The Trump administration hit the “gender-affirming care” industry Wednesday with a one-two punch, launching financial oversight into pediatric gender clinics and pressuring them to stop treating minors with drugs and surgeries.
Health and Human Services Secretary Robert F. Kennedy Jr. directed clinics to review the department’s lengthy May 1 report, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” which found “weak evidence” to support the use of medical intervention for minors.
“Given your ‘obligation to avoid serious harm’ and the findings of the Review, HHS expects you promptly to make necessary updates to your treatment protocols and training for care for children and adolescents with gender dysphoria to protect them from these harmful interventions,” he said in his Wednesday letter to “health care providers, risk managers, and state medical boards.”
The same day, the Centers for Medicare & Medicaid Services sent requests for information to hospitals that perform “pediatric sex trait modification procedures,” including revenue projections and an explanation of how “informed consent” is obtained before treating minors.
“These are irreversible, high-risk procedures being conducted on vulnerable children, often at taxpayer expense,” said CMS Administrator Mehmet Oz in a statement.
“Hospitals accepting federal funds are expected to meet rigorous quality standards and uphold the highest level of stewardship when it comes to public resources — we will not turn a blind eye to procedures that lack a solid foundation of evidence and may result in lifelong harm,” Mr. Oz wrote.
He gave the hospitals 30 days to produce their quality standards and financial data, including billing codes for “sex trait modifications,” facility profits, and revenue projections for pediatric gender-transition services.
The letters came as the latest salvos in the Trump administration’s attack on puberty blockers, cross-sex hormones and gender-transition surgeries outlined in the president’s Jan. 28 executive order, “Protecting Children from Chemical and Surgical Mutilation.”
The order prompted some hospitals to suspend or cancel gender-transition treatment for children while expressing concerns that the move could increase anxiety, depression and suicidal thoughts or acts in youth seeking to change their gender.
The World Professional Association for Transgender Health warned that restrictions on “access to necessary medical care for transgender youth are harmful to patients and their families.”
On the other side was Dr. Kurt Miceli, medical director of the advocacy group Do No Harm, which opposes gender-transition medical procedures for children.
“Health care providers should not rely on an organization that suppresses evidence and has pushed a political agenda when it comes to caring for children with gender dysphoria,” Dr. Miceli said in a Wednesday statement.
“For too long, vocal, activist doctors and medical associations have relied on WPATH guidance to inform treatment guidelines,” he said.
He said the HHS review “thoroughly highlighted the weak evidence WPATH used to justify so-called ‘gender-affirming care.’”
“In reality, sex-change procedures can cause devastating and often irreversible harms for the long-term development of minors – including infertility, surgical complications, cardiovascular disease, diminished bone density, and regret, to name a few,” Dr. Miceli said. “Children with gender dysphoria deserve evidence-based, high-quality care, not irreversible experimental interventions grounded in a political ideology.”
President Trump’s “Big, Beautiful Bill” includes an amendment sponsored by Rep. Dan Crenshaw, Texas Republican, that prohibits Medicaid, Children’s Health Insurance Program, and Affordable Care Act funds from being used to pay for gender-transition procedures on minors.
