Nearly every hospital in America will lose Medicare and Medicaid certification if it performs gender-transition procedures on children under two rules announced by the Department of Health and Human Services. The regulations also end federal funding for puberty blockers, cross-sex hormones, and surgical interventions through Medicaid and CHIP programs covering 53% of American children.
CMS Administrator Mehmet Oz estimated the changes save $250 million over ten years. Then he listed procedure costs: $60,000 for vaginoplasty, $150,000 for phalloplasty. “If they’re so diehard desirous of helping children and they don’t get paid,” Oz said, “the question is, will they do these procedures?”
Both rules enter 60-to-90-day comment periods before taking effect.
HHS Secretary Robert F. Kennedy Jr. signed a declaration stating sex-rejecting procedures fail to meet professionally recognized standards of care. Medical professionals or entities providing these procedures to children are now “out of compliance” with healthcare standards. Kennedy called the practices “junk science driven by ideological pursuits, not the wellbeing of children.”
The declaration cites a 300-page HHS review finding the procedures impose medical dangers and lasting harm. Kennedy estimated 300,000 American youth ages 13 to 17 have been conditioned to believe sex can be changed.
FDA Commissioner Marty Makary issued warning letters to 12 manufacturers marketing breast binders to children for treating gender dysphoria. The devices have legitimate medical uses for breast cancer recovery patients. Marketing them to children commits “significant regulatory violations” requiring swift corrective action. Manufacturers face product seizures if they don’t comply.
HHS proposed reversing Biden-era rules that designated gender dysphoria as a disability under the Rehabilitation Act. The change has a 30-day comment period. Deputy Secretary Jim O’Neill said misuse of disability statutes “injures the statutes themselves and injures other people who are entitled to that protection.”
Assistant Secretary for Health Brian Christine signed a public health message stating current evidence doesn’t support claims these treatments are safe or effective for pediatric gender dysphoria. Christine noted procedures tripled between 2016 and 2019 despite mounting evidence of harm and policy reversals by European countries.
NIH Director Jay Bhattacharya announced the agency ended support for gender transition research. Activist courts have prevented immediate elimination of the entire portfolio, but Bhattacharya promised it would be gone by year’s end. The NIH will instead fund research helping children who underwent transitions and now regret them or are considering detransitioning.
Bhattacharya described one NIH-funded researcher who found children who didn’t transition were not more likely to commit suicide. The researcher refused to release the study or data because the findings contradicted prevailing ideology. NIH obtained the data and made it available for replication studies.
Detransitioner Chloe Cole received puberty blockers at 13, testosterone in high doses, and mastectomy at 15. Her questions about future reproductive health went unanswered. The mastectomy ensures she can never breastfeed. “My doctors, rather than guiding me, affirmed my childish misgivings about my developing body,” Cole said.
Cole detransitioned at 16. She filed a lawsuit against her medical providers and now advocates against pediatric gender procedures. “There is grief that every single day I carry with me silently,” she said. “The only thing in the world that makes me angrier is knowing that this is continuing to happen to children all across the United States.”
Officials didn’t address why these procedures proliferated so rapidly between 2016 and 2019, what alternative mental health interventions the administration recommends, or how providers should handle children already on puberty blockers or cross-sex hormones. Kennedy said lawsuits challenging the regulations are expected but expressed confidence the administration will prevail.
The policy changes implement President Trump’s week-one executive order. Twenty-six states already passed laws restricting pediatric gender procedures—laws the Supreme Court upheld earlier this year. Federal policy now catches up to what half the states demanded through their legislatures while the other half relied on market forces that generated $4.4 billion in revenue for these procedures in 2023.
Support Independent Local Journalism — High Country Advocate was created as a real alternative to regional media that too often silences dissenting voices while taking sides in the political struggle. Producing in-depth, unflinching reporting like this series and others is expensive: servers, editing, research time, and legal review all add up quickly. If these articles have informed you or given you new perspective, please consider supporting HCA with a paid subscription — every subscriber helps keep this reporting strong and independent. 