Federal agency sounds alarm on “gender-affirming care”

Editor’s note: This story contains descriptions of medical attempts to alter sex characteristics. It may not be suitable for all readers.

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) expressed serious concerns about the transgender treatments prescribed by doctors for tens of thousands of children diagnosed with gender dysphoria.

The statement, made public on its website March 5, makes it the second federal agency to officially question the benefits of puberty blockers, cross-sex hormones, and surgeries, what many call “gender-affirming care,” for children. The first—the U.S. Department of Health and Human Services—issued an announcement on Feb. 19 saying it would “promote policies acknowledging that women are biologically female and men are biologically male.”

Both announcements come just weeks after President Donald Trump issued an executive order stating the U.S. government will not support any medical interventions that try to alter sex characteristics for children. Both the order and the agency announcements contradict positions long held by professional medical associations, including the American Medical Association and the American Academy of Pediatrics, which say pediatric gender interventions are based on scientific evidence and are medically necessary.

The most recent announcement did not spell out any specific changes, only that CMS “may begin taking steps to align its policies and regulations with medical evidence and to safeguard children from often irreversible experiments.” CMS could potentially end all coverage for pediatric gender treatments, which means, instead of seeking Medicaid coverage for such procedures, parents would have to either seek private insurance or stop the interventions.

Compared to other Western nations, the United States remains an outlier when it comes to how it treats gender-distressed children. The U.K., for example, has scaled back access to its pediatric gender services after a comprehensive review showed “remarkably weak” evidence in April 2024. Similarly, Finland warned of uncertainty about the use of hormones and surgery on children, and a 2022 report from Sweden said the risks of such interventions outweighed the benefits.

Meanwhile, most U.S. professional medical societies recommend the opposite. The American Medical Association, which represents 132,000 members, states that forgoing gender treatments could increase the risk of anxiety, stress, substance use disorder, and suicide in youth. In 2023, the American Academy of Pediatrics reaffirmed its commitment to transgender treatments in children, though it also agreed to conduct a systematic review of existing research.

The Centers for Medicare & Medicaid Services, which is housed under the Department of Health and Human Services, provides health coverage for more than 160 million Americans. This includes people over the age of 65, those with specific disabilities, and people who cannot afford private insurance. It is not clear how many pediatric patients have their gender treatments covered by Medicaid. WORLD reached out to CMS multiple times but received no response.

During a National Detransitioner Awareness Day event at Capitol Hill on Wednesday, Forrest Smith said Medicaid covered both his breast implants and the removal of his testicles. He added that he decided to pursue medical attempts to identify as a woman when he was 19, after he was admitted to a psych ward.

There, Smith said a social worker who identified as queer gave him a “transgender road map.” “It has every operation you can think of related to transgender related operations, covered by public health insurance,” he said.

“There were social workers seeing the way I was dressing, seeing how I was presenting, asking me, ‘Do you want to be on the waitlist for breast implants?’” Smith said. “If I hesitated, they said, ‘Well, you have a year to make up your mind, and it’s free, so why not?’”