President Donald Trump on Tuesday ordered an end to all federal funding or support for healthcare that aids the transition of transgender youth, the latest in a series of actions limiting transgender rights in his first eight days in office.
The executive order, which is certain to face legal challenges, follows another executive order banning transgender people from service in the armed forces and others that appeal to Trump's most conservative supporters by limiting diversity, equity and inclusion programs.
The order fulfills a campaign promise to end "child sexual mutilation," an apparent reference to transgender-related healthcare such as puberty blockers and hormone therapy that help people transition from one gender to another.
"It is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures," Trump's executive order said.
Trump supporters such as the Alliance Defending Freedom, a Christian law firm, applauded the order as "a refreshing return to sanity," while opponents such as Marci Bowers, a gynecologist and surgeon who provides transgender care, declared Trump would "have blood on his hands."
Although such therapies have come under attack by religious conservatives and the Republican Party, major medical associations have endorsed them and in some cases found them life-saving for distressed transgender youth prone to suicide.
Republicans in more than half of the 50 states have passed laws or policies that ban gender-affirming care for minors, some of which have been blocked or overturned by the courts.
A challenge to Tennessee's law has been heard by the U.S. Supreme Court, which has yet to issue a ruling that could determine the legality of such bans nationwide.
Chase Strangio, a lawyer for the American Civil Liberties Union who argued against the Tennessee law before the Supreme Court, indicated the executive order would be challenged in court.
"We will not allow this dangerous, sweeping, and unconstitutional order to stand," Strangio said in a statement.
Lambda Legal, an LGBTQ civil rights organization, also declared it was "ready to fight back" against the Trump order, saying it would cause "unnecessary pain and suffering" for transgender youth and their parents.
The order aims to block Medicare payments for such healthcare and inhibit Section 1557 of the Affordable Care Act, also known as Obamacare, which prohibits insurance companies from denying coverage to transgender patients.
Trump directed the health and human services secretary to within 90 days "publish a review of the existing literature on best practices" for transgender healthcare for minors.
The HHS secretary would then "use all available methods to increase the quality of data" for transgender care.
Bowers, a former president of the president of the World Professional Association for Transgender Health (WPATH) who said she was speaking only for herself, said the best, peer-reviewed data would support the prevailing existing standards, which are to provide transition services for youth who are "insistent, consistent and persistent" about their gender identity.
"They're trying to make gender binary, and that's simply not how gender is," Bowers said. "That's not biology. Biology has diversity. Genitals have diversity. They just refuse to accept what biology actually teaches us."
Critics of the medical establishment say history will judge the current standards to be in error.
"Gender ideology has worked its way into our culture and our schools, but its worst manifestation has been in pediatric medicine," said Jay Richards, a senior research fellow at the Heritage Foundation.
