Gender Care in the United States
The United States is the most polarized country in the world when it comes to gender care. While Northern Europe is undergoing a scientific reorientation based on systematic evidence reviews, the US is embroiled in a politicized battle between states, the federal government, professional organizations, and the courts. In 2025, the Supreme Court ruled state restrictions constitutional, while WPATH — based in the US — has come under intense criticism following the leak of internal documents.
Federal versus state authority
Gender care in the US is regulated primarily at the state level. News about legislation in the states is covered, among others, by Deseret News, a newspaper from Utah. Under the Biden administration (2021–2025), efforts were made to protect gender care for minors at the federal level, but courts limited the scope of those efforts. Under the second Trump administration (from January 2025), Executive Order 14187 ("Protecting Children from Chemical and Surgical Mutilation") was issued, significantly restricting federal funding for gender care for minors. Under the same administration, the Department of Health and Human Services (HHS) published a comprehensive review in May 2025 of the scientific basis for pediatric gender care, with conclusions aligned with the Cass Review. In 2026, this was followed by a Medicaid rule ending coverage of hormones and surgeries for minors; an explanation of the rule is available on genderbeleid.nl.
FDA warnings
In recent years, the Food and Drug Administration (FDA) has issued several safety warnings concerning GnRH analogues (puberty blockers). In 2022, the FDA added a warning about pseudotumor cerebri (idiopathic intracranial hypertension) in minors using these drugs — a serious neurological adverse effect. The off-label status of blockers for gender dysphoria remains a central issue in the American debate: these drugs have never been approved by the FDA for this use. On August 20, 2026, President Trump nominated physician Heidi Overton as FDA commissioner; the article about the FDA nominee who previously wrote critically about gender-affirming care for minors describes her background. The Senate has yet to confirm the nomination.
State laws: bans and protections
Since 2021, more than 25 states have passed laws banning or severely restricting 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, and Oregon — have instead enacted 'shield laws' that actively protect gender care and prohibit cooperation with restrictive states. This has led to a geographic divide: families sometimes cross state lines either to obtain treatment or to avoid it. In Colorado, voters may vote directly on a ban on genital surgery for minors. That the growth of gender care among young people in the US is also disproportionate to the quality of the evidence is demonstrated by genderzorgnederland.nl using American data.
United States v. Skrmetti (2025)
In June 2025, the US Supreme Court ruled in United States v. Skrmetti that Tennessee's 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 held that the law makes distinctions based on age and medical indication, not sex. This ruling confirms the authority of states to impose such restrictions and marks a turning point in the American legal landscape.
Medical organizations 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 come under intense pressure since 2024. The WPATH Files — leaked internal messages — and documents from a US court case (2024) showed that WPATH suppressed its own systematic literature reviews at Johns Hopkins University when their findings were unwelcome. It also became clear that the age limits in SOC8 were removed at the last minute under political pressure.
At the same time, increasing numbers of former gender clinicians, detransitioners, and concerned scientists in the US are speaking out. Stephen Levine, Patrick Hunter, Erica Anderson, and others have publicly called for caution. In 2023, the AAP announced its own systematic evidence review; its findings were expected by the end of 2025. In 2026, the American Society of Plastic Surgeons stated that there is insufficient evidence for genital surgery in minors.
Detransition lawsuits
A growing number of detransitioners have filed lawsuits against American clinics and doctors, alleging medical negligence and inadequate informed consent. The cases of Chloe Cole and Layla Jane against healthcare provider Kaiser Permanente have attracted considerable attention. In Texas, the largest children's hospital must open a detransition clinic following a ten-million-dollar settlement. These lawsuits represent an important parallel legal avenue alongside the political debate. In 2022, the news agency Reuters described American gender care for minors and the significance of detransition in the series of reports Youth in Transition. See also detransition.