Executive Order Related to Gender Affirming Care
HDJ Advisory on this issue: Executive-Order-re-Gender-Affirming-Care.pdf
The Medical Society, as a 501C(6), provides this information for educational purposes only for its members and this information does not constitute legal advice. Members are encouraged to seek the advice of their own counsel.
Overview
An Executive Order (EO) rejecting the practice of gender-affirming care for minors was issued on January 28, 2025. Protecting Children from Chemical and Surgical Mutilation, Exec. Order No. 14,187, 90 Fed. Reg. 8,771 (Jan. 28, 2025). The EO notes the United States 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.”
The EO directs federal agencies to take immediate steps to ensure institutions receiving federal research or education grants end chemical and surgical interventions related to gender transition in individuals under nineteen years old. The targeted care includes chemical interventions such as hormone treatments and puberty blockers for the purpose of aiding with gender transition and surgical procedures aimed at altering an individual’s physical appearance to resemble that of the opposite gender.
Legal challenges to the EO have resulted in Temporary Restraining Orders (TROs) being issued by two separate federal courts with enforcement of the EO stayed until at least February 27, 2025.
Frequently Asked Questions
1. To whom does the EO apply?
The EO directs the heads of agencies that provide research or educational grants to medical institutions to take immediate steps to ensure institutions receiving grants stop medication and surgical gender transitions of children under age 19. The EO does not specifically relate to institutions and practices that do not receive federal research or educational grants, but it does raise questions about potential private causes of action, investigations, and exclusion from federal programs.
2. Does the EO place an outright ban on gender-affirming care?
No. The EO articulates a position that the US will not fund, propose, or support gender transition treatment and surgery for patients under age nineteen. While regulatory guidance is presumably forthcoming, hospitals and providers could continue to provide these services but risk losing any/all federal grant money and potentially the ability to participate in Medicare, Medicaid, Tricare, and other federal programs.
3. Does the EO related to gender-affirming care for adults?
The EO relates only to gender-affirming care for patients age nineteen and under.
4. Is there guidance from HHS or the Attorney General’s Office?
The EO directs HHS and the AG’s office to evaluate and consider guidance and propose legislation on these matters. We anticipate additional documents will be forthcoming.
5. Is there ongoing litigation related to the EO?
Yes. On February 5, 2025, several plaintiffs including PFLAG, Inc, a transgender advocacy group, filed suit in the United States District Court in Maryland seeking injunctive relief, asserting the EO violates constitutionally protected rights to free speech, due process, and equal protection as well as anti-discrimination laws, and exceeds executive authority. PFLAG, Inc. v. Trump, Civil Action No. 1:25-cv-00337. Briefing in the case is ongoing and a hearing is scheduled for today (D.C.M.D. 2025). On the afternoon of February 13, 2025, the Court granted Plaintiffs’ Motion for a TRO which prohibits HHS, NIH, and NSF from conditioning or withholding federal funding based on the fact that a healthcare entity performs gender affirming care to a patient under the age of nineteen. The TRO will be in effect for fourteen days. On February 7, 2025, the states of Washington, Minnesota and Oregon filed a federal suit with a group of doctors seeking a temporary restraining order on the basis that the EO violates patients’ constitutional rights. State of Washington v. Trump, Civil Action No. 2:25cv244 (W.D. Wa. 2025). On February 14, 2025, the Court granted Plaintiffs’ Motion for a TRO.
6. What type of care is addressed in the EO?
Chemical and surgical interventions related to gender transition in individuals under nineteen years old are addressed in the EO. Mental health services are not prohibited by the EO.
7. What is the status of gender-affirming care at hospitals in the Commonwealth?
VCU and UVA initially suspended gender affirming medications and surgical procedures for patients under 19 years old. After a TRO went into effect on February 13, 2025, it is our understanding UVA has resumed the provision of those services. As of this morning, February 17, 2025, VCU is continuing to suspend care. This is a rapidly evolving area. See:
