Trump Administration Proposes Restrictions on Gender-Affirming Care

The Trump administration has introduced significant regulatory changes aimed at limiting gender-affirming care for minors. This proposal could have far-reaching consequences for hospitals, including the Children’s Hospital of Philadelphia (CHOP), one of the largest centers providing such care in the United States. Among the proposed measures is the withdrawal of federal Medicaid and Medicare funding for hospitals that offer gender-affirming services to children.

On Thursday, the administration, led by former President Donald Trump and Robert F. Kennedy Jr., revealed plans to enforce strict regulations that would categorize gender-affirming procedures as harmful. Trump has previously referred to these treatments as “chemical mutilation,” equating them with child abuse and dismissing the associated medical research as “junk science.”

CHOP’s Gender and Sexuality Development Program, established in 2014, serves hundreds of families each year seeking support for transgender and gender-nonbinary children. The program provides comprehensive medical and psychological evaluations prior to any treatment, ensuring that prescribed hormone therapies and puberty blockers are administered responsibly. The American Academy of Pediatrics and other leading medical organizations endorse these treatments as safe and effective for managing gender dysphoria—a condition experienced when a person’s gender identity does not align with their biological sex.

Despite the legal framework supporting gender-affirming care in Pennsylvania, the federal government is moving to impose penalties on institutions that continue to provide these services. This includes potential consequences for hospitals like CHOP, which has been at the forefront of care for transgender youth.

The proposed rules also indicate that the U.S. Food and Drug Administration plans to take action against companies marketing breast binders to minors. This initiative aligns with the administration’s broader strategy to control the narrative around gender-affirming care and restrict access to necessary services.

In June, the U.S. Department of Justice issued subpoenas to CHOP and at least 19 other hospitals as part of an investigation into alleged healthcare fraud related to the treatment of transgender youth. The subpoenas demanded sensitive patient information, including medical records, Social Security numbers, and detailed communications from healthcare providers dating back to January 2020.

Legal responses to these subpoenas have been vigorous, with hospitals, including CHOP, seeking to protect the privacy of their patients. Federal judges in Philadelphia, Boston, and Washington State have previously ruled in favor of hospitals, stating that the privacy interests of children significantly outweigh the federal government’s need for such information. In a recent ruling, U.S. District Court Judge Mark A. Kearney emphasized that the administration’s demands were politically motivated, thereby safeguarding the confidentiality of sensitive patient data.

The legal challenges surrounding these subpoenas continue, with parents and advocacy groups joining the fight to limit the breadth of information requested by the federal government. The Public Interest Law Center, representing families affected by these policies, has expressed strong opposition to the proposed federal rule that aims to eliminate funding for hospitals treating transgender youth, describing it as a potential violation of their rights.

Mimi McKenzie, the legal director at PILC, stated, “These records are so deeply personal and contain such highly sensitive information about these young patients. There is no anonymization or redaction that can protect their privacy interests.” She emphasized that the proposed federal rule would likely face numerous legal challenges, asserting that gender-affirming care is vital for the well-being of many children.

As some hospitals, including Nemours Children’s Hospital in Delaware and UPMC Children’s Hospital in Pittsburgh, have already announced a cessation of gender-affirming care for new patients, the landscape for transgender healthcare remains uncertain. The proposed regulations threaten to deeply impact the availability of necessary medical interventions for youth in need of support.

The federal government has a 60-day window to appeal the ruling from Judge Kearney, which could set a critical precedent for the future of healthcare for transgender youth across the country. The unfolding situation continues to attract scrutiny and debate, highlighting the complex intersection of healthcare, politics, and civil rights in the United States.