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US - Protecting children from chemical and surgical mutilation (Executive Order, White House, January 28, 2025)

Pathfinder

Editor, Senior Moderator
PROTECTING CHILDREN FROM CHEMICAL AND SURGICAL MUTILATION

EXECUTIVE ORDER
January 28, 2025

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered:

Section 1. Policy and Purpose. Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions. This dangerous trend will be a stain on our Nation’s history, and it must end.

Countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding. Moreover, these vulnerable youths’ medical bills may rise throughout their lifetimes, as they are often trapped with lifelong medical complications, a losing war with their own bodies, and, tragically, sterilization.

Accordingly, it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called “transition” of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.

Sec. 2. Definitions. For the purposes of this order:

(a) The term “child” or “children” means an individual or individuals under 19 years of age.

(b) The term “pediatric” means relating to the medical care of a child.

(c) The phrase “chemical and surgical mutilation” means the use of puberty blockers, including GnRH agonists and other interventions, to delay the onset or progression of normally timed puberty in an individual who does not identify as his or her sex; the use of sex hormones, such as androgen blockers, estrogen, progesterone, or testosterone, to align an individual’s physical appearance with an identity that differs from his or her sex; and surgical procedures that attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions. This phrase sometimes is referred to as “gender affirming care.”

Sec. 3. Ending Reliance on Junk Science. (a) The blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity, spurred by guidance from the World Professional Association for Transgender Health (WPATH), which lacks scientific integrity. In light of the scientific concerns with the WPATH guidance:

(i) agencies shall rescind or amend all policies that rely on WPATH guidance, including WPATH’s “Standards of Care Version 8”; and

(ii) within 90 days of the date of this order, the Secretary of Health and Human Services (HHS) shall publish a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion.

(b) The Secretary of HHS, as appropriate and consistent with applicable law, shall use all available methods to increase the quality of data to guide practices for improving the health of minors with gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion, or who otherwise seek chemical or surgical mutilation.

Sec. 4. Defunding Chemical and Surgical Mutilation. The head of each executive department or agency (agency) that provides research or education grants to medical institutions, including medical schools and hospitals, shall, consistent with applicable law and in coordination with the Director of the Office of Management and Budget, immediately take appropriate steps to ensure that institutions receiving Federal research or education grants end the chemical and surgical mutilation of children.

Sec. 5. Additional Directives to the Secretary of HHS. (a) The Secretary of HHS shall, consistent with applicable law, take all appropriate actions to end the chemical and surgical mutilation of children, including regulatory and sub-regulatory actions, which may involve the following laws, programs, issues, or documents:

(i) Medicare or Medicaid conditions of participation or conditions for coverage;

(ii) clinical-abuse or inappropriate-use assessments relevant to State Medicaid programs;

(iii) mandatory drug use reviews;

(iv) section 1557 of the Patient Protection and Affordable Care Act;

(v) quality, safety, and oversight memoranda;

(vi) essential health benefits requirements; and

(vii) the Eleventh Revision of the International Classification of Diseases and other federally funded manuals, including the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

(b) The Secretary of HHS shall promptly withdraw HHS’s March 2, 2022, guidance document titled “HHS Notice and Guidance on Gender Affirming Care, Civil Rights and Patient Privacy” and, in consultation with the Attorney General, issue new guidance protecting whistleblowers who take action related to ensuring compliance with this order.

Sec. 6. TRICARE. The Department of Defense provides health insurance, through TRICARE, to nearly 2 million individuals under the age of 18. As appropriate and consistent with applicable law, the Secretary of Defense shall commence a rulemaking or sub-regulatory action to exclude chemical and surgical mutilation of children from TRICARE coverage and amend the TRICARE provider handbook to exclude chemical and surgical mutilation of children.

Sec. 7. Requirements for Insurance Carriers. The Director of the Office of Personnel Management, as appropriate and consistent with applicable law, shall:

(a) include provisions in the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs call letter for the 2026 Plan Year specifying that eligible carriers, including the Foreign Service Benefit Plan, will exclude coverage for pediatric transgender surgeries or hormone treatments; and

(b) negotiate to obtain appropriate corresponding reductions in FEHB and PSHB premiums.

Sec. 8. Directives to the Department of Justice. The Attorney General shall:

(a) review Department of Justice enforcement of section 116 of title 18, United States Code, and prioritize enforcement of protections against female genital mutilation;

(b) convene States’ Attorneys General and other law enforcement officers to coordinate the enforcement of laws against female genital mutilation across all American States and Territories;

(c) prioritize investigations and take appropriate action to end deception of consumers, fraud, and violations of the Food, Drug, and Cosmetic Act by any entity that may be misleading the public about long-term side effects of chemical and surgical mutilation;

(d) in consultation with the Congress, work to draft, propose, and promote legislation to enact a private right of action for children and the parents of children whose healthy body parts have been damaged by medical professionals practicing chemical and surgical mutilation, which should include a lengthy statute of limitations; and

(e) prioritize investigations and take appropriate action to end child-abusive practices by so-called sanctuary States that facilitate stripping custody from parents who support the healthy development of their own children, including by considering the application of the Parental Kidnapping Prevention Act and recognized constitutional rights.

Sec. 9. Enforcing Adequate Progress. Within 60 days of the date of this order, the heads of agencies with responsibilities under this order shall submit a single, combined report to the Assistant to the President for Domestic Policy, detailing progress in implementing this order and a timeline for future action. The Assistant to the President for Domestic Policy shall regularly convene the heads of agencies with responsibilities under this order (or their designees) to coordinate and prepare for this submission.

Sec. 10. Severability. If any provision of this order, or the application of any provision to any person or circumstances, is held to be invalid, the remainder of this order and the application of any of its other provisions to any other persons or circumstances shall not be affected thereby.

Sec. 11. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

THE WHITE HOUSE,

January 28, 2025.


https://www.whitehouse.gov/presiden...ildren-from-chemical-and-surgical-mutilation/
 
President Trump is Delivering on His Commitment to Protect our Kids

February 3, 2025

Last week, President Donald J. Trump took executive action to protect American children from irreversible chemical and surgical mutilation.

It’s already having its intended effect — preventing children from being maimed and sterilized by adults perpetuating a radical, false claim that they can somehow change a child’s sex. Hospitals around the country are taking action to downsize or eliminate their so-called “gender-affirming care” programs:
  • NEW YORK: NYU Langone Health has started canceling appointments for so-called “gender-affirming care” involving minors. They canceled appointments for “two 12-year-olds who had been scheduled to receive implants that dispense puberty-blocking medication.”
  • COLORADO: Denver Health announced it would stop performing sex change surgeries on minor children, while UCHealth said it is ending so-called “gender-affirming care” for all minors.
  • VIRGINIA: VCU Health and Children’s Hospital of Richmond have “suspended” providing transgender-related medication and surgeries for minors, while UVA Health has “suspended” all transgender-related services for minors.
  • WASHINGTON, D.C.: Children’s National Hospital has “paused” prescribing puberty blockers and hormone therapies for minors, while Northwest Washington Hospital has done the same.
  • ILLINOIS: Lurie Children’s Hospital of Chicago is “reviewing” their transgender-related services for minors.
  • PENNSYLVANIA: Children’s Hospital of Philadelphia is “closely reviewing” the transgender-related services they provide for minors.
...
https://www.whitehouse.gov/uncatego...vering-on-his-commitment-to-protect-our-kids/
 
University message on care services


Aug. 25, 2025

The University of Michigan, including Michigan Medicine, is one of multiple institutions across the country that has received a federal subpoena as part of a criminal and civil investigation into gender-affirming care for minors. In light of that investigation, and given escalating external threats and risks, we will no longer provide gender affirming hormonal therapies and puberty blocker medications for minors.
...

https://publicaffairs.vpcomm.umich.edu/key-issues/university-message-on-care-services/

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Related to:

Press Release

Department of Justice Subpoenas Doctors and Clinics Involved in Performing Transgender Medical Procedures on Children

Wednesday, July 9, 2025

For Immediate Release
Office of Public Affairs

WASHINGTON — Today, the Department of Justice announced that it has sent more than 20 subpoenas to doctors and clinics involved in performing transgender medical procedures on children.

The Department’s investigations include healthcare fraud, false statements, and more.

“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice.” — Attorney General Pamela Bondi

Updated July 9, 2025


https://www.justice.gov/opa/pr/depa...inics-involved-performing-transgender-medical
 
FOR IMMEDIATE RELEASE
December 18, 2025

Contact: HHS Press Office

202-690-6343
Submit a Request for Comment

HHS Acts to Bar Hospitals from Performing Sex-Rejecting Procedures on Children

WASHINGTON — DECEMBER 18, 2025 — The U.S. Department of Health and Human Services (HHS) today announced a series of proposed regulatory actions to carry out President Trump’s Executive Order directing HHS to end the practice of sex-rejecting procedures on children that expose young people to irreversible harm. These procedures include pharmaceutical or surgical interventions of specified types that attempt to align a child’s physical appearance or body with an asserted identity different from their sex.

The Centers for Medicare & Medicaid Services (CMS) will release a notice of proposed rulemaking to bar hospitals from performing sex-rejecting procedures on children under age 18 as a condition of participation in Medicare and Medicaid programs. Nearly all U.S. hospitals participate in Medicare and Medicaid and this action is designed to ensure that the U.S. government will not be in business with organizations that intentionally or unintentionally inflict permanent harm on children. CMS is proposing this rulemaking pursuant to its longstanding authority in sections 1861(e)(9), 1871, and 1905(a) of the Social Security Act, which authorize the agency to establish standards necessary to protect patient health and safety in Medicare- and Medicaid-participating hospitals.

CMS will release an additional notice of proposed rulemaking to prohibit federal Medicaid funding for sex-rejecting procedures on children under age 18. The same prohibition would apply to federal Children’s Health Insurance Program (CHIP) funding for these procedures on individuals under age 19. Currently, 27 states do not provide Medicaid coverage of sex-rejecting procedures on children.

Sex-rejecting procedures on children — which include puberty blockers, cross-sex hormones, and surgical operations — expose them to irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other irreversible physiological effects.

Health and Human Services Secretary Robert F. Kennedy, Jr. today signed a declaration, based on an HHS peer-reviewed report, finding that these procedures do not meet professionally recognized standards of health care. Under the declaration, practitioners who perform sex-rejecting procedures on minors would be deemed out of compliance with those standards.

“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” Secretary Kennedy said. “This Administration will protect America’s most vulnerable. Our children deserve better—and we are delivering on that promise.”

“Children deserve our protection, not experimental interventions performed on them, that carry life-altering risks with no reliable evidence of benefit,” said CMS Administrator Dr. Mehmet Oz. “This proposal seeks to clarify that hospitals participating in our programs cannot conduct these unproven procedures on children. CMS will ensure that federal program standards reflect our responsibility to promote the health and safety of children.”

The U.S. Food and Drug Administration (FDA) is issuing warning letters to 12 manufacturers and retailers for illegal marketing of breast binders to children for the purposes of treating gender dysphoria. Breast binders are Class 1 medical devices used for purposes such as assistance in recovery from cancer-related mastectomy. The warning letters will formally notify the companies of their significant regulatory violations and how they should take prompt corrective action.

“Illegal marketing of these products for children is alarming, and the FDA will take further enforcement action such as import alerts, seizures, and injunctions if it continues,” said FDA Commissioner Marty Makary, M.D., M.P.H.

HHS is also moving to reverse the Biden administration’s attempt to include gender dysphoria within the definition of a disability. The Office for Civil Rights’ newly proposed revision to Section 504 of the Rehabilitation Act of 1973 clarifies that the definitions of “disability” and “individual with a disability” exclude “gender dysphoria” not resulting from physical impairments. The rule would reassure recipients of HHS funding that policies preventing or limiting sex-rejecting procedures do not violate Section 504’s disability nondiscrimination requirements.

“The Biden administration abused a law that was never intended to require health care providers or health programs to support transgender surgeries for minors,” said Health and Human Services Deputy Secretary Jim O’Neill. “Our rule would restore regulatory clarity and ensure that organizations receiving federal funds can set evidence-based policies without fear of violating federal civil rights requirements.”

Last month, HHS published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, its peer-reviewed study of the medical dangers posed to children from attempts to change their biological sex. According to claims data, nearly 14,000 minors received sex-rejecting procedures between 2019 and 2023.

Assistant Secretary for Health and Head of the United States Public Health Service Commissioned Corps Admiral Brian Christine, M.D., today signed a public health message [PDF] to inform health care providers, families, and policymakers that current evidence does not support claims that puberty blockers, cross-sex hormones, and surgeries are safe and effective treatments for pediatric gender dysphoria. “Children’s health and well-being guide our every move,” said ADM Christine. “Evidence shows sex-rejecting puberty blockers, cross-sex hormones, and surgeries are dangerous. Providers have an obligation to offer care grounded in evidence and to avoid interventions that expose young people to a lifetime of harm.”

View the Declaration of the Secretary of the Department of Health and Human Services Re: Safety, Effectiveness, and Professional Standards of Care for Sex-Rejecting Procedures on Children and Adolescents [PDF, 315 KB].

###

https://www.hhs.gov/press-room/hhs-...orming-sex-rejecting-procedures-children.html
 
FOR IMMEDIATE RELEASE
August 11, 2026

Contact: HHS Press Office


202-690-6343
Submit a Request for Comment

HHS Ends Federal Medicaid and CHIP Funding for Sex-Rejecting Procedures for Children and Youth

WASHINGTON, D.C. — AUGUST 11, 2026 — The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today is implementing an administration priority consistent with its commitment to protect children from experimental and life-altering sex-rejecting procedures that carry serious long-term health risks and lack sufficiently reliable evidence of clinical benefit. The final rule ends the use of federal Medicaid and CHIP funds to pay for these procedures on children and youth.

“Today, we are ending federal taxpayer funding for sex-rejecting procedures on children,” Secretary of Health and Human Services Robert F. Kennedy, Jr. said. “These interventions carry serious risks and can cause irreversible harm. The federal government will no longer use Medicaid and CHIP dollars to fund procedures that fail to meet the evidentiary standard our children deserve.”

“Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” said CMS Administrator Dr. Mehmet Oz. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”

Sex-rejecting procedures on children, which include puberty blockers, cross-sex hormones, and surgical operations, can result in irreversible damage, including infertility, impaired sexual function, diminished bone density, altered brain development, and other lasting physiological effects.

CMS’s decision follows a review of national and international research by the U.S. Department of Health and Human Services that identified significant evidence gaps, documented serious safety concerns, and concluded that the evidence supporting these interventions for children remains insufficient to justify federal taxpayer funding. That reassessment is increasingly reflected within the medical community, as leading professional organizations — including specialty societies with direct expertise in this area, such as the American Society of Plastic Surgeons — clarify their positions on these interventions. CMS also points to international reviews, including the United Kingdom’s Cass Report, and actions taken by other countries and states here in the U.S. that have moved to restrict these procedures for minors.

Under the final rule, federal Medicaid and CHIP funding will be available for a tapering-off period of up to six months from the effective date of the final rule for children currently on hormone therapy. The rule does not affect coverage of mental health services. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions continue to ensure comprehensive coverage of mental health services for eligible children, and CHIP continues to require coverage of necessary mental health services in accordance with federal law.

This action applies only to federal Medicaid and CHIP funding.

Today’s action reflects CMS’s commitment to protecting children, safeguarding taxpayer resources, and ensuring that federal healthcare programs support treatments grounded in the best available evidence — not experimental interventions that carry potentially irreversible consequences for minors.

The final rule is scheduled to take effect October 13.

The final rule can be viewed at the Federal Register.
###​

https://www.hhs.gov/press-room/hhs-ends-medicaid-chip-funding-sex-rejecting-procedures-children.html
 
FOR IMMEDIATE RELEASE
August 13, 2026

Contact: HHS Press Office


202-690-6343
Submit a Request for Comment

HHS Releases Report Exposing Fraudulent Insurance Coding For Sex-rejecting Procedures On Minors

WASHINGTON, D.C. — August 13, 2026 — The U.S. Department of Health and Human Services (HHS) today released a report Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine,” a commissioned report examining insurance coding practices, perverse financial incentives, and the provision of sex-rejecting procedures for minors. Drawing on Centers for Medicare & Medicaid Services (CMS) Guidance, Department of Justice (DOJ) investigations, peer-reviewed scientific literature, hospital records, whistleblower testimony, nationwide insurance claims analyses, and interviews with patients and parents, the report presents HHS’ findings and recommendations about the industry pushing and profiting off so-called “gender medicine.” A shortform documentary illustrating the report’s findings and highlighting the stories of victims of predatory gender medical practices was also released in conjunction with the report.

According to the report, more than 225 hospitals and health systems established pediatric gender programs nationwide. The report also analyzes nationwide claims data from 2015 through 2025 and identifies approximately $50 million in insurance claims for puberty blockers billed using endocrine disorder diagnostic code E34.9 (Endocrine Disorder, Unspecified). It further reports that nearly $11 million in claims for patients ages 13–17 were billed using a diagnosis code for precocious puberty E301 — findings the report says warrant additional review of insurance coding practices.

Pursuant to that recommendation, today Vice President JD Vance, as Chairman of the White House Task Force to Eliminate Fraud, and Secretary Kennedy referred hospitals and clinics identified by the report to the Department of Justice and the HHS Office of Inspector General [PDF, 316 KB], respectively, for possible violations of federal law.

“Doctors and hospitals must put children’s health ahead of ideology and financial gain,” said HHS Secretary Robert F. Kennedy, Jr. “This report identifies troubling billing practices that demand scrutiny. HHS will follow the evidence, protect taxpayers, and hold accountable anyone who broke the law or violated the trust of patients and families. Under President Trump’s leadership, we are restoring transparency and integrity to American medicine.”

The report recommends that federal and state agencies review coding and billing practices, strengthen oversight of claims submitted to public health programs, and refers suspicious billing activity for appropriate investigation when warranted.

“CMS has a duty to ensure taxpayer dollars are spent lawfully and honestly,” said CMS Administrator Dr. Mehmet Oz. “When billing practices obscure what care was actually provided, especially when children are involved, we have an obligation to follow the facts. We will protect the integrity of our programs, demand accountability, and make sure the American people are not footing the bill for sex rejecting procedures that inflict potentially irreversible harm on young patients.”

The report’s claims analysis draws on nationwide insurance billing data and reviews federal medical coding guidance to examine billing patterns associated with puberty blockers prescribed to minors. The report recommends continued oversight of insurance coding practices and appropriate review of billing activity that may warrant further investigation under applicable federal and state authorities.

“Our responsibility as healthcare professionals, first and foremost, is to do no harm. As HHS’ commissioned report Wolves in White Coats details, the medical establishment created what the report describes as ‘captive patients,’ placing vulnerable children on a path toward potentially lifelong medical interventions. Under the Trump Administration, HHS is committed to protecting children from irreversible sex-rejecting procedures, following the evidence, and restoring trust in American medicine,” said Assistant Secretary for Health Admiral Brian Christine.

The report recommends strengthening oversight of insurance coding practices, enhancing program integrity, and ensuring appropriate review of potentially improper billing practices. It also encourages continued evaluation of clinical practices and policies related to pediatric “gender medicine” and outlines recommendations intended to improve accountability across the healthcare system.

The full report, Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine,” is available here [PDF, 3.70 MB].

The Executive Summary of the report is available here [PDF, 943 KB].

###​

https://www.hhs.gov/press-room/hhs-report-insurance-coding-sex-rejecting-procedures-minors.html
 
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