The United States government has unveiled sweeping proposals aimed at banning gender-related surgical and medical procedures for minors, marking a major policy shift in federal healthcare regulation under President Donald Trump’s administration.

The Department of Health and Human Services (HHS) announced on Thursday that it is taking regulatory steps to implement an executive order directing federal agencies to halt what it describes as “sex-rejecting procedures” on children. According to HHS, these medical interventions expose minors to irreversible physical and psychological harm.

The proposed measures target both surgical and pharmaceutical treatments intended to alter a child’s physical characteristics to align with a gender identity different from their biological sex. These include puberty blockers, cross-sex hormones, and gender-related surgeries.

As part of the move, the Centers for Medicare & Medicaid Services (CMS) plans to issue a notice of proposed rulemaking that would bar hospitals from performing such procedures on individuals under the age of 18 if they wish to continue participating in Medicare and Medicaid programmes. Given that nearly all hospitals in the United States rely on these federal programmes, the policy would have far-reaching implications across the healthcare system.

HHS explained that the proposal is grounded in existing provisions of the Social Security Act, which empower CMS to set standards to protect patient health and safety in federally funded hospitals. The agency also intends to prohibit Medicaid and Children’s Health Insurance Program (CHIP) funding for gender-related procedures on minors. While 27 states already do not provide Medicaid coverage for these treatments, the new rule would establish a nationwide standard.

Health officials argue that these interventions can result in permanent consequences such as infertility, impaired sexual function, reduced bone density, altered brain development, and other long-term health effects. HHS cited claims data showing that nearly 14,000 minors received gender-related medical procedures between 2019 and 2023.

Health and Human Services Secretary Robert F. Kennedy Jr. said the administration is acting to protect children from treatments that, in his words, “do not meet professionally recognised standards of health care.” He warned that practitioners who continue to perform such procedures on minors could be deemed out of compliance with federal healthcare standards.

“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,” Kennedy said, adding that protecting minors remains a top priority of the administration.

CMS Administrator Dr. Mehmet Oz echoed the position, stressing that children should not be subjected to what he described as experimental interventions with life-altering risks and no reliable evidence of benefit. He said the proposed rules are meant to clarify that hospitals benefiting from federal programmes must uphold standards that prioritise child safety.

Beyond hospital regulations, the U.S. Food and Drug Administration has also stepped in. The FDA is issuing warning letters to 12 manufacturers and retailers accused of illegally marketing breast binders to children for gender dysphoria. These products are typically intended for specific medical uses, such as post-mastectomy recovery. FDA Commissioner Dr. Marty Makary warned that further enforcement actions, including seizures and injunctions, could follow if the practice continues.

In another significant move, HHS announced plans to reverse a previous effort by the Biden administration to include gender dysphoria under the legal definition of disability. Deputy Secretary Jim O’Neill said the earlier interpretation stretched the intent of disability laws and created regulatory pressure on healthcare providers. According to him, the new approach would restore clarity and allow organisations receiving federal funds to adopt evidence-based policies without fear of violating civil rights rules.

Public health officials within HHS also defended the proposals. Assistant Secretary for Health and head of the U.S. Public Health Service Commissioned Corps, Admiral Brian Christine, said available evidence shows that puberty blockers, cross-sex hormones, and surgeries pose serious risks to young people. He stressed that healthcare providers have an obligation to rely on sound evidence and avoid interventions that could cause lifelong harm.

HHS noted that its stance is supported by a peer-reviewed report titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, which outlines what the agency describes as the medical dangers associated with these procedures.

The proposals are expected to generate intense debate across the United States, with supporters viewing them as necessary safeguards for children and critics arguing they restrict access to care. If adopted, the measures would represent one of the most significant federal interventions to date in the regulation of gender-related healthcare for minors.