On December 18, 2025, HHS Secretary Robert F. Kennedy Jr. signed a declaration and proposed rules to defund hospitals providing gender-affirming care—such as puberty blockers, cross-sex hormones, and surgeries—to minors through Medicare and Medicaid. This Trump administration policy labels these treatments “malpractice” and “junk science,” aiming for a nationwide restriction to protect children from lasting physical and psychological harm. RFK Jr., known for challenging medical practices, argues minors cannot consent to irreversible procedures and that the evidence base is weak, citing risks like infertility and bone loss. While supporters say the care alleviates gender dysphoria and reduces suicide risk in trans youth, critics point to reviews like the UK’s Cass Report urging caution. With 27 states already restricting such care, this federal move could override allowances, sparking lawsuits over discrimination. The policy emphasizes child protection and “do no harm,” potentially shifting youth transgender health care dramatically.
Long Version
HHS Secretary RFK Jr. Declares Crackdown on Gender-Affirming Care for Minors
On December 18, 2025, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. signed a pivotal declaration and unveiled proposed rules aimed at restricting gender-affirming care for minors across the United States. This federal policy move, enacted under the Trump administration, targets hospitals and health care providers that offer such treatments to children and youth, labeling them as “malpractice” and “junk science.” By leveraging Medicare and Medicaid funding mechanisms through the Centers for Medicare & Medicaid Services (CMS), the initiative seeks to impose a nationwide restriction, effectively limiting access to puberty blockers, hormone therapy, cross-sex hormones, and surgeries for transgender minors experiencing gender dysphoria.
This announcement represents a significant escalation in the ongoing government debate over transgender health care, aligning with broader administration efforts to prioritize child protection amid concerns about lasting physical damage and psychological harm. As a known vaccine skeptic, RFK Jr. has extended his scrutiny of medical practices to what he describes as “ideological pursuits” in medicine, framing these interventions as violations of the Hippocratic oath and the principle of “do no harm.”
Understanding Gender-Affirming Care and Its Components
Gender-affirming care encompasses a range of medical interventions designed to align an individual’s physical characteristics with their gender identity. For trans youth, this often begins with non-invasive options like social transition or the use of breast binders, but can progress to more intensive treatments. Puberty blockers, which temporarily halt the onset of puberty, are typically the first medical step, followed by hormone therapy involving cross-sex hormones to induce secondary sex characteristics opposite to one’s assigned sex at birth. In rarer cases, gender transition procedures may include surgeries, though data shows these are seldom performed on minors under 18, with no recorded instances for those 12 and younger in recent years.
Proponents argue that these interventions are essential for alleviating gender dysphoria—a condition where a person’s gender identity does not match their biological sex—reducing risks of depression, anxiety, and suicidality among LGBTQ+ youth. Studies indicate high satisfaction rates among transgender adolescents receiving such care, with low regret levels and significant mental health benefits, including a dramatic decrease in suicidal ideation when puberty blockers are administered during adolescence. Organizations like the Human Rights Campaign emphasize that these treatments follow established standards of care from medical bodies such as the World Professional Association for Transgender Health.
However, critics, including RFK Jr., contend that the evidence base is weak, pointing to reviews like the UK’s Cass Report, which recommends extreme caution for hormones in those under 18 and restricts puberty blockers to research settings due to concerns over long-term effects. HHS’s recent comprehensive review, released in May 2025, echoes these worries, highlighting potential risks of infertility, bone density loss, and other lasting physical damage from what it terms “sex-rejecting procedures.” Detractors label these as “chemical mutilation” and “surgical mutilation,” arguing they represent experimental medicine rather than proven science.
RFK Jr.’s Role and the Trump Administration’s Stance
As HHS Secretary, RFK Jr. brings a history of challenging mainstream medical narratives, from his vaccine skepticism to his current focus on pediatric transgender medicine. In past statements, he has expressed that minors cannot fully consent to procedures with irreversible consequences, comparing puberty blockers to “repurposed castration drugs.” His pivot on this issue, detailed in interviews, underscores a belief that compassion for those with gender confusion should not extend to interventions before adulthood.
Under the Trump administration, this aligns with a broader crackdown on what officials view as harmful practices in health care. The declaration explicitly states that “so-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people,” deeming it not medicine but malpractice. Proposed rules from CMS would prohibit federal funding for these procedures on minors, forcing hospitals to forgo all Medicare and Medicaid reimbursements if they continue providing them—a move that could effectively ban such care nationwide. This builds on a May 2025 HHS letter urging providers to update protocols, disregarding prior treatment guidelines.
Involvement from other agencies, including the Food and Drug Administration (FDA) and National Institutes of Health (NIH), may follow, potentially reevaluating approvals and research funding for these therapies. The policy emphasizes a public health message of protection, asserting that children deserve safeguards from decisions that could lead to harm.
State-Level Precedents and Federal Implications
This federal regulation comes amid a patchwork of state actions. As of July 2025, 27 states have enacted laws restricting or banning gender-affirming care for minors, affecting over 40% of trans youth aged 13-17. States like Arkansas pioneered these bans in 2021, with recent additions including Ohio, Wyoming, South Carolina, and New Hampshire. These policies often prohibit puberty blockers, hormone therapy, and surgeries, citing similar concerns over evidence and child welfare.
Federally, the reliance on Medicare and Medicaid—key funding sources for hospitals—amplifies the impact, potentially overriding state allowances and creating a uniform restriction. Advocates warn of lawsuits, arguing this violates disability non-discrimination laws under Section 504 of the Rehabilitation Act, which protects transgender individuals from discrimination in federally funded programs. Health care providers face ethical dilemmas, balancing patient needs with funding threats that could jeopardize services for all patients.
The Broader Debate: Science, Harm, and Protection
The scientific community remains divided. While some research affirms the benefits of gender-affirming care in reducing psychological harm and improving quality of life, critics highlight methodological flaws and call for more rigorous, long-term studies. For instance, evidence suggests that most youth on puberty blockers proceed to hormones, raising questions about desistance rates and whether these treatments truly address underlying gender dysphoria.
Opponents argue the interventions stem from “junk science,” potentially driven by ideological pursuits rather than empirical data, and stress the need for alternatives like therapy focused on acceptance without alteration. Supporters counter that bans exacerbate harm, denying trans youth vital care and increasing risks of self-harm.
To enhance understanding, it’s worth noting that international perspectives vary widely. Countries like Sweden and Finland have imposed similar restrictions based on systematic evidence reviews, emphasizing psychotherapy over medicalization for minors. In contrast, regions with supportive policies report improved outcomes for transgender youth, though access disparities persist due to socioeconomic factors.
Looking Ahead: A Defining Moment for Youth Health Policy
RFK Jr.’s actions signal a paradigm shift in federal health policy, prioritizing child protection over expansive gender-affirming options for minors. As proposed rules advance through public comment and potential litigation, the landscape for LGBTQ+ health care could transform dramatically. This initiative underscores the tension between individual rights, medical ethics, and government oversight, urging a reevaluation of how society supports vulnerable youth navigating gender identity.
Ultimately, as RFK Jr. stated in his announcement, “There is divine worth in every person. It shines most brightly in our children,” framing this as a protective measure rooted in compassion and evidence. Stakeholders from hospitals to advocacy groups will watch closely, as this policy could set precedents for broader reforms in medicine and science. Future developments may include expanded mental health resources for gender dysphoria, alternative support frameworks, and ongoing research to bridge the divide in scientific consensus.
