Take cover

US health providers get busy reducing their exposure after President Trump's executive order against paediatric gender treatment

Photo by Josep Castells on Unsplash

Health services in the US have begun to restrict poorly evidenced hormonal and surgical interventions in response to President Trump’s January 28 executive order seeking to radically curtail the gender medicalisation of young people.

Hospitals and other providers in New York, Rhode Island, Washington DC, Virginia and Colorado have reportedly taken actions to avoid threatened sanctions and loss of federal funds by suspending these medical treatments for patients under 19 or cancelling appointments. One high-profile hospital took down a webpage that offered puberty blockers and cross-sex hormones.¹

Denver Health announced it would no longer offer gender surgery to patients under 19, and said it was seeking to understand and “comply with the full implications of the broadly worded order,” which it read as involving criminal as well as financial penalties.

The provider received $89 million a year in federal funds, not including proceeds from the publicly subsidised program Medicaid, and said the loss of this money would “critically impair” its health services for the Denver community.

The Trump order says: “Across the country today, medical professionals are maiming and sterilising 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.”

The executive order instructs the Secretary of the US Department of Health and Human Services to “issue new guidance protecting whistleblowers” who disclose information “ensuring compliance with this order.”

Erin Friday, a California lawyer and lifelong Democrat who became president of the parents’ group Our Duty USA, said the Trump order was “spectacular in its simplicity and clear language.”

“Parents are hopeful for the first time in years,” Ms Friday told GCN. “Trump made promises and kept his promises, doing so in less time than it took [former US president] Biden to walk up a staircase.”

The LGB Alliance USA, which seeks to defend same-sex orientation from gender ideology, also welcomed the executive order.

“We support attempts to protect minors from medical transition,” a spokeswoman for the group told GCN.

“We believe all kids are entitled to go through their natural, healthy puberty—free from disruptions from puberty blockers or exogenous hormones.

“We also know that a disproportional number of medicalised youths will grow up to be LGB, and this is one of the reasons why our organisation is involved in this issue.

“We think the President’s executive order is a step in the right direction.”

“When the history of 21st-century gender mania is written, it should include this signal entry: In 2020, a website called GoFundMe, usually a place to find disaster-relief appeals and charities for starving children, contained more than 30,000 urgent appeals from young women seeking to remove their perfectly healthy breasts.”—Journalist Abigail Shrier, author of the 2020 book Irreversible Damage: The Transgender Craze Seducing Our Daughters, opinion article, The Free Press, 31 January 2025

Detransitioners in the spotlight

President Trump’s 1,350-word executive order cites the regret of detransitioners and treatment-inflicted harms including the inability to conceive children or breastfeed, and costly “lifelong medical complications.”

The order states it is now “the policy of the US 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.”

Michigan detransitioner Prisha Mosley—who says she was referred for high-dose testosterone after one 15-minute appointment at age 17, when her mental health was already poor—welcomed President Trump’s order as proving he had listened to detransitioners.

“He mentioned the struggles we face in his [order], and there is talk of helping us with holding our providers accountable,” Ms Mosley told GCN.

“I also appreciate the way he did not lie by using the language of the Left. My gender wasn’t ‘affirmed’ and what I received wasn’t ‘care.’ I was harmed and abused for believing I had been born in the wrong body. I am hopeful for a new era when soon no child is punished ever again for such beliefs.”

A 2022 analysis by Reuters, using the limited data from US insurance claims, estimated that over the five years from 2017 to 2021—

At least 121,882 American minors aged 6-17 were diagnosed with gender dysphoria

At least 4,780 minors in the same age range were begun on puberty blockers

At least 14,726 minors started cross-sex hormones.

Reuters counted at least 776 mastectomies, with patients aged 13 to 17, in the three years ending in 2021; and 56 genital surgeries in the same age group over the same period. All these figures are likely to be underestimates.

A more recent analysis of insurance claims and publicly available information by Do No Harm, a group opposed to identity politics in medicine, estimated that between 2019 and 2023—

13,994 minors underwent gender transition medical treatments

5,747 minors had gender transition surgeries

8,579 minors received cross-sex hormones and puberty blockers

62,682 gender transition prescriptions were written for minors

The number of detransitioners in the US is unknown but believed to be on the rise.²

“Two new Canadian reviews of the evidence for puberty blockers and cross-sex hormones have been published. Exactly like [England’s 2020-24 Cass review], they found ‘very low confirmatory evidence of any substantive change in gender dysphoria, depression or overall health.’

“This scandal will be studied to death in years to come. An ideology spawned in academia met greedy, unethical medics, while a tidal wave of activists, politicians, corporations and self-serving celebs glamourised and normalised irreparable harm to minors.”—UK writer JK Rowling, tweet, 1 February 2025

Not over yet

Detransitioner Chloe Cole, from California, said the White House executive order was “incredibly helpful and a huge milestone,” but not a national ban on treatment and by no means the end of the battle against the gender medicine industry, in which private providers also transition children.

Ms Cole, who was put on testosterone at age 13 and had a double mastectomy two years later, spoke of the plight of young people once they decide that transition was a mistake.

“All the support that I had before [when I was identifying as a boy] was just completely gone the moment that I chose to stop and live my life truthfully and healthily,” Ms Coles told NEWSMAX.

A lawyer with experience in US federal administration, who spoke to GCN on condition of anonymity, said: “Combined with the President’s executive order last week on defending women, this is the most decisive attempt and plan by any national government in the Western world to extricate itself from the harm caused by endorsing sex denial and ‘identity medicine’.”

“Overall this couldn’t be a stronger commitment of the US federal government to ending the medical scandal of paediatric ‘gender-affirming care’,” she said.

“Critics of so-called gender-affirming care, especially as to minors, understand that this harmful practice has mushroomed in the US over the past 10-15 years via many tentacles spanning many areas.”

She cited as examples the changes to the diagnostic manual of psychiatry, the DSM; coverage of gender medical procedures under publicly funded health insurance and benefits programs; the teaching, training and promoting of gender-affirming care in medical schools; and the feeding of a demand pipeline by funding in schools that promotes gender identity ideology.

“All of these sources that have greased the wheels of ‘paediatric gender medicine’ are addressed in this executive order,” she said.

“I really wish the [Trump] gender-related executive orders and messaging were taking into account that we’re dealing with a radicalised population that includes a lot of very vulnerable, psychologically unwell young people who’ve been told for years to expect a ‘trans genocide.’

“I don’t think we have a mass-deradicalisation playbook. But [it is] imperative to be as clear and specific about what’s being proposed and as compassionate about the ‘why?’ as possible.”—US scholar who goes by the name Eliza Mondegreen, tweet, 30 January 2025

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Video: Chloe Cole on the shift from cheer-led medical transition to the isolation and unknowns of detransition

Out with the junk

Declaring an end to “reliance on junk science,” the Trump executive order says the World Professional Association for Transgender Health (WPATH) “lacks scientific integrity.” Many international treatment guidelines for gender dysphoria are heavily influenced by WPATH.

In its current 2022 standards of care, WPATH did away with minimum ages for surgeries, such as double mastectomy, under pressure from the Biden administration. Those guidelines also speak of the “unique needs” of males who identify as “eunuchs” and may seek “medically necessary gender-affirming care” in the form of castration.

WPATH—a hybrid professional-activist organisation which is also accused of having suppressed systematic evidence reviews which turned up inconvenient results—said it was “disappointed” by the White House order.

“Policies that restrict or ban access to necessary medical care for transgender youth are harmful to patients and their families,” said a statement from WPATH president Asa Radix and the board of directors.³

The Trump order directs the US Department of Justice—which under president Biden had harried gender medicine whistleblowers—to investigate and act against consumer deception, fraud or breaches of the Food, Drug and Cosmetic Act arising from the claims made for “gender-affirming care.”⁴

Federal agencies are instructed by the January 28 White House order to abandon policy reliance on WPATH.

The US Department of Health and Human Services—which aggressively promoted paediatric gender medicine under its transgender-identifying assistant secretary Rachel Levine—is given 90 days to publish a review of the scientific literature on children with “gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion.”

The president of Our Duty USA, Ms Friday, said: “Every hospital and medical society basing its policy on WPATH would be smart to revisit that decision and rapidly move towards cessation of its harming of children.”

“Many of the largest gender clinics in the US receive between 50-80 per cent of their revenues through [the publicly subsidised] Medicare. If that funding ceases, some of the largest hospitals performing these horrors on children will suffer crippling financial blows,” Ms Friday said.

Consumer protection lawyer Glenna Goldis, who is active in the group LGB Alliance USA, said she believed the Trump policy directions, such as erasing WPATH influence, were on firm legal ground.

She cited the caveat that the federal agencies affected “follow certain procedural rules, stay within the bounds of the authorising statute, and don’t make a change that is ‘arbitrary or capricious’.”

As president, Mr Trump was “entitled to set policy priorities,” such as prosecuting gender clinicians for fraud or deception of consumers, Ms Goldis told GCN.

Whistleblower Jamie Reed, executive director of the LGBT Courage Coalition, praised the Trump order as “comprehensive.”

She noted its coverage included university medical schools with which many gender clinics are linked.

“I do honestly feel both relief [after the executive order] and apprehensive of the activist reaction, which will come,” Ms Reed told GCN.

In her work as a case manager for the Washington University Transgender Center at St Louis Children’s Hospital in Missouri, she became alarmed at the reckless medicalisation especially of teenage girls with serious psychiatric co-morbidities and no childhood history of gender distress—a new patient profile referred to as “rapid-onset gender dysphoria.”

After Ms Reed turned whistleblower, an investigation followed and the paediatric gender clinic closed.

“To those uneasy about [the Trump executive order], remember that ‘gender-affirming care’ would be nowhere without the massive cross-agency support—in funding, administrative rules, guideline adoption, political capital, media framing, and lawfare—of the Obama and Biden administrations.”—Manhattan Institute commentator Leor Sapir, tweet, 29 January 2025

Paediatric academy in denial

Oregon paediatrician Dr Julia Mason—a Democrat supporter who has campaigned for the American Academy of Pediatrics (AAP) to reform its contentious 2018 affirmation-only policy—said she was “very impressed” with the “breadth and depth” of the Trump order, although dismayed by the use of the term “mutilation.”

“I’m frustrated that it had to come to this—the election of Trump, the dereliction of duty by American medical associations to follow the evidence,” Dr Mason told GCN.

Despite an August 2023 promise to carry out a systematic review—the gold standard for weighing the evidence for medical interventions and not undertaken before the 2018 policy—the AAP had not even taken the step of registering a protocol for such a review in the Prospero portal, she said.

“I expect that the Secretary of Health and Human Services will come out with a review before the AAP does,” Dr Mason said.

“In many [US schools], innocent children are compelled to adopt identities as either victims or oppressors solely based on their skin colour and other immutable characteristics. In other instances, young men and women are made to question whether they were born in the wrong body and whether to view their parents and their reality as enemies to be blamed.

“These practices not only erode critical thinking but also sow division, confusion, and distrust, which undermine the very foundations of personal identity and family unity.”—Trump White House executive order Ending Radical Indoctrination in K-12 Schooling, 29 January 2025

Reversal of fear

Institutions in receipt of federal research or education grants—including hospitals and medical schools—are to be vetted by the federal bureaucracy to ensure they are not engaged in gender medicalisation of young people, the Trump order says.

“While the executive order cannot entirely dismantle the transgender movement because we are a federal republic, it is a giant leap forward, and might just be the fire that is needed to get more people pressuring the Democrats to stop the gender madness,” said Ms Friday of Our Duty USA.

“We have been playing defence for the better part of almost a decade, and it is an incredible feeling to watch those who have been harming children unabated, suddenly feel some fear.”

Ms Friday’s daughter used to believe she was a boy. At age 11 the girl had succumbed to gender confusion, enabled by her school and an outside activist allowed into the classroom, with gender ideology sending the message that her body was “wrong,” and she was destined for suicide.

More than a score of Republican-run US states have prohibited or restricted gender medicalisation of minors, while some Democratic states have created “sanctuary” regimes offering a legal shield and potentially gender medicine to children who have fled transition bans and their parents opposed to irreversible interventions.

“Most of our parents are or were Democrats, but we are all thrilled with the [Trump executive order] stopping medicalising distressed youth.

“We are finally seen and hopefully, going forward, children are protected, even though ours were not.”—Parents of Desisters, a group of parents of children who abandon or “desist” from a trans identity before medicalisation, tweet, 1 February 2025

Asserting parental duty

Under the Trump order, the US Department of Justice is to investigate and take measures against these Democratic sanctuary states, possibly drawing on the federal Parental Kidnapping Prevention Act and the constitutional rights of parents to direct the care of their children.

“[In his executive order] Trump tried to tackle the trans sanctuary states,” said Ms Friday of Our Duty USA.

“I know firsthand that his administration is looking for openings to use the power of the purse and federal law to protect parents from having their children taken from them because they refuse to medicalise their gender-confused children.”

The author of the activist gender dysphoria policy of the American Academy of Pediatrics (AAP), Dr Jason Rafferty, also appears to have pressured WPATH to abandon minimum ages in its 2022 standards of care, according to court documents.

In addition, detransitioner Isabelle Ayala is suing the AAP and Dr Rafferty, who allegedly prescribed testosterone for her at age 14 after brief consultation. Ms Ayala says she was sexually abused at age 7, and had been self-harming.

Dr Rafferty is medical director of the Hasbro Children’s Hospital Gender and Sexuality Program in Rhode Island. That hospital’s webpage headlined “Gender and Sexual Health Services for Children, Teens, and Young Adults” has been taken down without explanation since the Trump order, The Daily Caller reported on January 31.

“Whatever you think of the Trump [executive order] on paediatric medical transition, it is important to keep in mind that it is a consequence of the abject failure of American medicine—including my colleagues in bioethics and other medicine-adjacent academic disciplines—to self-regulate.”—US philosopher Dr Moti Gorin, tweet, 29 January 2025

Doctors in the dock

The Trump order directs the US Department of Justice to work with congress on legislation to create “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”—complete with a “lengthy statute of limitations.”

On January 29, Republican Senator Josh Hawley, of Missouri, introduced the “Jamie Reed Protecting Our Kids from Child Abuse Act” to establish a federal tort against “paediatric gender clinics and other entities pushing gender-transition procedures that cause bodily injury to children or harm the mental health of children.”

The federal bill would enact a private right of action for young people harmed by paediatric gender medicine that would be available for use in court “not later than 30 years after the date on which the individual turns 18 years of age.”

Statutes of limitations have closed off legal action for some detransitioners.

“Victims often do not know they have been misled and harmed until many years later,” said Josh Payne, founding partner of the Texas-based law firm Campbell Miller Payne, which specialises in detransition cases.

Mr Payne said a federally enacted private right of action “should help expand victims’ access to the courts,” since litigation against doctors is usually run in the state system.

“Other aspects of the [Trump] order support victims’ arguments in their individual cases that sound science was not followed and proper care was not provided,” Mr Payne told GCN, citing for example the order’s strictures against WPATH as an unreliable authority.

Also helpful, he said, could be two sections of the executive order requiring the Secretary of Health and Human Services to take actions to promote children’s health and end transition procedures.

1. The Trump order defines a child as anyone under age 19.

2. Gender clinicians and activists have clung to outdated and misleadingly low estimates of detransition and regret.

3. “Medically necessary” is a catch phrase used by WPATH to try to ensure that treatments will be covered by health insurance.

4. Texas has prosecuted gender clinicians under state consumer protection law for allegedly using the false diagnosis of “endocrine disorder, unspecified” so that puberty blockers for gender-distressed children will be covered by medical insurance.