ACLU Moves to Challenge Trump Administration’s Proposed Federal Ban on Gender-Affirming Care for Transgender Youth

The American Civil Liberties Union has vowed to challenge a set of new Trump administration proposals that would significantly restrict access to gender-affirming medical care for transgender youth at the national level, escalating a policy battle that advocates say could reshape transgender health care across the United States.

In a statement released from Washington, D.C., the ACLU said it will “see in court” if the federal government moves forward with rules that would effectively ban hospitals from providing evidence-based gender-affirming care to transgender people under 18 as a condition of participating in federal health programs.

According to the ACLU, the administration’s proposal would bar hospitals from offering gender-affirming treatments such as puberty blockers, hormone therapy, and certain surgical interventions to transgender youth if those hospitals receive federal funding, including through programs like Medicare and Medicaid.

The ACLU describes these proposals as “an unprecedented federal intrusion into the private medical decisions of families and their doctors,” arguing they would override clinical judgment and established standards of care supported by leading medical associations.

The ACLU’s announcement comes as the Trump administration pursues a broader series of executive and regulatory actions that aim to roll back federal recognition of gender identity and limit access to gender-affirming health services.

An advocacy brief by HealthLGBTQ , drawing on a list of federal executive actions compiled by the Kaiser Family Foundation , reports that since January 2025 the administration has advanced policies framed as “Defending Women from Gender Ideology Extremism,” “Protecting Children from Chemical and Surgical Mutilation,” and related initiatives that direct federal agencies to restrict recognition of gender identity in health programs and to scrutinize or curtail funding related to gender-affirming care.

The HealthLGBTQ analysis notes that one of the early actions, issued under the title “Protecting Children from Chemical and Surgical Mutilation,” set the stage for further federal moves to limit coverage and provision of gender-affirming care for minors, including through guidance to health agencies and potential rulemaking affecting Medicaid and other federal health programs.

Separately, a recent notice in the Federal Register outlines a proposed rule that would prohibit state Medicaid agencies from using federal Medicaid or Children’s Health Insurance Program funds to pay for “sex-reassignment” procedures for individuals under 18, signaling a parallel effort to restrict funding for gender-affirming care for youth through public insurance programs.

That proposed rule states that, as a condition of receiving federal matching funds, state Medicaid plans would need to certify that they will not cover specified gender-affirming procedures for minors, potentially including hormone therapies and surgeries, depending on how “sex-reassignment procedures” are defined in the final regulation.

In addition to the Medicaid-focused rulemaking, the United States Department of Health and Human Services has promoted administration actions that it describes as efforts to “bar hospitals from performing sex-rejecting procedures on children,” language used in public communications amplifying the administration’s position that gender-affirming surgical care for minors should not be performed in hospitals participating in federal health programs.

The ACLU contends that the administration’s latest proposals violate constitutional protections and federal civil rights law by specifically targeting transgender youth and denying them medically necessary care that remains available to non-transgender patients for other diagnoses.

According to the ACLU, the proposed measures are “cruel and unconstitutional attacks on the rights of transgender youth and their families,” and amount to discrimination on the basis of sex and transgender status, in tension with Supreme Court precedent that has recognized discrimination against transgender people as a form of sex discrimination in certain contexts.

Chase Strangio, Co-Director of the ACLU’s LGBTQ & HIV Rights Project, said in the organization’s statement that by “attempting to strip away essential healthcare,” the administration is “weaponizing the federal government to target a vulnerable population for political gain,” and that healthcare decisions “belong with families and their doctors, not politicians.”

The ACLU argues that conditioning federal funding on hospitals’ refusal to provide gender-affirming care would force clinicians to choose between their ethical obligations to patients and the risk of losing critical resources, and could particularly harm families who have already relocated across state lines to secure medically recommended care for their transgender children.

The civil rights organization also points to the track record of litigation against state-level bans on gender-affirming care, where federal courts in multiple jurisdictions have considered whether such laws violate the Equal Protection Clause and other constitutional provisions, as a basis for contesting a similar policy at the federal level.

Advocates note that the federal proposals are unfolding against a backdrop of rapid growth in state-level laws restricting access to gender-affirming care.

The Trans Legislation Tracker , which monitors bills affecting transgender people across the country, reports that in 2025 alone, lawmakers introduced numerous measures that seek to block or criminalize access to gender-affirming care, restrict legal recognition, and limit transgender people’s participation in public life, continuing trends seen in 2023 and 2024.

An overview by the National Center for Transgender Equality’s “A4TE” project describes how, as new legislative sessions began, at least 120 anti-transgender bills were pre-filed nationwide since late 2024, many of them aimed at curtailing access to health care for transgender youth and, increasingly, transgender adults.

The Movement Advancement Project , which maintains national “Equality Maps” on health care bans, characterizes bans on best-practice medical care for transgender youth as “one of the most extreme and coordinated political attacks on transgender people in recent years,” noting that these laws often criminalize providers or parents for facilitating evidence-based care.

MAP’s analysis emphasizes that the targeted treatments—including puberty blockers and hormone therapy—are backed by years of research and endorsed by major professional associations such as the American Academy of Pediatrics and the American Medical Association, which consider gender-affirming care medically necessary for many transgender youth when provided according to established guidelines.

In one example of recent developments at the state level, MAP reports that New Hampshire’s 2024 ban on certain surgical care for transgender youth is already in effect, and that additional bans on surgical procedures and prescription medications for youth, passed in 2025, are scheduled to take effect in 2026, with limited grandfather provisions for youth already in care.

Advocates say this landscape of state bans has already forced some families with transgender children to travel long distances, relocate to states with more protective laws, or go without care, and warn that a new federal restriction on hospital-based care or Medicaid funding would compound these challenges.

If implemented, the administration’s HHS-advanced proposals and the related Medicaid rule could place hospitals and clinicians in a difficult position, particularly large health systems that rely heavily on federal funds.

Hospitals that currently provide gender-affirming care to transgender youth—often through multidisciplinary clinics that include pediatric endocrinologists, mental health professionals, and social workers—would be required to revisit their policies and potentially discontinue services for minors in order to maintain eligibility for federal reimbursement.

Clinicians who specialize in transgender health care have repeatedly stated, through medical organizations and public statements, that gender-affirming interventions for youth, when carefully assessed and guided by clinical standards, can be life-saving and are associated with improvements in mental health and well-being.

The ACLU notes that the federal proposals run counter to the positions of “every major medical association in the United States” that supports gender-affirming care as evidence-based and medically necessary for many transgender youth.

LGBTQ+ health advocates argue that by targeting only treatments used in a gender-affirming context—for example, blocking hormones when they are prescribed for gender transition but not when prescribed for other conditions—the policies single out transgender youth for different treatment, reinforcing stigma and creating what advocates characterize as a two-tiered system of care.

HealthLGBTQ’s advocacy brief warns that the administration’s broader set of 2025 executive actions could “erase gender identity from federal health policy” and “restrict affirming care,” with downstream effects on HIV services, mental health care, and culturally competent programs that many transgender and queer people rely on.

The brief also highlights concerns about proposed cuts to public health and HIV programs in the administration’s budget submissions, which would reduce resources for clinics that often serve LGBTQ+ communities, including transgender people living with HIV.

LGBTQ+ organizations across the country have framed the administration’s moves as part of a wider campaign to narrow the legal and social space in which transgender and queer people can access health care, participate in public life, and be recognized by federal systems.

The National Center for Transgender Equality’s “State of Trans Healthcare Laws in 2025” resource emphasizes that access to gender-affirming care “has been studied by experts for decades,” that this care “is both safe and effective” when provided according to standards of care, and that decisions about gender-affirming treatment “belong with trans people and our doctors – not politicians.”

Advocacy groups are using online tools such as the Movement Advancement Project’s Equality Maps and the Trans Legislation Tracker to inform transgender people and allies about rapidly changing laws, encourage civic engagement, and coordinate legal and grassroots responses across states.

According to HealthLGBTQ, the administration’s 2025 health-related executive actions are already affecting how LGBTQ+ people, and especially transgender and nonbinary individuals, access care and navigate federal programs, underscoring what the group calls a “systemic effort” to reshape federal health policy away from gender identity inclusion.

In response, legal organizations including the ACLU are preparing for a new round of federal litigation focused specifically on national restrictions, while community-based LGBTQ+ health centers and advocacy groups are working to help families understand their rights and options as the policy landscape shifts.

The ACLU states that it “will not rest until the rights of transgender youth to live authentically and access the care they need are fully protected,” signaling that any final rules emerging from the current proposals are likely to face immediate court challenges.

For transgender and queer communities, the outcome of these legal and policy battles will help determine whether gender-affirming care for youth remains primarily a matter of medical judgment and informed consent, or becomes more tightly constrained by federal funding conditions and national regulatory bans.