The Trump Executive Order on Trans Kids is Anti-Science
Trump's order is dangerous and at odds with medical and scientific consensus.
As part of the avalanche of executive orders issued since his inauguration, Trump released a new one about gender-affirming medical care for adolescent gender dysphoria. He titled it, “protecting children from chemical and surgical castration.” As a physician-scientist who has spent my career studying the best ways to support trans kids (including at Harvard, Yale, Stanford, and my current position at UCSF), I can tell you that the order is fully disconnected from reality.
First and foremost, people should be aware that his position of wanting to ban medical treatments for trans kids is far outside the American medical mainstream. While the executive order attacks the World Professional Association for Transgender Health (WPATH), it fails to mention that essentially every medical organization in the U.S. opposes banning these treatments. This includes The American Medical Association, The American College of Physicians, The American Academy of Family Physicians, The American College of Obstetricians and Gynecologists, The American Osteopathic Association, The American Psychiatric Association, The American Academy of Pediatrics, The American Academy of Child and Adolescent Psychiatry, The Endocrine Society, and The Pediatric Endocrine Society.
Parts of Trump’s executive order simply don’t make sense. For instance, it reads that medical professionals are promoting a “radical and false claim that adults can change a child’s sex…” Doctors are well aware of what gender-affirming medical interventions do and what they do not do. They do change some secondary sex characteristics (body fat distribution, the pitch of one’s voice, body hair distribution, etc.), which can help trans people feel more comfortable in their bodies. There has never been any claim that they change one’s reproductive cells (the current administration’s choice definition of sex). These are scientific facts that are not up for debate.
Other parts of the executive order misrepresent these interventions as being new. The use of hormonal interventions to treat gender dysphoria goes back to the early 20th century, notably at the Institute for Sexual Science founded by Magnus Hirschfeld in Berlin (the institute was burned by the Nazis in one of their earliest moves against minority groups). The use in pediatrics is also not particularly new. Historian Jules Gil-Peterson, in her award winning book Histories of the Transgender Child, explains that these treatments have been used to support transgender youth going back to at least the 1970s.
The Trump executive order instructs the department of Health and Human Services to publish a document outlining best practices for treating adolescent gender dysphoria within 90 days (an absurdly short time frame for such a project, suggesting they may already have something drafted, potentially by conservative think tanks). Concerningly, the executive order says the document should include treatment protocols for “rapid-onset gender dysphoria,” a supposed phenomenon in which adolescents become transgender suddenly due to social contagion. The paper that hypothesized this condition was corrected in 2019 to emphasize that “rapid onset gender dysphoria is not a formal mental health diagnosis at this time.” With the trend towards Trump’s health appointees lacking credentials and holding conspiratorial views, it will be vital to watch what happens with this HHS report closely.
People should be aware that the Trump executive order has been challenged in court. The U.S. Supreme Court is already considering the case of US v Skrmetti, which asks whether government bans on gender-affirming care for minors violate the Equal Protection Clause of the U.S. Constitution.
Unfortunately, this litigation may get messy, as the Trump administration wrote a broad executive order that hints at attacking this medical care in multiple ways. This includes banning insurance coverage through TRICARE and Medicaid. They may try to withhold federal funding from academic medical centers that offer medical care to transgender youth. They may try to investigate doctors through the DOJ to create a chilling effect. They even seem to imply in the order that they will take control of the American Psychiatric Association’s manual of mental health conditions, The Diagnostic and Statistical Manual of Mental Disorders (DSM). These multiple avenues of assault are guaranteed to create chaos and fear. We are already hearing reports that some pediatric gender clinics are closing in anticipation of these attacks.
As these strategies are challenged in court, there will be real damage in the meantime. As a mental health provider who cares for transgender youth and their families, I’m already getting a flood of messages from scared parents. They are wondering if they need to flee the country. Some have already made plans to move. They are wondering if they’ll be physically safe with anti-trans rhetoric on the rise. Though it will take time for this administration to implement its strategies, the negative effects on vulnerable youth and their families are already being felt.
Thank you! As someone who participated as a patient in taking a year working with medical staff to design a gender pathways clinic, and later as an employee supporting the patient advisory council that worked with staff to assure the clinic was meeting its patients needs, these executive orders are beyond concerning.
And as an 80 year old transgender woman who had to raise money to pay for her own gender confirming surgeries in 2012 at a time when the Centers for Medicare and Medicaid services was denying them I am horrified. I went on to play a small role in convincing CMS to stop those denials and I am proud of having done so. I hope the law suits challenging these executive orders are successful.
I have 2 trans and 1 non-binary adult kiddos. Thank you for posting.