Executive Order 14187, titled "Protecting Children from Chemical and Surgical Mutilation", is an executive order issued by Donald Trump on January 28, 2025. Part of a broader targeting of transgender people, the order acts to prevent gender-affirming care for Americans under 19 years old by withholding federal funding and directing agencies to take a variety of steps to prevent surgeries, hormone therapy, the use of puberty blockers, and other gender-affirming treatments.
In response, some hospitals paused providing gender-affirming care for minors, while others continued. Attorneys general from 15 states said their states are committed to continuing to provide gender-affirming care to minors. Multiple groups filed lawsuits challenging the legality of the executive order. In response to one of the lawsuits, several federal judges issued injunctions blocking the government from withholding federal funds from hospitals that provide gender-affirming care to minors. Following the injunctions, some hospitals that initially paused gender-affirming care for minors resumed the care.
Background On January 20, 2025, Donald Trump signed executive order Executive Order 14168 ("Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government"), which described transgender identity as an ideology. On January 27, 2025, Donald Trump signed executive order Executive Order 14183 ("Prioritizing Military Excellence and Readiness") which stated that the policy of United States military readiness is "inconsistent with the medical, surgical, and mental health constraints on individuals with gender dysphoria" and that beyond that, being trans "conflicts with a soldier’s commitment to an honorable, truthful, and disciplined lifestyle, even in one’s personal life." This order is seen as consistent with these prior orders.
Summary The order described gender-affirming care for minors as "chemical and surgical mutilation of children" as well as "maiming" and "sterilizing". It stated "countless children" who received such care would regret a "horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding." The order also described the World Professional Association for Transgender Health's (WPATH) guidance as "junk science".
The order states that the U.S. Federal Government will not "fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another." Its provisions include: Directing the United States Department of Health and Human Services to review the terms of insurance under Medicare, Medicaid, and the Affordable Care Act to end certain types of gender-affirming care Ordering federal agencies providing federal grants to medical institutions to make sure those institutions are not carrying out any gender-related procedures Protecting whistleblowers who report on institutions that provide gender-affirming care in violation of the executive order
Implementation In February 2025, the Office of Personnel Management announced that insurance carriers that provide health insurance coverage to Federal employees under the Federal Employees Health Benefits Program will no longer be allowed to provide coverage for gender-affirming care for minors. Carriers must identify any resulting premium reductions and incorporate those reductions into their 2026 rates. Carriers may continue to offer coverage for gender-affirming care for persons 19 years old and older, but they are not required to do so.
In May 2025, the United States Department of Health and Human Services published a report titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. The report promotes gender exploratory therapy, a form of conversion therapy intended to delay or prevent someone suffering gender dysphoria from seeking gender transition.
In the summer of that year, the Department of Justice began sending subpoenas to "over 20" hospitals demanding the full records of trans patients who received medical care under 19 - including their names, social security numbers, doctors' notes, and treatments prescribed. This practice continued into 2026, expanding to many more hospitals across the nation.
In 2026, the Trump admin began forcing hospitals which it had found to have acted in violation of the order - beginning with Texas Children's Hospital and The Cleveland Clinic - to establish detransition clinics, which would perform medical detransitions on any patient who had previously received transgender healthcare.
Analysis According to The New York Times, this executive order, in combination with other gender related executive orders, results in "essentially placing the federal government in opposition to a wide variety of gender-related therapies and to anyone who seeks them." The New York Times has also said that the financial implications of the order are "enormous" since a large fraction of many health care institutions' research budgets come from the federal government, and patient care income comes from Medicare and Medicaid. Contributor Masha Gessen argued that this order, along with the wide array of restrictions implemented as part of Executive Order 14168 and Executive Order 14183, constituted an effort by the Trump administration to "denationalize" transgender people, much in the way that Jews were in 1930s Germany.
In an interview with The Conversation, Elana Redfield, federal policy director at the Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy, stated: "...a big part of the executive order is directing the federal agencies that administer these programs to review their own policies to ensure that they are not supporting gender-affirming care for minors" "Ultimately, the president can only take actions in ways that are designated by the Constitution, or through some specific power that Congress has granted to the executive branch. I don’t see that authority granted for a lot of what’s contained in this executive order." "...there’s a pending U.S. Supreme Court decision regarding a Tennessee law banning gender-affirming care for minors. Should the Supreme Court determine that Tennessee is able to ban gender-affirming care for minors, it’s possible to see how this could impact private health insurance coverage for gender-affirming care." "...it’s important to remember that executive orders aren’t established policy. They’re simply directing agencies to craft certain policies and encouraging lawmakers to enact legislation." NBC News described the language in the executive order as inflammatory and noted that major medical associations support access to transgender health care for minors. It also referenced a study published in JAMA Pediatrics that found "less than 0.1% of adolescents with private insurance in the U.S. are transgender or gender-diverse and are prescribed puberty blockers or gender-affirming hormones."
The executive order is similar to a portion of Project 2025 that called for withdrawing "guidance issued under the Biden Administration concerning sexual orientation and gender identity under Section 1557" of the Affordable Care Act.
After some hospitals began pausing or ending gender-affirming care for minors in response to the executive order, psychiatrist and professor Dr. Robert Klitzman said he believed that providers, local governments or nonprofit organizations would look into setting up private clinics to continue offering gender-affirming care for minors. Such clinics would be entirely separate from other hospitals and the federal government.
Reactions
Hospitals The following hospitals or health care providers have paused or ended gender-affirming care for minors in response to the executive order: Children's National Hospital in Washington DC paused prescriptions of puberty blockers and gender-affirming hormone therapy for minors in order to "assess the situation further" as of January 30, 2025. The hospital already did not perform gender-affirming surgeries on minors. In 2022, the hospital was subject to a harassment campaign for allegedly providing gender-affirming surgeries to minors. NYU Langone Health has reportedly cancelled appointments for providing puberty blockers for some children as of February 3, 2025. They have not, however, made any announcement. VCU Medical Center and Children's Hospital of Richmond at VCU, both in Virginia, suspended gender-affirming medication and gender-affirming surgeries for those under 19 as of January 30, 2025. On February 25, 2025, both announced that they would resume gender-affirming care for their existing patients, but would be keeping the pause on new patients. On July 29, 2025, VCU Health announced that they would once again be suspending care for existing patients under 19. Memorial Health in Georgia reportedly began cancelling gender-affirming surgery appointments for transgender adults in their mid-20s, despite the executive order only applying to those under 19. A state law in Georgia already bans gender-affirming surgery for people under 18. El Rio Community Health Center in Arizona said in February 2025 that gender-affirming care for both minors and adults had been "put on hold" for the time being. Lurie Children's Hospital and Northwestern Memorial Hospital, both in Illinois, "paused" gender-affirming care for people under 19 following the executive order. UCHealth in Colorado paused all gender-affirming care for people under 19. After the executive order was temporarily blocked in court, UCHealth said that they would not be resuming care and were waiting for a permanent court decision. Boston Children's Hospital in Massachusetts reportedly began canceling gender-affirming care appointments scheduled for minors. Seattle Children's hospital in Washington State reportedly began to postpone some gender-affirming surgeries for patients under 19. New York-Presbyterian Hospital and Mount Sinai Health, both in New York, canceled some appointments for gender-affirming care. Phoenix Children's Hospital in Arizona announced that they would be "indefinitely" stopping its gender-affirming care program for patients under 19 years old to comply with the executive order. Penn State Health, University of Pittsburgh Medical Center and UPMC Children's Hospital of Pittsburgh, all in Pennsylvania, said in April 2025, that they would be stopping gender-affirming care for patients under the age of 19 to comply with the executive order. Medical University of South Carolina (MUSC) reportedly canceled a gender-affirming surgery appointment for a transgender adult in their early 30s, despite the executive order only applying to those under 19. A state law in South Carolina already bans gender-affirming surgery for people under 18. Cherokee Health Systems (CHS) in Tennessee is no longer accepting new patients for gender-affirming hormone therapy even for adults in response to this executive order and the related executive order. Nonetheless, they are still providing treatment for existing patients that are 19 years old and older in response to a recent court order. CHS was already in compliance with a Tennessee law banning gender-affirming hormone therapy for people under 18 prior to the executive order. Children's Healthcare of Atlanta announced in April 2025 that they had stopped offering gender-affirming care for minors. However, this was largely due to a new state law prohibiting doctors from treating children with gender dysphoria, in addition to Trump's executive order. In May 2025, Penn Medicine in Pennsylvania announced that they had stopped all gender-affirming surgeries for people under 19. However, they are continuing to provide puberty blockers and hormones for people under 19. In May 2025, Central Outreach Wellness Center in Pennsylvania announced that they would stop providing gender-affirming care to minors due to the executive order.