A note to readers: This week, we're introducing a federal policy update on "gender identity" policy which we plan to share once a month in place of the Gender Debriefs weekly updates. Our normal Debrief content will resume next week. Thanks for reading.
Executive Orders
EO 14168 – Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government (1/20/25) -
The federal government will only recognize two sexes, male and female.
- Agencies must interpret laws governing sex-based rights accordingly.
- The Secretaries of State and of Homeland Security must ensure that government issued documents reflect the holder’s sex.
- Federal agencies must end federal funding for “gender ideology.”
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Agencies must rescind any previously issued guidance documents that are inconsistent with this order—including a notice of interpretation considering Bostock that expands the definition of sex under Title IX to include “gender identity.”
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Bureau of Prisons must revise policies allowing federal inmates to receive “gender-affirming care” while incarcerated. Attorney General must ensure that men are not housed in women’s prisons.
Current Status: Partially Active (some provisions have been blocked by the courts). In PFLAG v. Trump, a federal judge granted the plaintiffs a preliminary injunction blocking enforcement of the provision prohibiting the federal funding of “gender ideology.” Similarly, in Kingdom v. Trump, a judge issued a PI blocking enforcement of the directive to the Bureau of Prisons on “gender-affirming care” (GAC). In Orr v. Trump a district court ruled that the State Department must allow trans-identified applicants to self-select their “gender” on passports, however, the Trump administration appealed to the Supreme Court who granted the administration’s application for a stay.
EO 14183 – Prioritizing Military Excellence and Readiness (1/27/25) - Having a diagnosis of gender dysphoria or even a transgender identity is inconsistent with the standards expected of service members.
- Use pronouns and facilities consistent with EO on defining sex.
Current Status: Active. Although litigation is ongoing and there are several active cases (Nicolas Talbott, et al. v. Donald Trump, et al., & Shilling v. Trump), the EO is in effect after the Supreme Court issued a stay after the 9th Circuit temporarily blocked enforcement.
EO 14187 – Protecting Children from Chemical and Surgical Mutilation (1/28/25) - The government may not fund, sponsor, promote, or assist with medical transition procedures for youth under 19.
- Federal agencies shall remove any guidance reliant on WPATH.
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HHS shall publish a report on evidence and best practices within 90 days of the EO and use the means at its disposal to acquire more high-quality data on minor patients who seek transition procedures.
- Heads of agencies shall take steps to ensure that institutions receiving federal research or education grants end their support for GAC.
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Rescinds Biden-era guidance on GAC and calls on the Secretary of Defense to engage in rulemaking to end TRICARE’s coverage of medical transition for the children of enlisted servicemembers.
- DOJ/AG shall investigate “female genital mutilation” and consumer fraud related to GAC.
Current Status: Partially Active. Litigation is ongoing in several cases (PFLAG v. Trump, State of Washington v. Trump, Massachusetts v. Trump, & Doe v. Department of Defense). In PFLAG v. Trump, a judge issued a nationwide injunction blocking enforcement of the funding provisions of EO 14187, which aimed to prohibit federal funds for GAC for persons under 19. In Washington v. Trump, a judge also issued a PI blocking enforcement in the states of Washington, Minnesota, Oregon and Colorado as litigation plays out.
EO 14190 – Ending Radical Indoctrination in K-12 Schooling (1/29/25) - Aims to eliminate federal funding and support for programs that advance gender ideology.
- Takes aim at the practice of social transition in schools.
Current Status: Active
EO 14201: Keeping Men Out of Women’s Sports (2/5/25) -
Conditions the receipt of federal funds for education programs on promoting “fair athletic opportunities” for women and girls.
- The order also calls on the domestic policy advisors to work with athletic organizations to ensure that their policies are consistent with the EO.
Current Status: Active, despite ongoing litigation (Tirrell v. Edelblut & California v. Department of Justice). |
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U.S Department of Health and Human Services (HHS)
2/19/20: The Office of the Assistant Secretary of Health releases sex-based definitions to guide the enforcement of EO 14168.
2/20/25: HHS rescinded previous guidance on GAC, civil rights, and patient privacy -
Previous guidance (“HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy”): providers who refuse to render GAC may violate Section 1557 of the ACA; health care providers and other “covered entities” may not release private health information relating to GAC without patient clearance; GAC may qualify as a disability under the ADA, despite being excluded in the language of the ADA itself.
3/5/25: Quality and Safety Special Alert Memo 4/11/25: CMS Issues Letter to Medicaid Directors 5/1/25: HHS Releases Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices 6/5/25: Rescission of 2023 Guidance on Adding SOGI Questions to State Medicaid and CHIP Applications for Health Coverage 6/25/25: Final Rule on Marketplace Integrity and Affordability -
The rule prohibits health insurers from considering “sex-trait modification procedures” as an essential health benefit (EHB) under the Affordable Care Act, which would apply to plan year 2026 if allowed to go into effect. (21 states have challenged the rule, but no injunction has been issued.)
8/26/25: Administration for Children and Families (ACF) Issues Notice on PREP Grants 9/30/25: ACF Issues Letter to the Massachusetts DCF Addressing Foster Policy -
ACF sent a letter to the Massachusetts Department of Child and Families vowing to investigate its “LGBTQIA+ Non-discrimination Policy" which requires foster parents to agree to affirm a child’s “gender identity” as a condition for maintaining their foster license.
10/22/25 -
Federal court in Mississippi vacates Biden HHS rule (2024) that codifies sex = gender identity in Section 1557. Rejects Bostock reasoning, adds that even if Bostock reasoning applied, it wouldn’t apply to medical issues (resolved in Skrmetti). Interpreting 1557 to include sex must be done by Congress.
10/30/25 -
NPR reported on two proposed rules yet to be formally announced. One rule would prohibit Medicaid and CHIP reimbursement for GAC while the other would block Medicare and Medicaid funding from going to health care entities that render GAC.
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U.S. Department of Justice 2/7/25: Letter to the Supreme Court -
The letter notified the Court that “the government’s previously stated views” on U.S. v. Skrmetti “no longer represents the United States’ position.”
4/22/25: AG Pam Bondi Issues Memo Preventing the Mutilation of American Children -
Bondi’s memo builds on the groundwork laid in EO 14187 (“child mutilation”). Outlines several key priorities including: 1) investigating cases of GAC that culminate in “female genital mutilation” of anyone under 18; 2) investigating cases in which medical providers and pharmaceutical companies may have violated the FDA Act and False Claims Act; 3) removing all guidance, materials and court filings that rely on WPATH SOC-8; 4) collaboration with state AGs for information-sharing; 5) outlining a proposal for national legislation that bans GAC for minors.
6/1/25: FBI Calls for Tips on Practitioners and Hospitals Rendering GAC -
The FBI made a request on social media for the public to report tips about possible violations of the government’s directives on GAC.
6/11/25: Brett Shumate Letter to DOJ's Civil Division Employees -
Assistant AG Brett Shumate sent a letter to all Civil Division employees of the DOJ outlining enforcement priorities. The memo reiterates the Division’s priorities outlined in the Bondi memo (April) and asserts that the division will use its resources to prioritize investigations related to violations of the FDA Act and False Claims Act (e.g., submitting claims to Medicaid with false diagnostic codes to evade state bans on GAC <18).
7/9/25: Investigations into Doctors and Clinics Rendering GAC -
DOJ released a press release announcing that over twenty subpoenas had been sent to physicians, clinics and hospitals, including CHOP and BCH, as part of investigations into healthcare fraud.
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After BCH challenged the subpoena, a federal judge ruled in its favor, arguing that the subpoena was “too broad” and that the administration showed clear signs of animus. The injunction is currently being challenged.
Summer, 2025: Establishment of Enforcement and Affirmative Litigation Division - Focused on gender medicine action (e.g., subpoenas).
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U.S. Department of Education 2/4/25: Dear Colleague Letter 8/7/25: DOE Issues Notice of Revision to Civil Rights Data Collection policy -
DOE proposed a revision which would culminate in ending data collection on transgender identities, to comply with EO 14168.
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Federal Trade Commission 7/9/25: FTC Holds Workshop on Deceptive Trade Practices -
FTC held workshop on unfair or deceptive trade practices related to GAC, subject to the agency’s Section 5 powers.
7/28/25: FTC Requests “Public Comment” on GAC -
FTC announced a request for information to “better understand how consumers may have been exposed to false or unsupported claims about ‘gender-affirming care,’ especially as it relates to minors, and to gauge the harms consumers may be experiencing.” The comment period extended until September 26th, 2025.
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