Jan. 28, 2025, 8:53 p.m.
With a few strokes of his pen, President Trump has started his work to fulfill his campaign promises to end the “left-wing gender insanity,” targeting gender-affirming care for kids and support for transgender individuals.
In a video on his campaign website, Trump said he would revoke the Biden administration’s policies on gender-affirming care, calling them “ridiculous,” and sign an executive order instructing federal agencies to cease programs promoting gender transition.
One of the many executive orders issued on Day One of the new administration laid out a strategy to immediately begin to squash policies aimed at supporting transgender, non-binary, and intersex people. The order calls for establishing just two sexes—male and female—and calls for immediately changing government documents and limiting care provided in federal prisons. Legal experts told National Journal immediate impacts from last week's order are expected in prisons and on government documents such as passports.
This week alone, he has released two other executive orders aimed at transgender and gender-diverse individuals: one targeting military service members, and another attempting to limit access to gender-affirming care, particularly for minors, labeling these treatments "chemical and surgical mutilation."
Even before Trump issued the orders, Beth Cronin, an OB-GYN in Rhode Island who provides gender-affirming care to transgender and nonbinary individuals, said patients have been sharing their worries since Trump won the election.
“Since November, I’ve had patients in my office very concerned about what the potentials are for them to be able to access health care in the long-term,” said Cronin, who is also a fellow with the American College of Obstetricians and Gynecologists. “I was in clinic last week having similar conversations with patients, and I think it still is this fear of: ‘Will I be able to access hormones down the road?’”
Defining only two sexes: ‘male’ and ‘female’
The directive to recognize only two sexes, and the definitions included for male and female, have received backlash from advocacy groups and experts.
The executive order states that “female” means a person belonging, “at conception,” to the sex that produces the large reproductive cell. “Male” is defined as those who produce the small reproductive cell. The Health and Human Services Department is ordered to provide guidance expanding on these definitions, and all agencies are expected to enforce statutes and regulations in alignment with these meanings.
“Unfortunately, the attempt to legislate that everyone in the world falls into two neat categories does not reflect biological reality,” said Sean Tipton, chief advocacy and policy officer at the American Society for Reproductive Medicine, in an emailed statement. “There are thousands of Americans whose chromosomes, external genitalia, and reproductive capacity do not match with some politician’s notion of how the world should be.”
An intersex advocacy group, interACT, called the definitions “a vague and unenforceable bid to redefine gender.” Trump's order “fails to consider the existence of intersex people and misunderstands embryonic development,” the group said, emphasizing that “no embryo produces reproductive cells at conception.”
Sylvan Fraser Anthony, legal and policy director for interACT, said the most immediate impact the organization is seeing for intersex youth and adults is anxiety, fear, and distress: “We are seeing a lot of people feeling like they’re being defined away, out of existence.”
Fraser Anthony said the executive order ignores “scientific reality and it also ignores people’s lived experience.” Laws and regulations trying to target transgender individuals often sweep in intersex people, Fraser Anthony said, and “the existence of intersex variations does fundamentally undermine what they’re trying to do.”
The order directs the assistant to the president for legislative affairs to produce legislative text within 30 days codifying the definitions.
On Monday, Trump signed another executive order aimed at pushing transgender service members out of the military.
“A man’s assertion that he is a woman, and his requirement that others honor this falsehood, is not consistent with the humility and selflessness required of a service member,” the order states. The order says the definitions laid out in the Jan. 20 directive are to be applied at the Pentagon.
Trump ordered the Defense Department to end “invented and identification-based” pronoun usage. The order also calls for “males” not to use or share sleeping, changing, and bathing facilities meant for “females,” and vice versa. The Pentagon is directed to identify other steps and develop guidance to implement the order within 30 days.
Lambda Legal and the Human Rights Campaign immediately announced their intention to sue over these policies.
Immediate impacts on prisons and passports
Under Trump’s initial executive order focused on sex and gender, individuals in federal prisons are likely feeling the immediate impacts, according to legal experts. The order directs the Federal Bureau of Prisons to ensure federal funds are not used for gender-affirming care and calls for transgender women to be removed from women’s prisons and placed in men’s prisons, a move the American Civil Liberties Union says “puts them at a severely heightened risk of sexual assault and abuse by other incarcerated persons and prison staff.”
Jenny Pizer, chief legal officer at Lambda Legal, echoed these concerns, saying the “track record is truly appalling of authorities not being able to or willing to protect trans women from violence in male facilities."
"We are hearing of incarcerated folks being moved right away," Pizer said, "That means immediate risk to people.”
Cutting off federal funding in prison for gender-affirming care, such as hormone therapy, will “forcibly detransition a person,” said Pizer, adding that it would be damaging to their health.
Lambda Legal, which focuses on litigation and public policy to further LGBTQ+ rights, immediately condemned the executive order and announced it is prepared to bring legal action.
Incarcerated intersex people could also be impacted by this directive, said Fraser Anthony, pointing to people who have differences that impact their gonads, such as an intersex woman with androgen-insensitivity syndrome who could have internal testes, as examples of individuals who could be swept up in the order. People with androgen-insensitivity syndrome are unable to respond to male sex hormones, so they may develop female genitals although they have male chromosomes.
“Under the executive order, they would be defined as male,” Fraser Anthony said. “If this is reflected on any of their records that are accessible to prison officials, they could be at risk of being transferred to a male facility.”
The executive order could also immediately impact individuals trying to update passports to match their gender identity and individuals seeking an “X” gender marker.
Advocates for Trans Equality (A4TE) issued a statement Saturday saying Secretary of State Marco Rubio has suspended passport applications to change sex markers or request an “X” marker. The group said the timeline for updated policies remains unclear.
“In the meantime, trans individuals are advised to proceed with caution when applying for or renewing their passports,” said A4TE Executive Director Rodrigo Heng-Lehtinen. “These attacks are nothing but a selfish effort to divide and distract us.”
When asked about reports of this pause on passport applications, including by The Guardian, the State Department told National Journal Friday that it “does not comment on leaked internal documents.”
Harper Seldin, senior staff attorney at the ACLU’s LGBTQ & HIV Project, said his understanding currently is that passports already issued remain valid.
Aggressive actions against gender-affirming care for youths
Just a little over a week after Trump signed his initial executive order outlining his general gender policies, he issued another order with directions to the Health and Human Services Department “to end the chemical and surgical mutilation of children.” In the order, this description refers to puberty blockers, hormone therapy, and surgical procedures.
“Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions,” the order released Tuesday night states. “This dangerous trend will be a stain on our Nation’s history, and it must end.”
The order directs HHS to end these procedures through regulatory and sub-regulatory actions, including ones that touch on Medicare and Medicaid conditions of participation or conditions for coverage, essential-health-benefits requirements, and Affordable Care Act anti-discrimination protections.
The heads of departments and agencies that provide grants for research or education at medical institutions are directed to take steps to ensure recipients stop gender-affirming care for children.
While Seldin said Tuesday night he was still evaluating what, if anything, could be immediately enforced in the order, he said the wording “is from an alternate universe.”
“This care can be lifesaving and enormously helpful in helping young people become happy, healthy, productive members of their communities, their schools, and the broader civic society. That is the beautiful reality of gender-affirming care in this country for transgender people,” he said. “Seeing an executive order that has an entirely different account, I think, is deeply harmful to transgender people and their families.”
Pizer said the order “attempts to, simply with a Sharpie, eliminate decades of knowledge about gender identity and gender dysphoria, including research and data and studies by people with medical and clinical credentials.”
The order, unlike the many state laws banning gender-affirming care, doesn’t include an exemption for procedures often performed on intersex infants and children, said Fraser Anthony, who added that this was likely unintentional because “this order is not about protecting anybody."
"Let’s be real. This order is about denying bodily autonomy and enforcing sex stereotypes.”
Fraser Anthony pointed to the first section of the order, where it says its purpose is to stop medical professionals from providing these procedures.
“Ironically enough, if you were to change the framing and just change a few words, most of what is in that Section One would be essentially accurate with respect to non-consensual surgeries on intersex infants and young children, but it’s exactly backwards when it comes to gender-affirming care sought by trans adolescents or some intersex adolescents, too."
Fraser Anthony added that “there’s no justifiable reason to be restricting access to necessary care that people want and need, where there would be every justification to restrict the practice of non-consensual medical interventions that are not medically necessary like the ones performed on intersex infants and young children.”
