The federal government has taken a series of steps to limit gender-affirming care for people under 19, and a landmark Supreme Court decision has given states wide latitude to do the same.
Executive Order 14187, “Protecting Children from Chemical and Surgical Mutilation,” signed January 28, 2025, directs federal health agencies to curb support for puberty blockers, hormones, and surgery for minors — including through Medicare and Medicaid, federal employee health plans, and research funding. In December 2025, agencies proposed rules that would bar Medicaid and Medicare coverage of such care, followed by public comment periods.
In United States v. Skrmetti, decided June 18, 2025, the Supreme Court upheld a Tennessee law restricting these treatments for minors by a 6–3 vote, holding that the law did not warrant heightened constitutional scrutiny. The ruling effectively cleared the way for the roughly two dozen states with similar bans.
Supporters of the restrictions cite caution about irreversible interventions in adolescents and point to more restrictive approaches recently adopted by some European health systems. Major U.S. medical organizations — including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society — maintain that such care can be medically necessary and warn that bans harm transgender youth. Several federal funding cuts were temporarily blocked by courts in 2025, leaving parts of the policy unsettled.
Sources: Executive Order 14187; United States v. Skrmetti; KFF policy overview.
Frequently asked questions
What did United States v. Skrmetti decide?
On June 18, 2025, the Supreme Court upheld 6-3 a Tennessee law restricting puberty blockers and hormones for minors, holding that the law did not warrant heightened constitutional scrutiny.
What has the federal government done on youth care?
Executive Order 14187 (January 28, 2025) directs federal health agencies to limit support for such care, and in December 2025 agencies proposed rules to bar Medicaid and Medicare coverage.
Where do medical organizations stand?
Major U.S. groups such as the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society say the care can be medically necessary. Supporters of restrictions cite caution about irreversible interventions and more restrictive approaches abroad.