The Federal Government Finally Says No

HHS applies emergency brake

When it comes to health policy, the Trump administration closed 2025 not with a whimper but with a massive bang, an explosion that garnered less coverage than it should have, what with all the folderol going on in the Democratic party, not to mention Trump’s own bold foreign policy moves.

But over at the nation’s health agencies, the sweeping reduction in the nation’s vaccination schedule—reducing the recommended childhood vaccine doses by between 54 and 58—as well as the government’s announcement that it would stop compensating clinicians based on the number of patients they vaccinate was an unprecedented upheaval in policy.

Even before those announcements, though, the U.S. Department of Health and Human Services (HHS) had unveiled another sweeping regulatory reversal: hospitals participating in Medicare and Medicaid will no longer be permitted to perform pharmaceutical or surgical interventions intended to medically transition minors away from their biological sex.

Most consequentially, the federal government has formally declared that those interventions do not meet professionally recognized standards of care for children.

Aimed at ending what the department describes as “sex-rejecting procedures” performed on children, the changes at HHS amount to nothing less than a regulatory earthquake. Announced on December 18, they are designed to carry out an executive order signed by President Donald Trump earlier this year and would impact nearly all U.S. hospitals, since most participate in Medicare and Medicaid programs.

Federal officials said the changes are anchored in a newly released, peer-reviewed HHS report reviewing the safety and effectiveness of medical interventions used to treat pediatric gender dysphoria.

“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” HHS secretary Robert F. Kennedy, Jr., said in announcing the rulemaking. “This administration will protect America’s most vulnerable. Our children deserve better—and we are delivering on that promise.”

The changes will be part of a formal notice of proposed rulemaking from the Centers for Medicare & Medicaid Services (CMS) barring hospitals from performing sex-rejecting procedures on children under age 18 as a condition of participation in federal health care programs.

“We don’t provide healthcare to every child, but at 53 percent, we’ve got most, and we’re not going to let taxpayer money go to hurt these children and those children will no longer be hurt with this ideology,” CMS administrator Dr. Mehmet Oz said at a news conference announcing the changes. “We know that inflicting these procedures on young people cost them and the Medicaid system countless dollars, not just in medical bills, but also all kinds of downstream issues while providers reap the rewards.”

Too many providers inappropriately profit from performing destructive procedures, Oz said, citing data suggesting that certain surgical procedures can cost tens of thousands of dollars per patient: 2022 JAMA data put the price of a typical vaginoplasty at $60,000, while a phalloplasty, the creation of a penis, costs on average $150,000 per child.

Oz made an important point, too, about the popularity of the procedures. He said the prices have continued to increase because of an increase in manufactured demand. That is, the mutilation of our children is not just ideologically driven; it has become an industry, the last short-term way to profit from woke before the whole enterprise goes broke.

CMS cited its statutory authority under the Social Security Act to undertake the rulemaking. That authority authorizes the agency to establish standards necessary to protect patient health and safety in Medicare- and Medicaid-participating hospitals. In addition to preventing federal Medicaid funding for those procedures, the administration says the same prohibition would apply to federal Children’s Health Insurance Program (CHIP) funding for those procedures on individuals under age 19.

Currently, 27 states do not provide Medicaid coverage of sex-rejecting procedures on children, the agency states.

HHS defines sex-rejecting procedures as pharmaceutical or surgical interventions intended to align a child’s physical appearance or body with an asserted gender identity different from biological sex. The department’s announcement specifically referenced puberty blockers, cross-sex hormones, and certain surgical operations.

According to the department, such interventions pose risks including infertility, impaired sexual function, diminished bone density, altered brain development, cardiovascular complications, and other irreversible physiological effects.

Kennedy signed a formal declaration, based on findings from the HHS report released in November, stating that sex-rejecting procedures for minors do not meet professionally recognized standards of health care. Under the declaration, HHS stated, practitioners who perform such procedures on minors would be deemed out of compliance with those standards.

Needless, irreversible

At the press conference, Kennedy said doctors assume a solemn obligation to protect children, yet doctors across the country now provide needless and irreversible sex rejecting procedures that Kennedy said violate the doctors’ Hippocratic oath.

“The American Medical Association, the American Academy of Pediatrics battle to lie that chemical and surgical sex-rejecting procedures could be good for children who suffer from gender dysphoria,” he said. “They betrayed the estimated 300,000 American youth ages 13 to 17 conditioned to believe that sex can be changed.”

So-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people, Kennedy said.

“This is not medicine,” he said. “It is malpractice. We’re done with junk science driven by ideological pursuits, not the well-being of children.”

Oz said many physicians have been pressured into compliance and that dangerous progressive ideology treats children like lab mice.

“And because often in medical school you’re taught to go along to get along, they have not been willing to rear their heads and bravely say what they know to be right, which is that these procedures are wrong,” he said. “Individuals who question their sexuality are treated by many medical professionals on the fast track, that’s what it’s called, approach to care, resulting in drastic interventions that merely increase the distress they’re already suffering from.”

Under politicized medicine, Oz asserted, people suffer long-term consequences.

“This dangerous fast track approach in invasive treatment, what it really does is slap a bandaid on a much deeper pathology, a much deeper problem, the underlying issue of gender dysphoria,” he said. “It denies patients the opportunity to be seen for who they really are. The doctor can’t look them in the eyes and treat them like a child that’s confused and lost and needs help.”

Those children become an opportunity, Oz added, and eventually, he said, they become a victim.

“Reasonable evidence-based objections that a child’s confusion might resolve over time have been ignored, even though it makes common sense,” he said. 

“And it turns out from numerous studies now in Europe to be true. … This is not how clinicians respond to the care of other pediatric issues, but it’s how we respond to pediatric adolescent mental distress. And the medically honest approach is to at least start slowly, the least invasive possible psychotherapy, counseling, including family counseling, evaluation of other conditions like ADHD and autism, and of course, treatment of the anxiety and depression that so often is included with this diagnosis.”

Oz said a pathology had afflicted the medical profession.

“It is shameful that clinicians have profiteered off this,” he said.

“I do not understand how it could possibly have been tolerated by the leadership of these institutions, but it will no longer be funded. And I can tell you, if they’re so diehard desirous of helping children and they don’t get paid, the question is, will they do these procedures? And I think we know the answer.”

Oz said the savings to taxpayers over the coming decade would be $250 million but that was irrelevant compared to the harm prevented for the next generation.

“We want our hospitals returning to healing, not harming the patients entrusted with their care, or they’re going to pay a very steep price,” he said. “… This is not just smart science-based health policy. It is our moral duty, as Senator [Hubert] Humphrey mentioned 50 years ago.”

Peer-reviewed study

The regulatory push follows publication of “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” a peer-reviewed report commissioned under an executive order signed by President Trump in January and released Nov. 19 by HHS.

The report examined existing research on medical interventions for children and adolescents diagnosed with dysphoria and concluded that the evidence base supporting puberty blockers, cross-sex hormones, and surgical interventions remained “remarkably weak,” particularly with respect to long-term outcomes.

In his formal declaration, based on the comprehensive evidence review, Kennedy wrote that the decentralized and largely privatized nature of the American healthcare system has facilitated the proliferation of specialized gender clinics alongside numerous independent practitioners offering those services.

“Conservative estimates from March 2023 identified 271 gender clinics operating across the United States, with approximately 70 rendered inactive due to state legislative restrictions,” Kennedy wrote. 

“The treatment approach referenced in this declaration as sex-rejecting procedures—terminology that some refer to as ‘gender-affirming care’—encompasses several intervention types, when provided to minors: puberty-suppressing drugs that prevent the onset of puberty, cross-sex hormones that induce secondary sex characteristics of the opposite-sex, and surgical procedures, including breast removal and, less commonly, genital reconstruction.”

Thousands of American minors have undergone such interventions, Kennedy wrote.

“Research published in 2023 estimated that from 2016 through 2020, approximately 3,700 adolescents in the U.S., aged 12 to 18 with gender dysphoria diagnoses underwent surgical interventions,” he wrote. “This figure includes more than 3,200 youth who underwent breast or chest surgery and over 400 who had genital surgeries resulting in permanent reproductive organ alterations and compromised sexual function.”

Separate research examining the period from 2017 to 2021 identified more than 120,000 children ages 6 through 17 diagnosed with gender dysphoria, with over 17,000 of these minors initiating either puberty blockers or hormonal therapy, even though though current medical evidence does not support a favorable risk/benefit profile for the use of chemical or surgical procedures in children to treat gender dysphoria, Kennedy contended.

Aligning with international standards, at long last

Finally, it seems, the HHS findings align the U.S. with conclusions made across the European landscape, conclusions made after undertaking rigorous scientific inquiries.

Kennedy revisited those standards in his declaration.

“Sweden, Finland, and the United Kingdom each commissioned independent systematic evidence reviews through their public health authorities,” he wrote. “All three nations concluded that medicalization risks may exceed benefits for children and adolescents with gender dysphoria, subsequently implementing sharp restrictions on gender transition interventions for minors.”

Those three countries now recommend exploratory psychotherapy as initial treatment, Kennedy continued.

In the United Kingdom, Kennedy wrote, the influential Cass Review, a four-year independent evaluation of Pediatric Gender Medicine published in 2024, recommended restructuring the care delivery model away from centralized ‘gender clinic’ approaches toward more holistic frameworks emphasizing psychosocial support delivered through regional hubs.

“The Review's findings also led the United Kingdom to prohibit puberty blocker use outside clinical trial settings and substantially restrict cross-sex hormone access,” he wrote. Though cross-sex hormones remain officially available, the National Health Service (NHS) recently disclosed that since the Cass Review’s publication, no minor has satisfied eligibility criteria for receiving cross-sex hormones under updated policies.

In addition, Kennedy continued, Sweden’s National Board of Health and Welfare (NBHW) reviewed and revised its guidelines for minors under age 18 in 2022.

“The NBHW determined that risks from puberty-suppressing treatment using GnRH-analogues (injectable medications preventing ovarian and testicular hormone production) and hormonal treatment promoting opposite-sex characteristics likely exceed potential benefits,” he wrote. 

“The NBHW specified that mental health support and exploratory psychological care should constitute first-line treatment. ….Sweden has elected to restrict gender transition procedures for minors to research settings exclusively, limiting eligibility to early childhood-onset gender dysphoria cases.”

In Finland, Kennedy underscored, Finland’s Council for Choices in Health Care, the monitoring agency for national public health services, issued guidelines in 2020 calling for psychosocial support as primary treatment, hormone therapy only after careful case-by-case consideration, and no surgical treatment for minors

“Finland has restricted gender transition procedure eligibility to minors with early childhood-onset gender dysphoria and without mental health comorbidities,” he wrote.

At the press conference announcing the changes, Kennedy correctly said that the Biden era amendments that designated gender dysphoria as a disability served the commercial interest of a predatory multi-billion dollar industry that betrayed the original intention of those laws, engendered widespread public resentments against those laws among the American people, and discredited the statutes in the public mind.

“These are statutes that were designed to protect the most vulnerable Americans, and the misuse of these statutes for these purposes, injures the statutes themselves and injures other people who are entitled to that protection and who Americans want to see protected,” he said. “Our proposed rule will reassure recipients of HHS funding that policies preventing or limiting sex-rejecting procedures do not violate disability non-discrimination requirements.”

It’s important to understand that Kennedy’s declaration does not criminalize doctors or mandate specific treatments. It does not prohibit counseling or psychotherapy. What it does do is end federal endorsement and funding of irreversible medical interventions on minors in the absence of reliable evidence.

It restores a boundary that medicine and so-called science abandoned.

And so hospitals now face a choice: evidence or ideology. For years, critics were told to “trust the experts.” Now the experts have been forced to show their work.

So far anyways, the work does not support their claims.