U.S. federal restrictions on pediatric gender transition

The U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have implemented efforts to restrict medical interventions for sex transitions in minors. Since May, six major hospital systems have entered into settlement agreements to cease providing procedures such as puberty blockers, cross-sex hormones, and surgeries for children.

Recent settlements involve NYU Langone Hospitals, which agreed to pay $8.5 million, and the University of Pittsburgh Medical Center (UPMC), which agreed to pay $950,000. These resolutions follow investigations into allegations that false diagnosis codes were used to obtain payments from private insurers and government programs, potentially violating the Food, Drug, and Cosmetic Act and the False Claims Act.

Other institutions that have reached agreements include Texas Children’s Hospital, the Cleveland Clinic Foundation, Connecticut Children’s Hospital, and Mount Sinai Health System. While the Human Rights Campaign has described these restrictions as a “crisis for families and transgender youth,” HHS officials have defended the actions, stating that protecting children from irreversible procedures is not discrimination and citing research that found “extremely weak evidence” for the benefits of such care for young people.