Restricting Gender-Affirming Care for Transgender Youth

Over the past year and a half, the Trump Administration has moved to restrict access to gender-affirming care—treatments supporting individuals’ expression of gender identity—for transgender youth.

On his first day in office, President Donald J. Trump signed an executive order directing all federal agencies to recognize only two biological sexes. One week later, he signed another executive order, titled Protecting Children from Chemical and Surgical Mutilation, directing federal agencies to withhold funding from any medical institutions providing gender-affirming care to individuals under the age of 19.

Federal agencies have taken the lead in the Trump Administration’s attack on gender-affirming care. In June 2025, former Attorney General Pam Bondi issued a memo directing the U.S. Department of Justice to investigate and prosecute institutions under the False Claims Act for billing federal health programs for some gender-affirming treatments. The next month, the Justice Department subpoenaed more than 20 children’s hospitals, seeking the medical records of transgender patients.

The Centers for Medicare & Medicaid Services proposed two rules that would limit federal insurance coverage for gender-affirming care in December 2025. The first rule would prevent hospitals that accept Medicare and Medicaid from providing gender-affirming care to young patients. The other would exclude federal Medicaid and Children’s Health Insurance Program funds from covering gender-affirming care.

These proposed rules would affect thousands of transgender youths. Researchers have found that current state bans on gender-affirming care already impact half of transgender youth aged 13 to 17.

Public opinion remains divided. In a recent study, the Pew Research Center found that 56 percent of Americans support banning gender transitions for minors. But 56 percent of Americans also support policies aimed at protecting transgender individuals from discrimination in areas such as employment and housing.

In response to recent restrictions on gender-affirming care, every major U.S. medical association—including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society—expressed support for evidence-based health care for transgender youth.

Advocates for transgender rights, health care providers, and families of transgender children caution that gender-affirming care restrictions often cause grievous harm. The Trevor Project, for example, found that the rate of suicide incidents among transgender and nonbinary youth increased by almost 72 percent following the passage of anti-transgender laws. Health care providers sometimes experience violence and threats of violence for providing gender-affirming care, including arson attempts and bomb threats, and families face financial hardships when bans force parents to travel to states without restrictions on gender-affirming care to seek treatment for their children.

In United States v. Skrmetti, the Supreme Court held that a Tennessee ban on gender-affirming care for minors was constitutional, suggesting the constitutionality of similar bans in 25 states. Litigation opposing these bans remains pending in 17 states, placing courts at the center of the ongoing fight over gender-affirming care.

In this week’s Saturday Seminar, scholars discuss the legal implications of restrictions on gender-affirming care for transgender youth.

• In a policy brief, Elana Redfield of the Williams Institute at the UCLA School of Law argues that the over 180,000 transgender youths in states allowing gender-affirming care will be most affected by President Trump’s executive order Redfield explains that the orders will disproportionately affect three already vulnerable populations: low-income transgender youth enrolled in Medicaid, military dependents covered under an armed services health care program, and 18-year-olds not covered by most existing state bans but falling within the second executive order’s higher age threshold. Redfield notes that, despite the breadth of restrictions on gender-affirming care, such treatments for minors have been rare.
• In an article in UCLA Law Review Discourse, Craig Konnoth of the University of Virginia School of Law argues that hospital systems terminating gender-affirming care in response to President Trump’s executive orders are acting illegally. Many of the institutions that have ended gender-affirming care are within jurisdictions with controlling federal and state court opinions that plausibly require such care, Konnoth notes. Konnoth explains that President Trump’s second executive order could not—on its own—enforce the penalties it threatens, and that terminating needed care violates the ethical standards that bind medical professionals. Konnoth characterizes providers’ allegedly illegal activity as “anticipatory compliance,” concluding that it harms vulnerable patients and undermines the rule of law.
• Courts’ use of possessive language such as “its” or “their” when articulating states’ relationship to transgender children encroaches on parental rights, argues William J. Aceves of California Western School of Law in a Washington University Law Review article. Aceves explains that courts, in recent decisions concerning states’ gender-affirming care bans, have described transgender children as belonging to the state. Aceves contends this language indicates state authority to control transgender children and interfere with parent-child relationships through regulation. For children who do not deviate from societal norms, in contrast, courts protect parents’ rights and use possessive words to describe how parents relate to the children, Aceves claims. Aceves insists that “states have citizens; they do not have children.”
• In an essay in SCOTUSblog, Akhil Reed Amar of Yale Law School and Vikram Amar of UC Davis School of Law argue that the Supreme Court should have sent Skrmetti back to a lower court and applied intermediate scrutiny—a stricter standard than the rational basis analysis used by the Court. Amar and Amar decline to take a position on whether the case would survive such review, in part due to the unique procedural circumstances of the case. Amar and Amar also raise questions that the Court may decide in future cases—including the constitutionality of a restriction on gender-affirming care motivated by a combination of a legitimate government interest and an illegitimate government interest.
• In an article in the Harvard Law Review, Kate Redburn of Columbia Law School argues that the Supreme Court’s failure to articulate a limit for its reasoning in Skrmetti created a new, confusing approach for classifying individuals based on sex, especially for medical purposes. Redburn observes that a narrow reading of the majority approach would mean Skrmetti’s reasoning only applies to laws about transgender youth. But Redburn notes that a broader reading could apply Skrmetti to a “wide range of sex-related regulations” by depicting them as “essentially medical.” Redburn concludes that other cases before the Supreme Court raising questions surrounding transgender athletes, including Little v. Hecox and West Virginia v. B.P.J., will likely further develop the Skrmetti
• Many gender-affirming care bans for youth include exceptions for intersex children that undermine justifications for the bans, according to Holning Lau and Barbara A. Fedders of the University of North Carolina School of Law in an article in the Yale Journal of Law and Feminism. Lau and Fedders explain that doctors often perform medically unnecessary surgeries on intersex infants—individuals born with sets of features not exclusive to one sex—to align their bodies with standard male or female gender presentations. Exceptions for intersex procedures suggest that concerns about “medical harm, irreversibility, and lack of informed consent” do not motivate gender-affirming care restrictions, argue Lau and Fedders. They encourage courts to acknowledge that “stereotypes, irrational fear, and disgust” motivate bans when evaluating gender-affirming care regulations.