US moves to ban gender surgeries on minors

The U.S. Department of Health and Human Services (HHS) has unveiled a series of proposed regulations aimed at ending the use of so-called sex-rejecting procedures on children, following President Trump’s Executive Order directing the agency to act.

HHS officials said such procedures—including puberty blockers, cross-sex hormones, and surgical interventions intended to align a child’s body with a gender identity different from their biological sex—pose irreversible harm to minors. A Thursday release on the HHS website outlined the plan.

Under the proposals, the Centers for Medicare & Medicaid Services (CMS) would bar hospitals from performing sex-rejecting procedures on children under 18 as a condition for participation in Medicare and Medicaid programs. Since nearly all U.S. hospitals participate in these federal programs, HHS said the move is designed to prevent federal funding from supporting interventions that can permanently harm children.

CMS is pursuing the rule under its authority in sections 1861(e)(9), 1871, and 1905(a) of the Social Security Act, which empower the agency to set standards for patient health and safety in Medicare- and Medicaid-participating hospitals. The agency will also propose rules to prohibit federal Medicaid funding for these procedures for children under 18, and for the Children’s Health Insurance Program (CHIP) for those under 19.

Currently, 27 states do not provide Medicaid coverage for sex-rejecting procedures. HHS cited potential risks including infertility, impaired sexual function, diminished bone density, altered brain development, and other lasting physiological effects.

Health and Human Services Secretary Robert F. Kennedy Jr., who signed a declaration based on an HHS peer-reviewed report, said the procedures “do not meet professionally recognized standards of health care.” He added that practitioners performing such interventions on minors would be considered noncompliant with professional standards.

“Under my leadership, and responding to President Trump’s directive, the federal government will take every step to stop unsafe, irreversible practices that put children at risk,” Kennedy said. “Our children deserve better—and we are delivering on that promise.”

CMS Administrator Dr. Mehmet Oz echoed the concerns, stating, “Children deserve protection, not experimental interventions that carry life-altering risks with no proven benefit. This proposal makes it clear that hospitals in federal programs cannot conduct these unproven procedures.”

In addition, the U.S. Food and Drug Administration (FDA) is issuing warning letters to 12 manufacturers and retailers for illegally marketing breast binders to children for gender dysphoria products typically intended for post-mastectomy recovery. FDA Commissioner Marty Makary said enforcement measures, including import alerts and seizures, could follow if the practices continue.

HHS is also seeking to reverse a prior Biden administration effort to classify gender dysphoria as a disability. Deputy Secretary Jim O’Neill said the previous policy “abused a law never intended to require health care providers to perform transgender surgeries on minors. Our rule restores clarity and allows federally funded organizations to follow evidence-based policies without fear of violating civil rights laws.”

Assistant Secretary for Health and head of the U.S. Public Health Service Commissioned Corps, Admiral Brian Christine, M.D., emphasized, “Children’s health and well-being guide our actions. Evidence shows sex-rejecting puberty blockers, cross-sex hormones, and surgeries are dangerous. Providers must prioritize evidence-based care and avoid interventions that can cause lifelong harm.”

HHS reported that nearly 14,000 minors received sex-rejecting procedures between 2019 and 2023, citing claims data and its peer-reviewed study Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, which underscores the medical risks associated with these interventions.