The Trump administration announced Thursday a series of moves aimed at sharply restricting gender-affirming medical care for minors. If enacted, the rules could eliminate access to such care across the country, even in states like Massachusetts, which has been both a pioneer in gender-affirming care and a haven for people seeking it.
Under the proposals, announced in a news conference led by Health Secretary Robert F. Kennedy Jr., the government would bar hospitals that participate in Medicare and Medicaid from performing gender-affirming procedures on patients under 18. A separate rule would block federal Medicaid and Children’s Health Insurance Program funding for those treatments for youths 19 and younger.
Because nearly every hospital in the US relies on federal reimbursement, health policy experts say the move could amount to a virtual national ban.
Gender-affirming care — which includes puberty blockers, counseling, hormone treatment, and, in rare cases, surgery — is considered medically necessary by major professional organizations, including the American Academy of Pediatrics and the Endocrine Society. For many young people, this care aims to reduce gender dysphoria and improve mental-health outcomes, including suicide risk. Critics of gender-affirming care argue that minors are too young to make decisions with potential long-term consequences and that such treatments should be delayed or prohibited until adulthood.
Kennedy said that doctors who offer gender-affirming care to minors are betraying the Hippocratic Oath to do no harm and that sex-changing surgeries create “lasting physical and psychological damage.”
“This is not medicine. It is malpractice,” he said.
Other measures announced Thursday include plans by the FDA to issue warning letters to 12 manufacturers of breast binders, tight garments used to flatten the chest under clothing, for “illegal marketing” of the products to children as a treatment for gender dysphoria.
The rules would not take effect for at least two months to allow for a public comment period.
The Trump administration’s sweeping push to curtail medical care for transgender minors is “unprecedented,” and is an attempt “to preempt what states have done,” said Chris Erchull, an attorney at Boston-based GLAD Law. He expects the rules to be challenged, possibly under equal protection laws.
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Following Trump’s January executive order declaring that there are only two sexes, male and female, and that “these sexes are not changeable,” federal officials have intensified scrutiny of providers.
In July, the Department of Justice sent more than 20 subpoenas to doctors and clinics involved in performing transgender medical procedures on youths, demanding private patient information. In response to the pressure, a dozen hospitals, including two in Connecticut as well as Boston’s Fenway Health, scaled back gender-affirming services to minors.
In addition, 27 states, including New Hampshire, have banned or severely restricted the procedures.
“This is another attempt by President Trump and Secretary Kennedy to hurt the health and well-being of young people,” Governor Maura Healey said in an email Thursday. “I want families across Massachusetts, especially parents of LGBTQ youth, to know that the health care you need is still legal and available in our state. We have been preparing for this, along with the Legislature and providers, and will ensure continued access to health care in Massachusetts.”
According to HHS data, nearly 14,000 minors received gender-affirming care between 2019 and 2023.
Fenway Health declined to comment Thursday. Mass General Brigham and Planned Parenthood League of Massachusetts said care would continue as usual. Boston Children’s said the care would continue “while this rule-making process plays out.”
Dr. Keith Loud, physician-in-chief at Dartmouth Health Children’s, a major New Hampshire nonprofit health system, said he’s dismayed by the announcement.
“While legal constraints may limit the scope of care we can provide in the future, our commitment to this patient population remains as steadfast as ever,” Loud said.
Boston College psychologist Amy Tishelman said that while medical treatment for gender dysphoria should be approached carefully, eliminating access altogether would halt research needed to determine when such interventions might be effective. Tishelman was the director of research at Boston Children’s Hospital’s gender clinic for eight years and a lead author of the international standards of care for treatment of gender-diverse children.
At Thursday’s news conference, officials repeatedly questioned whether gender-affirming care reduces children’s suicide risk. Tishelman said the evidence is nuanced.
“I wouldn’t assume medical intervention would prevent suicide in all of these kids,” said Tishelman. “Interventions may reduce gender dysphoria, but they’re not empirically validated treatments for trauma or depression. Many young people seeking care have experienced substantial adversity, and trauma can continue even with medical treatment.”
Leor Sapir, a political scientist and fellow at the Manhattan Institute, a conservative think tank, said several European countries, including Finland and the United Kingdom, have already restricted aspects of gender-affirming care.
Sapir helped author an HHS report that was critical of the treatment for minors.
“To some extent, the United States is simply lagging behind its Western European counterparts,” Sapir said.
Lawyers, advocates, and leaders from Massachusetts’ community health centers and several hospitals, along with the state attorney general’s office, started plotting strategies Wednesday night over Zoom to push back against the new rules.
Attorney General Andrea Joy Campbell said in a statement that she’s “prepared to take action if any unlawful rule is finalized.”
Earlier this year, when the Trump administration subpoenaed records from Boston Children’s and several others nationwide that provide gender-affirming care, Campbell led a coalition of 19 states in fighting the administration. That pushback, said Nina Selvaggio, executive director of Greater Boston PFLAG, an LGBTQ advocacy group, helped quash the Trump administration’s action.
The Massachusetts Department of Health reiterated that the state has a $1 million gender-affirming care trust fund for treatment. DPH officials are in contact with care providers statewide to discuss how these funds could be used most effectively.
In New Hampshire, some families and doctors said Thursday’s announcement came as a blow.
“It’s pretty devastating,” said Sara Tirrell of Plymouth, N.H.
Her transgender daughter, Parker Tirrell, 16, is receiving puberty blockers and hormone replacement therapy at Dartmouth Health’s Transgender Health Program. Parker Tirrell was expecting to continue that care even after a state ban takes effect in 2026 under an exception for minors who were already receiving care to continue to do so.
Sara Tirrell said preserving her daughter’s access to transgender health care is “non-negotiable,” and the family has discussed whether they need to move to another state or country.
“For our family and for Parker in particular, this is life or death,” she said.
Thursday’s news devastated Rosie Emrich of Hooksett, N.H., whose 9-year-old child is transgender. Emrich’s child is on puberty blockers and receives care at Massachusetts General Hospital.
Emrich said she believes Massachusetts is likely to challenge the new rules, and stopping her child’s care unexpectedly would be irresponsible and even dangerous. If enacted, she and her family are considering moving abroad to Canada, Mexico, or Thailand.
“It’s just really anxiety-provoking,” she said. “Is the United States actually a safe place for trans youth and their families to be anymore?”
Meanwhile, some Republican lawmakers, including Representative Sayra DeVito, one of the cosponsors of New Hampshire’s ban, celebrated Thursday’s announcement.
“While Democrats bend the knee to radical gender ideology, Republicans will continue to stand to protect our children from these inhumane and failed medical experiments,” DeVito said.
Frances B. Lim-Liberty, a pediatric endocrinologist who provides gender-affirming care in New Hampshire, said the announcement did not come as a surprise.
“My main objective is to mitigate the harm these families are experiencing,” she said in an email. “These restrictions do not change their identities and who they are; but it now makes it that much harder for them to get the healthcare they need.”
Jason Laughlin of the Globe staff contributed reporting.
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