WASHINGTON, D.C. — The Trump administration on Thursday unveiled a sweeping set of proposed federal regulations aimed at halting what officials describe as irreversible and unsafe medical interventions performed on children, marking a major escalation in the administration’s effort to restrict sex-rejecting procedures nationwide.
The U.S. Department of Health and Human Services announced that it is moving to implement President Donald Trump’s executive order directing federal agencies to end the practice of pharmaceutical and surgical procedures intended to alter a child’s physical sex to match an asserted gender identity.
As part of the initiative, the Centers for Medicare & Medicaid Services will issue a notice of proposed rulemaking that would bar hospitals from performing sex-rejecting procedures on patients under age 18 as a condition of participation in Medicare and Medicaid. Nearly all U.S. hospitals rely on those federal programs, giving the proposal broad reach across the health care system.
CMS said the rule is grounded in its authority under the Social Security Act to establish standards protecting patient health and safety. Agency officials said the intent is to ensure that federal programs do not support practices that cause permanent harm to children, whether directly or indirectly.
A separate proposed rule would prohibit federal Medicaid funding for sex-rejecting procedures on minors under 18 and extend the same ban to the Children’s Health Insurance Program for individuals under 19. HHS noted that 27 states already do not cover such procedures through Medicaid.
HHS officials said the procedures in question — including puberty blockers, cross-sex hormones, and surgeries — can result in irreversible consequences such as infertility, impaired sexual function, reduced bone density, altered brain development, and other long-term physiological effects.
Health and Human Services Secretary Robert F. Kennedy Jr. signed a formal declaration Thursday concluding that these interventions do not meet professionally recognized standards of medical care. The declaration is based on an HHS peer-reviewed report and states that practitioners who perform such procedures on minors would be considered out of compliance with accepted health care standards.
Kennedy said the administration is acting to protect children from what he described as unsafe and irreversible practices. He said the federal government would use all available authority to prevent young people from being exposed to interventions that carry life-altering risks.
CMS Administrator Dr. Mehmet Oz said the proposal is intended to clarify that hospitals participating in federal programs cannot offer what he described as unproven procedures to children. He said CMS has a responsibility to ensure that federal standards reflect the obligation to safeguard children’s health and safety.
The Food and Drug Administration is also taking enforcement action, issuing warning letters to 12 manufacturers and retailers accused of illegally marketing breast binders to children for the treatment of gender dysphoria. The FDA said breast binders are classified as Class 1 medical devices intended for uses such as post-mastectomy recovery, not for pediatric treatment of gender-related conditions.
FDA Commissioner Dr. Marty Makary said the agency considers the marketing of such products to children to be a serious violation and warned that further enforcement actions, including seizures and injunctions, could follow if companies fail to comply.
In addition, HHS is proposing to reverse a Biden administration policy that sought to include gender dysphoria within the definition of a disability under Section 504 of the Rehabilitation Act of 1973. The revised rule would clarify that gender dysphoria not resulting from a physical impairment does not qualify as a disability, and that policies restricting sex-rejecting procedures do not violate federal disability nondiscrimination requirements.
Deputy Health and Human Services Secretary Jim O’Neill said the previous administration misapplied civil rights law in ways that pressured providers to support medical interventions for minors. He said the proposed change would restore regulatory clarity and allow federally funded organizations to adopt evidence-based policies without fear of civil rights violations.
Last month, HHS released a peer-reviewed report titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, which concluded that current evidence does not support the safety or effectiveness of sex-rejecting medical interventions for children. According to federal claims data cited by the agency, nearly 14,000 minors received such procedures between 2019 and 2023.
Assistant Secretary for Health and U.S. Public Health Service Commissioned Corps head Admiral Brian Christine signed a public health message Thursday warning providers, families, and policymakers that the available evidence shows significant risks associated with puberty blockers, cross-sex hormones, and related surgeries. He said health care providers have an obligation to offer care grounded in evidence and to avoid exposing children to interventions that could cause lifelong harm.
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