Trump Admin Attempts To Ban Trans Youth Care Nationwide With New Federal Rules

Three new rules pushed by the Trump administration may serve as the next wave of a federal crackdown on trans youth care.

Photo by René DeAnda on Unsplash

Over the past year, the Trump administration has made restricting transgender health care for youth one of its top priorities, seeking to ban treatment for anyone under 19 in both red and blue states. Its tactics have included threatening and subpoenaing providers for trans youths’ medical records, attempting to pull federal grants from hospitals and universities that offer gender-affirming care, and issuing vague guidance that’s driven even longtime allies into overcompliance. Now the administration is escalating with a blitz of three new rules that could effectively end most transgender youth care nationwide if enacted—pressuring many medical institutions to drop trans patients from receiving the care they need out of fear of federal reprisal, and punishing those who do not comply.

A federal rule finalized this morning would bar nonprofits from qualifying for Public Service Loan Forgiveness if they “engage in chemical and surgical castration” of minors—the administration’s inflammatory phrasing for what it later defines as puberty blockers and hormone therapy, both standard treatments for transgender youth diagnosed with gender dysphoria. The change would punish entire institutions: doctors, nurses, and staff at any hospital, university, or nonprofit that provides gender-affirming care to minors would lose access to loan forgiveness, effectively coercing organizations to abandon care or risk their employees’ financial security.

This rule is slated to go into effect on July 1, 2026, and is widely expected to face legal challenges. PSLF’s statute does not authorize excluding otherwise-eligible nonprofit employers based on providing gender-affirming care. Legal experts say the policy is vulnerable under the Administrative Procedure Act and post-Loper Bright statutory-authority review. Still, as seen in previous crackdowns on transgender health care, many hospitals—and even some LGBTQ+ organizations, including Fenway Health in Boston—have opted to comply rather than risk confrontation, underscoring how fear of federal retaliation can chill resistance even among supposed allies.

The same morning this first rule was finalized, NPR reported that two additional rule proposals are expected within days. One would prohibit federal Medicaid reimbursement for gender-affirming care provided to anyone under 19. The other would go even further, barring hospitals that treat transgender minors from receiving any Medicaid funds at all—a measure that would effectively eliminate access to such care nationwide, except at the few private clinics able to forgo Medicaid entirely, a rarity in transgender youth medicine.

The new rules echo the negotiations over the FY26 appropriations bills tied to the ongoing shutdown fight, where House Republicans are similarly pushing to ban federal funding for gender-affirming care nationwide. As the shutdown drags on, transgender advocates and trans Americans are watching closely to see whether any of those provisions slip into law. Though the shutdown has primarily centered around a clean continuing resolution without those provisions, there has been some shift towards negotiation of the full appropriations bills, which could be a mechanism for anti-trans and anti-LGBTQ+ provisions to enter into federal law. If Trump gains access to even a fraction of the restrictions embedded in those House bills, it would further streamline his administration’s efforts to dismantle trans health care across the country.

Gender-affirming care saves lives. A Cornell review of more than 51 studies found that such care significantly improves the mental health of transgender people. One major study reported a 73 percent drop in suicidality among trans youth who began treatment; another found a 40 percent reduction in actual suicide attempts in the previous year. Research published in the Journal of Adolescent Health in April 2024 showed puberty blockers sharply reduced depression and anxiety. Abroad, a German review backed by 27 medical organizations endorsed gender-affirming care for youth, and a recent French medical consensus did the same. The evidence has driven a historic resolution from the American Psychological Association—representing 157,000 members—formally condemning bans on trans care.

If enacted, these rules would make gender-affirming care for transgender youth far harder—if not impossible—to access across much of the country. Even now, with only the threat of enforcement hanging overhead, many hospitals and organizations have chosen compliance over resistance. Should these measures take full effect, the chilling impact on trans health care would be immediate and devastating, erasing years of medical progress and leaving thousands of young people without safe treatment options.

You can read the full text of the PSLF rule here, and view the Office of Information and Regulatory Affairs listings for the other two proposed rules here.