On December 18, 2025, the U.S. Department of Health and Human Services (HHS) announced a series of regulatory actions aimed at restricting access to gender-affirming care for minors. These proposals represent a continuation of efforts initiated by the Trump administration to limit transgender health care, specifically targeting puberty blockers, hormone therapy, and surgical interventions for transgender youth.

The proposed measures include cutting off federal Medicaid and Medicare funding to hospitals that provide gender-affirming care, effectively prohibiting the use of federal dollars for these procedures. HHS Secretary Robert F. Kennedy Jr. described gender-affirming procedures for children as 'malpractice,' claiming they deprive children of their futures. Currently, over half of U.S. states have enacted laws that either ban or restrict such care, but the new regulations could jeopardize access in nearly two dozen states where these treatments remain legal and funded by Medicaid.

In addition to funding restrictions, HHS plans to propose a rule that would exclude gender dysphoria from the definition of a disability under the Rehabilitation Act of 1973. This change follows a previous interpretation by the Biden administration that recognized gender dysphoria as a disability, which had led to confusion regarding the obligations of HHS funding recipients. Concurrently, the Food and Drug Administration (FDA) issued warning letters to companies marketing chest-binding vests and related equipment, stating that these products can only be marketed for FDA-approved medical uses.

The proposed regulations are not yet finalized and will undergo a lengthy rulemaking process, including public comment periods. Legal challenges are anticipated, which may delay or alter the implementation of these restrictions. However, the proposals are likely to discourage healthcare providers from offering gender-affirming care, as many hospitals have already ceased such services in anticipation of federal actions. Given that nearly all U.S. hospitals participate in Medicare and Medicaid, the loss of federal funding could threaten their operations.

These actions are part of a broader trend initiated by the Trump administration to target the rights of transgender individuals. On his first day in office, Trump signed an executive order recognizing only two immutable sexes and has since enacted measures to limit federal support for gender transitions for individuals under 19. Recent legislative efforts include a bill passed by the U.S. House that would impose prison time on healthcare providers treating minors with gender-affirming care, as well as another bill aimed at banning Medicaid coverage for such treatments.

Young individuals seeking gender-affirming care typically undergo evaluations by a team of professionals, which may include social transitions and, in some cases, hormone-blocking drugs. Surgical interventions for minors are rare. Currently, Medicaid programs in nearly half of the states cover gender-affirming care, while at least 27 states have enacted laws restricting or banning such care. Legal challenges have previously led to the striking down of similar bans in Arkansas and Montana, with ongoing litigation in those states.

Advocates for transgender youth have criticized the administration's claims regarding gender-affirming care, arguing that the proposed measures could endanger lives. Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health, stated that the administration's actions force healthcare systems to choose between providing essential care for LGBTQ+ youth and accepting federal funding. Rodrigo Heng-Lehtinen from The Trevor Project described the changes as a federal mandate that undermines the doctor-patient relationship, expressing concern over the ongoing legislative efforts to restrict healthcare access for transgender and nonbinary youth.