Trump Pressures International Orgs To Disavow Trans Care, Social Transition Globally "At Any Age" With Funding Ban

The new rule would enact the "Mexico City Policy" towards what it calls "gender ideology."

Wikimedia Commons // WHO // Thorkild Tylleskar

On Monday, the Trump administration published a new rule in the Federal Register that could affect more than $30 billion in U.S. foreign aid distributed to international organizations. The funding—supporting hospital clinics, HIV/AIDS programs, educational institutions, and more—would be conditioned on sweeping new restrictions barring “social transition” and gender-affirming care at any age, including therapy and counseling. While the administration has already frozen large portions of foreign aid, this rule would formalize those efforts and dramatically expand their reach, with potentially severe consequences for transgender people worldwide as the administration escalates its campaign against transgender lives both at home and abroad.

The rule, titled “Combating Gender Ideology in Foreign Assistance,” would impose sweeping conditions on U.S. foreign aid that effectively bar recognition of transgender people and the care they need to live safely and equally. It is modeled loosely on the Mexico City Policy, which restricts aid to organizations that provide abortion services, but goes significantly further. Rather than targeting specific medical procedures, the rule would apply broadly to any school, hospital, or organization receiving U.S. funding—or funded indirectly through partner organizations. Those entities would be prohibited not only from providing gender-affirming care to youth and adults, but from “promoting” such care at any age, including “social transition” and even counseling that acknowledges it as an option. In practice, the rule would attempt to force groups receiving U.S. aid worldwide to adopt extreme discriminatory policies toward transgender people as a condition of continued funding.

“The Department does not believe taxpayer dollars should support sex-rejecting procedures, directly or indirectly for individuals of any age. A person’s body (including its organs, organ systems, and processes natural to human development like puberty) either healthy or unhealthy based on whether they are operating according to their biological functions,” reads the policy. It goes on to institute specific bans for any organization receiving federal dollars internationally. Bans include:

• “The provision or promotion of sex-rejecting procedures or sex-rejecting social transition”

• “Committing resources, financial or other to increase the availability, or use of

  sex-rejecting procedures or sex-rejecting social transition”

• “Providing advice that sex-rejecting procedures or sex-rejecting social transition

  is an available option for treatment of gender dysphoria, or referring for, or encouraging individuals to consider, such activities”

Several more similar restrictions are outlined.

The rules also include pass-through requirements, meaning the restrictions would apply not only to primary recipients of U.S. funding but to any downstream organizations they support. In practice, that could force schools in countries receiving U.S. assistance to adopt anti-transgender policies of their own. The same would be true for clinics, including those serving HIV/AIDS patients, which often also provide LGBTQ+ health care or counseling related to that care. Under the rule, access to U.S. funding would hinge on enforcing those exclusions throughout the entire funding chain.

"This is about weaponizing U.S. foreign assistance to promote an ideological agenda," says Keifer Buckingham, managing director for the Council for Global Equality, in an interview with NPR. "This really represents a culmination of the Trump administration's ideological war on LGBTQI+ people, marginalized populations, people of color, women and takes it to a whole other level, exporting what has been a domestic crusade abroad.”

The policies also represent a significant escalation into two areas transgender rights advocates in the United States have long feared could eventually be pursued domestically: restrictions on adult transgender health care and limits on social transition. While the early phases of the Republican Party’s broad assault on transgender rights focused largely on youth and sports, recent efforts have increasingly targeted adult care. Attempts to impose similar restrictions through federal funding bills were rebuffed by Democrats, but the Trump administration appears to view global aid policy as a more permissive testing ground—arguing that formal legislation is unnecessary and that it has broader constitutional latitude when acting abroad.

This strategy—using federal rulemaking and funding threats—has also been central to how the Trump administration has targeted transgender youth domestically. By focusing on hospitals and schools that rely on public funding, the administration has repeatedly threatened to pull that support unless institutions agree to impose sweeping restrictions on transgender people. That approach has already been successfully weaponized, contributing to several pediatric hospitals ending their gender-affirming care programs and extracting concessions from universities on issues such as transgender sports participation and bathroom access.

The rule now will go for public comment. It will then go into effect 30 days after publication in the Federal Register.