Executive Order 14187

Executive Order 14187, titled "Protecting Children from Chemical and Surgical Mutilation", is an executive order issued by Donald Trump on January 28, 2025. 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, 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 US Federal Government will not "fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another." The 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 gender affirming care;
Told federal agencies providing federal grants to medical institutions to make sure those institutions were not carrying out any gender-related procedures;
Protects 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.

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.

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 in Virginia suspended gender-affirming medication and gender-affirming surgeries for those under 19 as of January 30, 2025.
Memorial Health in Georgia reportedly began canceling 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.

The following hospitals and healthcare providers have stated they will continue to provide gender affirming care to minors notwithstanding the executive order:

Transhealth in Massachusetts said on its website that it will continue providing care.
Lurie Children's Hospital and Howard Brown Health, both in Illinois, have issued statements stating they will monitor the executive order, but will otherwise continue to provide gender affirming care as needed by their patients.
M Health Fairview, Allina Health, Children's Minnesota and North Memorial Health, all in Minnesota, said that they will continue providing gender-affirming care for minors and adults.
On February 11, 2025, Legacy Health and Kaiser Permanente in Oregon said that they had not had not made any changes in the way they provide gender-affirming care.
Whitman-Walker Health in D.C. said that they will continue providing gender-affirming care to minors and adults.
Children's Hospital Colorado and Denver Health in Colorado both announced that they had stopped providing gender-affirming care in late January 2025. On February 20, 2025, it was announced that both hospitals would resume providing gender-affirming care after the Colorado Attorney General, Phil Weiser joined the legal challenge filed in Washington state to block the order.
Kaiser Permanente and Cedars-Sinai Medical Center in California said that they will continue to offer gender-affirming care for trans youth.
Children's Wisconsin Hospital canceled a transgender teenager's appointment to receive hormone therapy. The next day, the hospital reversed this decision and rescheduled the appointment.
Corewell Health in Michigan initially said that they would "pause" gender-affirming hormone therapy for new patients under 19, but a few days later said that they had lifted the pause following backlash.
Amoskeag Health in New Hampshire said that they would "pause" gender-affirming care for minors, but within 48 hours, they notified patients that they had reversed the decision and would resume the service.
Prisma Community Care in Phoenix, Arizona said during the week of February 3rd that they had "paused" gender-affirming hormones for minors. However, after the executive order was blocked in court, they swiftly lifted the pause saying "the court ruling was the green light to fully restore care."
University of Virginia (UVA) Health initially "paused" gender-affirming care for minors, but subsequently lifted the pause after the executive order was blocked in court. On February 21, 2025, The University of Virginia's governing board passed a resolution which said UVA Health could continue providing gender-affirming care to minors already receiving it, but should refer new patients to private providers "until further notice."
Children's Hospital Los Angeles (CHLA) in California paused gender-affirming care for trans youth while they review the executive order and court orders challenging it. In response Attorney General, Rob Bonta, warned hospitals in California that refusing to give gender-affirming care from transgender youth may violate state discrimination laws which protect access to the care in the state. On February 21, 2024, CHLA announced that they will resume gender-affirming care for trans youth due to Bonta's warning.
Children's Hospital of The King's Daughters in Virginia initially "paused" gender-affirming care for minors, but subsequently lifted the pause after the executive order was blocked in court.

For

According to The New York Times, "On social media, conservative activists struck a celebratory tone."

Against

Human Rights Campaign President Kelley Robinson said, "It is deeply unfair to play politics with people's lives and strip transgender young people, their families and their providers of the freedom to make necessary health care decisions."

After some hospitals announced that they had paused gender-affirming care for patients under 19 in order continue to receive federal funding, protests were held at the hospitals demanding that they reverse the pauses, including at Seattle Children's Hospital, Children's Hospital Colorado and Children's Hospital Los Angeles (CHLA). Some of these hospitals subsequently lifted their pauses on the care.

States

In February 2025, attorneys general from 15 states issued a joint statement that their states are committed to continuing to provide gender affirming care to minors despite the executive order. The statement cites a federal court's ruling that the Trump administration cannot halt funding approved by Congress. The states that signed the joint statement were California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Rhode Island, Vermont and Wisconsin.

New York's attorney general, Letitia James, sent a letter to New York hospitals and other health care providers on February 2, 2025 warning them that denying health care to pediatric transgender patients may violate New York's anti-discrimination laws. After Children's Hospital Los Angeles said that that it had paused some gender-affirming care for minors, California's attorney general, Rob Bonta, publicly warned the hospital that state law requires providing equal access to healthcare. On February 19, 2025, the California LGBTQ Health and Human Services Network, said that they were unaware of any healthcare providers in California other than CHLA that are continuing to restrict gender-affirming care for trans youth after Bonta issued his warning. On February 21, 2024, CHLA announced that they will resume gender-affirming care for trans youth due to Bonta's warning.

Legal actions

On February 4, 2025, several groups including ACLU, Lambda Legal, PFLAG, and GLMA filed a lawsuit, PFLAG v. Trump, in the federal District Court in Maryland against the Trump administration over the executive order. The lawsuit was filed on behalf of two young transgender adults, five transgender adolescents, and their families, whose health care has been disrupted by the executive order. The filing of the lawsuit was followed by a request for an immediate restraining order against the enforcement of the executive order. On February 13, Judge Brendan Hurson issued a temporary restraining order that prevents withholding federal funds from hospitals that provide gender affirming care to minors. On March 4, Hurson extended a nationwide block on enforcement of the executive order.

On February 7, 2025, the states of Washington, Minnesota, and Oregon, along with three doctors, filed a lawsuit in the federal District Court for the Western District of Washington requesting a court order to block enforcement of the executive order. The filing argues that the order is in violation of transgender people's rights to equal protection under the Fifth Amendment, and in violation of the Tenth Amendment by trying to unilaterally criminalize medical practices. All three states require Medicaid and private health plans to cover transgender health care. The lawsuit also argues that the president cannot discontinue research funding already authorized by Congress for hospitals and medical schools in Oregon, Washington and Minnesota. On February 19, 2025, Colorado Attorney General, Phil Weiser, announced that the state of Colorado had also joined the lawsuit. On March 1, 2025, Judge Lauren King blocked the executive order, but only in the four states that filed the lawsuit.