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Gender care in the United States
The United States is the most polarised country in the world on gender care. While Northern Europe is undergoing a scientific reorientation based on systematic evidence evaluations, in the US a politicised struggle rages between states, federal government, professional organisations and courts. The Supreme Court ruled state-level restrictions constitutional in 2025, while WPATH — based in the US — is under heavy criticism after the leaking of internal documents.
Federal versus state
Gender care is mainly regulated at state level in the US. Under the Biden administration (2021-2025) attempts were made to federally protect gender care for minors, but courts limited the reach. Under the second Trump administration (from January 2025) Executive Order 14187 ("Protecting Children from Chemical and Surgical Mutilation") appeared, which severely restricts federal funding for gender care for minors. Under the same administration the Department of Health and Human Services (HHS) published a detailed review in May 2025 on the scientific basis of paediatric gender care, the conclusions of which align with the Cass Review.
FDA warnings
The Food and Drug Administration (FDA) has issued several safety warnings for GnRH analogues (puberty blockers) in recent years. In 2022 the FDA added a warning about pseudotumor cerebri (idiopathic intracranial hypertension) on use in minors — a serious neurological side effect. The off-label status of blockers for gender dysphoria remains a central point in American debate: these drugs have never been approved by the FDA for this use.
State laws: bans and protection
Since 2021 more than 25 states have adopted laws that ban or severely restrict puberty blockers, cross-sex hormones and/or genital surgery for minors. Among the most restrictive are Tennessee, Texas, Florida, Alabama, Arkansas and Idaho. Other states — California, New York, Washington, Oregon — have instead adopted "shield laws" that actively protect gender care and prohibit cooperation with restrictive states. This has led to a geographical division: families sometimes travel across state lines for or against treatment.
United States v. Skrmetti (2025)
In June 2025 the US Supreme Court ruled in United States v. Skrmetti that the Tennessee law (SB1), which bans puberty blockers and hormones for minors with gender dysphoria, does not violate the Equal Protection Clause of the Fourteenth Amendment. The Court ruled that the law distinguishes on the basis of age and medical indication, not on the basis of sex. This ruling confirms the authority of states to impose such restrictions and is thereby a turning point in the American legal landscape.
Medical organisations and the WPATH debate
WPATH (World Professional Association for Transgender Health), based in the US, publishes the international Standards of Care. The American Academy of Pediatrics (AAP), American Medical Association (AMA) and Endocrine Society long supported the gender-affirmative model for minors. That position has been under heavy pressure since 2024. The WPATH Files — leaked internal documents — showed that WPATH suppressed its own systematic literature reviews at Johns Hopkins University when the outcomes were unwelcome. It also became clear that the age limits in SOC8 were removed at the last moment under political pressure.
At the same time, more and more former gender clinicians, detransitioners and concerned scientists are coming forward in the US. Stephen Levine, Patrick Hunter, Roy Eappen, Erica Anderson and others have publicly advocated restraint. The AAP announced its own systematic evidence evaluation in 2023; the outcome is expected at the end of 2025.
Detransition lawsuits
A growing number of detransitioners have brought lawsuits against American clinics and doctors, with arguments of medical malpractice and inadequate informed consent. Cases such as Cole v. UCSF and Layton v. Kaiser have drawn much attention. These lawsuits form an important parallel legal route alongside the political debate. See also detransition.