Federal Actions on Youth Gender-Affirming Care Spark Legal, Medical, and Institutional Responses

A series of federal policy announcements and proposed rules aiming to restrict gender-affirming medical care for individuals under 18 have prompted legal challenges from multiple states, opposition from major medical organizations, and led some hospitals to alter their services. The developments have created a complex landscape affecting healthcare providers, patients, and families across the United States.

Federal Policy Announcements and Proposed Rules

On a Thursday in December 2025, officials from the Department of Health and Human Services (HHS) announced measures to restrict gender-affirming care for transgender youth. Health Secretary Robert F. Kennedy Jr. led the announcement, joined by the heads of the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH).

The announcement included a declaration characterizing treatments such as puberty blockers, hormone therapy, and surgeries as "unsafe and ineffective" for children and adolescents experiencing gender dysphoria.

The declaration advised medical providers that offering such care could lead to their exclusion from federal health programs like Medicare and Medicaid.

Concurrently, HHS introduced two proposed rules:

• One rule would prohibit federal Medicaid reimbursement for medical care provided to transgender patients under 18.
• A second rule would block all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.

These proposed rules are in draft form, are not immediately effective, and must undergo a standard public comment period before potential finalization.

Basis of Federal Actions

HHS officials stated their actions were based on science and evidence. The department cited an internal peer-reviewed report from earlier in the year. This report advocated for an increased emphasis on behavioral therapy over broader gender-affirming medical interventions for youth. It also questioned existing treatment standards and raised concerns about adolescents' capacity to consent to treatments with potential irreversible effects, including future infertility.

During the announcement, some officials made statements on gender identity. Acting CDC Director Jim O'Neill stated, "Men are men. Men can never become women. Women are women. Women can never become men." Health Secretary Robert F. Kennedy Jr. alleged that doctors and medical groups had "peddled the lie" regarding the benefits of these treatments for children.

Legal Challenges to Federal Actions

A coalition of 19 states and the District of Columbia filed a lawsuit in U.S. District Court in Eugene, Oregon, challenging the HHS declaration. The plaintiffs, led by New York Attorney General Letitia James, allege the declaration is inaccurate and unlawful. The lawsuit contends that the Secretary cannot unilaterally alter medical standards via an online publication and that the action bypassed legal requirements for public notice and comment before significant policy changes.

In March 2026, a federal judge in Oregon ruled on the lawsuit. Judge Mustafa Kasubhai ruled that the government exceeded its authority, primarily because Secretary Kennedy did not follow proper administrative procedures when issuing the declaration. The judge denied a motion to dismiss the case. This ruling followed an earlier decision by a federal judge in Boston, who temporarily blocked several of Kennedy’s vaccine policy changes on similar procedural grounds. Federal officials have indicated plans to appeal the vaccine ruling.

The lawsuit does not address the proposed funding rules, as they have not been finalized.

Opposition from Medical Organizations

Major U.S. medical organizations have opposed the federal actions. The American Academy of Pediatrics (AAP), the American Medical Association (AMA), the Endocrine Society, and the American Psychological Association have issued statements challenging the administration's stance.

The AAP stated the policies "misconstrue the current medical consensus and fail to reflect the realities of pediatric care."

These organizations maintain that gender-affirming care is safe and effective for appropriate young patients when provided according to established guidelines. The AMA clarified it supports evidence-based treatment, including gender-affirming care, and that surgical interventions in minors should generally be deferred until adulthood, a position it described as a clarification of existing policy.

Impact on Healthcare Providers and Patients

Some hospitals have altered their services following the federal announcements, citing financial and regulatory risks.

• Baystate Health in Springfield, Massachusetts, announced in February it would no longer provide gender-affirming medications to minors, offering only counseling. The hospital stated its decision was based on concerns about losing government reimbursement, as nearly 70% of its patients rely on Medicaid and Medicare.
• Children’s Wisconsin and UW Health in Wisconsin announced they have ceased providing gender-affirming pharmacologic treatments to minors, citing "escalating legal and federal regulatory risk" and "recent federal actions."
• Similar program closures or reductions have been reported at hospitals in other states, including California, Illinois, and New York.

Private clinics, such as TransHealth in Northampton, Massachusetts, have reported absorbing patients from hospital programs. TransHealth's CEO stated the clinic can continue operations due to private donations and less dependence on government insurance programs.

Families affected by these changes have filed civil rights complaints with the Massachusetts Attorney General's office. Some families have transitioned care to primary care physicians or private clinics.

Broader Legislative and Regulatory Context

These federal actions occur within a broader landscape of state laws and congressional activity.

• State Laws: At least 27 states have enacted laws restricting or prohibiting gender-affirming care for minors. A recent Supreme Court decision upheld Tennessee's ban, which may impact the legal standing of similar state laws.
• Congressional Activity: In the House of Representatives, a bill introduced by Rep. Marjorie Taylor Greene (R-Ga.) passed. It proposes criminalizing the provision of gender-affirming care to transgender minors, with penalties including fines or up to 10 years in prison. A separate bill introduced by Rep. Dan Crenshaw (R-Texas), which would prohibit Medicaid reimbursement for such care, has advanced for a vote. Both bills would require Senate approval to become law.
• Surgical Recommendations: The Trump administration endorsed a position statement from the American Society of Plastic Surgeons (ASPS) recommending delaying gender-related surgeries until a patient is at least 19. The ASPS stated this was based on current evidence and the legal environment, not a reversal of prior stance. The administration presented this as aligning with its policy objectives.

Demographics and Patient Perspectives

According to a CDC survey, approximately 3% of teenagers aged 13-17 identify as transgender. A KFF poll found that less than one-third of transgender individuals use medication related to their identity, and 16% have undergone surgery. For minors, common medical options include puberty blockers and hormones, with surgery being rare.

Patients and advocates have expressed concern about the impact of restrictions. A 15-year-old transgender individual in California described worry about losing access to medication. Advocacy groups have stated that restricted access could negatively affect mental health.