The administration of President Donald Trump has proposed a suite of new rules that seek to bar hospitals across the United States from performing gender-affirming healthcare for transgender youth below 18 years of age.

On Thursday, the Centers for Medicare and Medicaid Services (CMS) announced that one of the proposed rules would block hospitals and clinics from accessing its programmes if they chose to continue providing gender-affirming care.

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A second rule would prohibit federal Medicaid funds from going to gender-affirming procedures.

Both Medicare and Medicaid are forms of government-provided health insurance, offered to vulnerable groups. Medicaid primarily serves low-income households, while Medicare offers coverage to older Americans and people with disabilities.

In a statement, the Trump administration noted that the vast majority of healthcare providers work with Medicare and Medicaid to provide health coverage for their patients. The proposed rule would therefore amount to a de facto ban on gender-affirming care.

“Nearly all US hospitals participate in Medicare and Medicaid,” the CMS statement reads.

“This action is designed to ensure that the US government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children.”

In addition to the two proposed rules, Health and Human Services Secretary Robert F Kennedy Jr signed a declaration on Thursday rejecting gender-affirming care as detrimental to youth.

Under his orders, the Food and Drug Administration also issued notices to 12 manufacturers of chest binders — which flatten the upper torso, where breasts are — warning that marketing to transgender youth would be considered illegal under the current administration.

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Diverging from medical consensus

The string of pronouncements marked the Trump administration’s latest broadside against transgender healthcare, despite repeated warnings from top medical associations that prohibiting such treatment could have devastating, lifelong consequences.

But in a news conference on Thursday, Kennedy, who has no formal medical training, lashed out against some of the country’s leading medical groups, accusing them of violating their professional duties.

“The American Medical Association, the American Academy of Pediatrics peddled the lie that chemical and surgical sex-rejecting procedures could be good for children who suffer from gender dysphoria,” Kennedy said.

“They betrayed their Hippocratic Oath to do no harm. So-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people. This is not medicine. It is malpractice.”

CMS Director Mehmet Oz likewise accused healthcare practitioners of abusing patients’ trust by prescribing gender-affirming treatments. He suggested the motivation was not the patients’ health but rather profit.

“ The doctor can’t look them in the eyes and treat them like a child that’s confused and lost and needs help. They become an opportunity. They become eventually a victim,” Oz said.

“ Reasonable evidence-based objections that a child’s confusion might resolve over time have been ignored, even though it makes common sense.”

The Trump administration has taken a hardline against the transgender community, denying such an identity even exists.

Instead, upon taking office on January 20, Trump issued an executive order announcing that the federal government would recognise only the concept of biological sex, not gender identity, and that people would be categorised as either male or female, according to their birth certificates.

The executive order also rejected transgender identity as a “false” concept.

‘Problem that does not actually exist’

Eight days later, on January 28, Trump followed that executive order with a second one that called on the Department of Health and Human Services (HHS) to end practices it described as “the chemical and surgical mutilation of children”.

That order was cited as the basis for Thursday’s proposed rule and declarations to limit gender-affirming care.

But there is a wide consensus in the healthcare community that gender-affirming care can improve the health of transgender youth, including by lowering incidents of suicide, anxiety, self-harm and depression.

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Gender-affirming care can take a range of forms, from surgery to puberty blockers, a treatment considered safe and reversible for children seeking to delay the onset of puberty.

Such treatments are recommended only after in-depth consultation with a trusted healthcare professional, and surgery is incredibly rare among transgender youth.

One 2024 study from Harvard University found that, for every 100,000 adolescents between the ages of 15 and 17, an average of 2.1 teenagers sought gender-affirming surgery, according to medical insurance claims from 2019.

That average dropped to 0.1 for teens between 13 and 14 years of age, and no cases were reported under the age of 12.

One of the study’s authors, Dannie Dai, said in a news release that the results suggested that “legislation blocking gender-affirming care among TGD [transgender and gender-diverse] youth is not about protecting children, but is rooted in bias and stigma”.

Dai added that such government actions seek “to address a perceived problem that does not actually exist”.

Shortly after Thursday’s announcements, groups like the Human Rights Campaign called on the public to voice their concern about the Trump administration’s proposed new rules.

“These rules now face a 60-day ‘comment period,’ where YOU can weigh in,” the Human Rights Campaign wrote on its social media.

“A large number of comments can slow it down, force changes, or lay the groundwork for future litigation. YOUR comments are where that starts.”

Congressional actions under way

Already, 27 states prohibit gender-affirming care for minors, including major population centres like Texas, Ohio and Florida.

As a result, the Human Rights Campaign estimates that, out of the 300,000 transgender youth in the US, nearly 40 percent live in a state where they cannot access the healthcare they may need.

Those state actions have been supported by actions on the federal level. In June, the Supreme Court’s conservative majority voted in a six-to-three decision to uphold Tennessee’s ban on gender-affirming care for minors.

Just this week, on Wednesday, the US House of Representatives passed a bill that would criminalise providing gender-affirming care for patients aged below 18. A total of 216 representatives, including several Democrats, voted in favour of sending the bill to the Senate, where it faces uncertain odds.

Another House bill, designed to cut off Medicaid benefits for transgender youth seeking gender-affirming care, is slated to be voted upon on Thursday.

While proponents fear youths may make healthcare decisions they come to regret later in life, advocates emphasise that some gender-affirming treatments, including puberty blockers, are reversible and that they can protect teenagers from physical and emotional harm.

Standing on the steps of Congress, Representative Sarah McBride, the first openly transgender member of the House, said she believes there is a gap in the public’s understanding of gender-affirming treatments.

“I get that it’s hard to understand this care and understand the need for it,” McBride told reporters. “But one of the things that gets so lost in this conversation is that the transgender adults of today were kids once. I was a kid once.”

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“My biggest regret in life,” she continued, “is that I never had a childhood without that pain.”

McBride voted against the legislation and denounced the “hate” she felt motivated it. “Politicians should never insert themselves into the personal health care decisions of patients, parents, and their providers — and that includes trans Americans,” she later wrote on social media.

Kennedy, meanwhile, told reporters that he anticipates lawsuits will challenge the Trump administration’s proposed changes.

“I think that’s going to happen. The number of lawsuits with my name on it right now is almost beyond counting,” he said.

He added that the Trump administration was confident it would win any lawsuits. “It’s a disgrace to the medical establishment that they let this go on for so long.”