A note to readers: This week's newsletter is our federal policy update on "gender identity" policy which we are sharing 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.”
- 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.”
-
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,” and the Fourth Circuit denied the admin’s motion to stay the injunction pending appeal. 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, and in January of 2026, a judge granted the defendant’s motion to stay proceedings and rejected the plaintiff’s motion to lift the partial stay. In June of 2026, the First Circuit vacated the district court’s preliminary injunction after both the government and Plaintiffs requested vacatur. While the admin signaled it would move to invalidate passports with cross-sex or non-binary markers, a FAQ on the State Department website asserts that “All passports will remain valid for travel until their expiration date, under International Civil Aviation Organization (ICAO) policy.”
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., Ireland v. United States & Shilling v. Trump), the EO is in effect after the Supreme Court issued a stay after the 9th Circuit temporarily blocked enforcement. On 12/9/25, the Court of Appeals for the D.C. circuit issued an order granting stay pending appeal. On 6/1/26, a D.C. circuit court upheld a district court ruling and narrowed relief to plaintiffs currently serving in the military.
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.
-
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.
-
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. In early November, District Judge Lauren King denied a second motion to stay the injunction issued in Washington v. Trump. On 6/3/26, a federal judge rejected a DOJ motion to dismiss Massachusetts v. Trump on the grounds the plaintiffs lack standing.
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). On 7/8/26, parties in Tirrell v. Edelblut filed a stipulation of dismissal.
|
|
|
|
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 -
The memo signals that CMS will begin taking steps to adjust its policies on GAC to better align with evidence-based standards.
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.
11/19/25 - HHS released a peer-reviewed version of its report on best practices and evidence for the treatment of pediatric gender dysphoria.
12/9/25 -
HHS announced an investigation into an unnamed state health department to determine if the department’s practices violated federal religious and conscience protections by requiring organizations and physicians to “facilitat[e] sex-rejecting procedures and female genital mutilation (FGM).”
12/18/25 -
HHS formally announced two anticipated proposed rules with implications for hospitals that render “sex-rejecting procedures” on dysphoric minors. One rule would prohibit Medicaid and CHIP reimbursement for GAC, while the other rule would block Medicare and Medicaid funding from going to health care entities that render GAC.
-
HHS announced a proposed rule which would modify a Biden-era rule to explicitly state that statutory exclusions for “gender identity disorder not resultant from physical impairments” include gender dysphoria.
-
HHS Assistant Secretary, Admiral Brian Christine, issued a public message on Evidence-Based Care for Children and Adolescents with Gender Dysphoria that aims to educate the public about the low-quality evidence for benefits, and unfavorable risk-benefit profile of, GAC. The message advises health care providers not to render these practices, and to prioritize developmentally informed psychotherapy and counseling that targets the comorbidities often associated with gender dysphoria.
- Health Secretary Kennedy issued a declaration formally asserting that “Sex-rejecting procedures” for pediatric gender dysphoria are inconsistent with professional health care standards.
12/23/25 -
In response to Health Secretary Kennedy’s declaration on sex-rejecting procedures, nineteen states plus D.C. have filed a legal challenge arguing that the declaration exceeds Kennedy’s authority and violates the Administrative Procedure Act and Medicare and Medicaid statutes. In March of 2026, a judge granted relief to the states and ruled that Kennedy’s declaration exceeded the scope of the Administrative Procedure Act.
12/30/25 1/9/26 -
HHS General Counsel Mike Stuart announced investigations into three California hospitals: Children’s Hospital of Orange County, UCSF Hyde Hospital and Benioff Children's Hospitals.
1/15/26 -
HHS General Counsel Mike Stuart announced new investigations into six hospitals—including Boston Children’s Hospital and Lurie Children’s Hospital of Chicago—for continuing to render “sex-rejecting procedures.”
1/26/26
2/3/26 2/11/26
3/3/26 -
The Administration for Children and Families sent a letter to all 50 states reminding them that children may not be removed from parental custody solely because parents do not affirm their child’s “gender identity.”
3/6/26 -
The Administration for Children and Families issued a notice of proposed rulemaking that would formally remove requirements under a Biden-era federal rule, Designated Placement Requirements Under Titles IV-E and IV-B for LGBTQI+ Children, which required foster placements to affirm the “gender identity” and sexual orientation of foster youth. As HHS notes, the rule was already struck down in its entirety by the U.S. District Court for the Eastern District of Texas.
5/29/26 -
HHS and forty other federal agencies issued a proposed rule that would modify the Guidance for Federal Financial Assistance to “improve government-wide policies and requirements related to the management of grants, cooperative agreements, and other forms of assistance,” including new stipulations that prevent the funding of “gender ideology” and medical transition for patients under 19.
6/2/26 7/14/26 |
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 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.
-
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).
12/4/25: DOJ Memo instructs Prison Auditors to Deviate from PREA LGBTQ Safeguards -
NPR reported that while the DOJ works to revise federal standards related to the 2003 Prison Rape Elimination Act (PREA), a memo has advised prison staff conducting PREA audits not to follow protocol for maintaining LGBTQ safeguards.
2/18/26 -
The DOJ’s Civil Rights Division announced investigations into three Michigan public school districts to determine if the districts are adhering to Title IX and the Supreme Court’s ruling in Mahmoud v. Taylor, which affirmed parents' rights to opt their children out of course content on sexual orientation and “gender identity” on religious grounds.
3/26/26 -
DOJ’s Civil Rights Division announced federal investigations to determine whether Maine’s and California’s practice of housing men in women’s prisons violates constitutional protections.
4/8/26 -
According to the New York Times, the DOJ has opened an investigation into the Los Angeles public school district after parents filed a suit arguing that the district’s secret social transition policies undermined their 14th Amendment rights and culminate in their child’s suicide.
4/30/26 -
DOJ has launched investigations into 36 Illinois school districts to assess whether or not they teach “gender identity” as part of any pre-K-12 instruction and allow parents to opt out.
5/1/26 5/6/26 -
DOJ announced a federal subpoena into NYU Langone from the U.S. Attorney’s Office of the Northern District of Texas seeking documents from 2020-2026. On 6/2/25, New York Families filed a suit challenging the legality of the DOJ’s records request.
5/15/26 -
In a joint effort with Texas, DOJ announced a groundbreaking resolution with Texas Children’s Hospital over allegations of false billing practices related to “affirming care.” As part of the resolution, TCH must cease practicing youth gender medicine, pay $10 million in fines, and establish the first of its kind clinic for detransitioners.
6/5/26 -
In an agreement with the DOJ and the Ohio Attorney General, the Cleveland Clinic has agreed not to render sex-rejecting procedures for ten years, to pay a financial penalty for allegations of fraudulent billing practices, and to set aside funds for detransition related medical care.
6/8/26 -
The DOJ has announced a compliance investigation into four California Public School Districts over their sexual orientation and “gender identity” instruction in K-12, and the degree to which parents were notified of “opt out” opportunities.
6/9/26 -
S. District Judge Julie Rubin denied a class action certification aiming to prohibit the DOJ from issuing subpoenas to children’s hospitals regarding “affirming care.” "Movants' request for class treatment is simply an ill fit for the matter before the court and the relief they seek," Rubin wrote.
|
U.S. Department of Education 2/4/25: Dear Colleague Letter -
OCR issued a Dear Colleague Letter making it explicit that educational institutions are expected to follow the principles and provisions of the 2020 (Trump I) Title IX rule, which does not redefine sex to include “gender identity.”
-
The Department simultaneously halted implementation of the 2024 Title IX regulations—which were also blocked nationwide by a U.S. District Court Judge—issued under the previous administration.
-
The administration has also published an overview of its Title IX policies.
-
OCR has conducted investigations in response to alleged Title IX violations and made determinations of non-compliance in cases involving the University of Pennsylvania, the California Dept. of Education (CDE) & California Interscholastic Federation (CIF), the Maine Department of Education, the Minnesota Department of Education, five Northern Virginia school districts, and Denver Public Schools, among others. As part of deals with the admin, the University of Pennsylvania, Columbia, Cornell, Brown and Northwestern have entered into resolution agreements with DOE vowing to uphold Title IX.
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.
1/14/26 - The DOE announced “investigations into eighteen educational entities in ten states” based on submitted complaints that allege the entities discriminate based on sex by permitting students to participate in sports based on their “gender identity.”
1/28/26 3/13/26 3/31/26 -
OCR has launched an investigation to determine whether a New Hampshire school district is in violation of Title IX by allowing boys to use girls’ facilities and restrooms.
4/6/26 -
OCR terminated resolution agreements made between the Obama and Biden administrations and various schools, which run afoul of Title IX by discriminating against girls and women.
4/17/26 -
The Student Privacy Office found four Kansas school districts in violation of both Title IX and FERPA for policies relating to “gender identity.” The DOE has proposed resolution agreements to bring the districts into alignment with federal law.
5/4/26 -
The DOE has opened an investigation into the women's college, Smith, to determine if its policies of admitting male students and granting them access to women’s spaces violates Title IX.
6/3/26
6/18/26 -
The Office for Civil Rights opened investigations into Ann Arbor Public Schools, Monroe Public Schools, and the Chippewa Valley School District (the Districts) in Michigan over potential Title IX violations related to youth athletics and locker room access.
6/23/26 -
The Office for Civil Rights opened new investigations into the Maryland State Department of Education, Montgomery County Public Schools, Prince George’s County Public Schools, and Frederick County Public Schools (the Districts) in Maryland over potential Title IX violations related to youth athletics and locker room access.
6/26/26 |
U.S. State Department 11/21/25: State Department Labels Pediatric Medical Transition a Human Rights Violation -
In anticipated new guidance, the State Department plans to issue new rules to US embassies and consulates outlining human rights violations for the purpose of record keeping, including labeling pediatric medical transition a human rights abuse.
1/23/26: State Department Expands “Mexico City” Abortion Policy to DEI and Gender Ideology -
The State Department is set to expand its Mexico City Policy—which prohibits recipients of foreign aid from promoting abortion—to DEI and Gender Ideology, with implications for both foreign and U.S. NGOs and $30 billion in foreign aid.
|
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.
2/10/26 -
The FTC launched a consumer protection probe into the American Academy of Pediatrics and the World Professional Association for Transgender Health (WPATH) seeking documents and testimony from the organizations to evaluate whether the non-profits made “false or unsubstantiated claims” when marketing or advertising medical interventions for the treatment of pediatric gender dysphoria. In early May, a S. District Judge granted WPATH and the US Endocrine Society preliminary injunctions, temporarily blocking enforcement of the FTC investigations.
6/17/26 -
The FTC, Alaska, Iowa, Nebraska and Texas have formally filed a lawsuit against WPATH, alleging that its “recommendations misled parents and children about the medical consensus and medical necessity, as well as the safety and effectiveness, of such [medical transition] services, in violation of the FTC Act.”
7/10/26 |
|
|
|
Housing and Urban Development 4/23/26 -
HUD Secretary Scott Turner has issued a directive blocking enforcement of HUD’s 2016 Equal Access Rule, which allows people to self-identify into sex categories when accessing certain housing services.
|
The U.S. Office of Personnel Management 3/31/26 -
Building off earlier policies, the OPM announced that it would be removing an exception process allowing for continued access to gender medicine via Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Programs.
|
Equal Employment Opportunity Commission 6/12/16 -
In response to the EEOC’s policies of deprioritizing “gender identity” discrimination cases and requiring heightened scrutiny, defendants filed a suit in FreeState Justice v. Equal Employment Opportunity Commission, however, a federal judge dismissed the case on the grounds that “EEOC’s decision to alter its investigations of gender identity discrimination claims constitutes a discretionary decision over which the Court lacks authority to review...”
|
For more information and media requests, please contact
communications@manhattan.institute. Are you interested in supporting the Manhattan Institute’s public-interest research and journalism? As a 501(c)(3) nonprofit, donations in support of MI and its scholars’ work are fully tax-deductible as provided by law. |
|
|
|
The Manhattan Institute works to keep America and its great cities prosperous, safe, and free. Manhattan Institute 52 Vanderbilt Ave. 3 floor New York, New York 10017 Copyright © 2025 Manhattan Institute, All rights reserved. |
|
|
|
|
