitia James released a letter Feb. 3, warning that “withholding the availability of services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria ... is discrimination under New York law.”

California Attorney General Rob Bonta released a similar statement, warning Children’s Hospital Los Angeles that transgender procedures are protected under state law. “I understand that the President’s executive order on gender affirming care has created some confusion,” Bonta said in a Feb. 5 statement. “Let me be clear: California law has not changed, and hospitals and clinics have a legal obligation to provide equal access to healthcare services.”

James and Bonto were also among the 15 state attorneys general who released a joint statement on Feb. 6, declaring that they “will continue to enforce state laws that provide access to gender-affirming care.”   

Despite such maneuvers, however, Trump’s executive order is likely to remain a persuasive force with medical institutions given how dependent hospitals are on federal funding. In the case of NYU Langone, for example, The New York Times noted that the hospital was not only in jeopardy of losing more than $800 million in funding from the National Institutes of Health if it continues providing transgender services to minors. Also potentially at risk is all of its federal Medicare and Medicaid funding. 

“In a recent 12-month period, NYU Langone made more than $9 billion from patient care,” the newspaper reported. “Nearly half that amount — $4.4 billion — was paid through government insurance programs.”

Lawsuits are another mechanism that supporters of transgender procedures are utilizing, in hopes of thwarting the executive order. On Feb. 4, two transgender activist groups and 7 minors who identify as transgender and some of their parents jointly filed a suit in a Maryland federal court, alleging that the transgender executive order and other new executive orders that restrict federal funding are “unlawful and unconstitutional.”

Lambda Legal, an LGBT legal organization that is representing the plaintiffs along with the American Civil Liberties Union, said an application seeking a restraining order against the executive actions would also be filed with the court “imminently.”

What the Evidence Says

According to the transgender activists’ lawsuit, gender transition procedures in U.S. hospitals “have long followed and continue to use evidence-based, well-researched, and widely accepted clinical practice and medical guidelines to assess diagnose and treat adolescents and adults with gender dysphoria, which is a medical condition characterized by the incongruence between a person’s gender and the sex they were assigned at birth.”

But in fact, the Trump administration’s bid to rein in transgender medical procedures for minors because of concerns about their adverse consequences is not an international outlier. Several European nations, including Sweden, Finland, France and the Netherlands, earlier scaled back such medical interventions after assessing the weakness of the actual evidence regarding their purported benefits.

“As a result, across Europe there has been a gradual shift from care which prioritizes access to pharmaceutical and surgical interventions, to a less medicalized and more conservative approach that addresses possible psychiatric comorbidities and explores the developmental etiology of trans identity,” a June 2023 article in Forbes reported.

Concerns about the shortcomings of the evidence that allegedly supports transgender treatments for minors accelerated significantly following the April 2024 release of the U.K.’s Cass Review. That review was commissioned in the wake of a court judgment in 2021 against the U.K’s Tavistock Gender Identity clinic in the case filed by Keira Bell, a biologically female former patient of the facility. While that verdict was later overturned, it prompted the U.K. government to permanently close the clinic in 2022.

Conducted under the oversight of Dr. Hillary Cass, the former president of the Royal College of Paediatrics and Child Health, the Cass Review examined the available scientific evidence regarding gender transitioning treatments for minors. 

“While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices,” the report stated. 

More specifically, it concluded that the rationale for prescribing puberty blockers “remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health,” and that prescribing opposite-sex hormones to minors “also presents many unknowns, despite their longstanding use in the adult transgender population.”

In light of this absence of reliable evidence, “For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress,” the report stated.

Targeting WPATH

The Cass Review’s researchers also concluded that most national and international clinical guidelines for minors who experience confusion about their sexual identity are deeply flawed. Such guidelines, including those used in the U.S., have generally been heavily influenced by the World Professional Association for Transgender Health (WPATH), a transgender advocacy group. 

“Most national and regional guidance has been influenced by the World Professional Association for Transgender Health and Endocrine Society guidelines, which themselves lack developmental rigor and are linked through cosponsorship,” one of the studies commissioned by the review stated.

The validity of WPATH’s recommendations also came under challenge last year following the publication of conversations that were gleaned from an internal WPATH online forum by a watchdog group. In their remarks, the WPATH participants acknowledged that minors often lacked the capacity to fully understand the permanent consequences of hormonal treatments, and that little is known about the long-term consequences of using puberty blockers, Catholic News Agency reported. 

WPATH’s influence over the clinical guidelines for transgender procedures is specifically targeted in Trump’s executive order. Section 3 of the order, titled “Ending Reliance on Junk Science,” mandates federal agencies to rescind or amend all policies that draw on WPATH’s guidance.

“The blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity, spurred by guidance from the World Professional Association for Transgender Health (WPATH), which lacks scientific integrity,” the executive order states.