The Federal Trade Commission (FTC) has served the American Academy of Pediatrics (AAP) with a Civil Investigative Demand (CID) seeking information regarding the AAP's policy statement and support for gender-affirming care (GAC) for minors. The AAP responded with a Petition to Quash the investigation, arguing that advocating for minors’ rights to gender-affirming health care is protected free speech under the First Amendment.
The AAP is a non-profit, non-governmental medical association for pediatricians, funded primarily by members, publications, and grants. Its stated mission is to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.
The Federal Government Investigating Children’s Doctors
According to the AAP, GAC reflects a range of interventions meant to support an individual when their gender identity conflicts with the sex assigned to them at birth. For minors, gender-affirming care generally refers to developmentally appropriate support as the child goes through a social transition, including changes in pronouns, names, hairstyles, clothing, puberty-blocking treatment and hormone replacement therapy (HRT). AAP asserts that GAC can have a positive effect on the mental health of adolescents and young adults, reducing the risk of depression and suicide.
The FTC is a federal government agency whose declared mission is “to protect the public from deceptive or unfair business practices and from unfair methods of competition through law enforcement, advocacy, research, and education.”
An FTC CID is an administrative subpoena served on businesses and individuals to compel the production of documents, written reports, and testimony during investigations into potentially unfair or deceptive conduct, or antitrust violations. According to court documents, the CID is part of a probe into whether AAP made false claims or engaged in unfair practices in connection with the marketing and advertising of pediatric gender dysphoria treatment.
Gender Dysphoria, Puberty Blockers, and HRT
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association, defines gender dysphoria in children as “a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months.”
Puberty blockers are prescribed for some adolescents who experience gender dysphoria to prevent the development of secondary sex characteristics such as breast growth in girls, facial hair in boys, and provide time until age 16 for the individual and the family to explore gender identity, access psychosocial supports, develop coping skills, and establish treatment goals. If pubertal suppression treatment is suspended, puberty will resume.
Proponents of puberty blockers being used to treat gender dysphoria contend that for transgender and gender-diverse youth who have gender dysphoria, delaying puberty might:
- Ease depression and anxiety
- Improve social interactions with others
- Lower the need for future surgeries
- Ease thoughts or actions of self-harm
Critics of puberty blockers argue that they might have long-term effects on:
- Growth spurts,
- Bone growth,
- Bone density,
- Fertility, depending on when the medicine is started.
HRT critics contend that there are significant safety risks relating to cross-sex hormone treatments, which involve very high doses of hormones of the opposite sex.
For natal girls, they argue the treatments may cause:
- increased cardiovascular risk,
- irreversible changes to vocal cords,
- atrophy of the lining of the uterus and vagina, and ovarian and breast cancer.
For natal boys, cross-sex hormones may cause:
- Increased cardiovascular risk
- breast cancer
- sexual dysfunction
It is generally accepted that hormonal treatment impairs fertility, which may be irreversible.
Supporters of HRT believe that:
- HRT significantly reduces anxiety, depression, and suicide,
- Physical Alignment: HRT induces secondary sex characteristics, such as breast growth and fat redistribution in feminizing and voice lowering and facial hair growth in masculinizing, allowing the body to better reflect gender identity
- Increased Quality of Life: The therapy, which may include estrogen/anti-androgens or testosterone, often enhances self-esteem and overall satisfaction with life
- Reduction of Distress: By altering hormone levels to match one's identity, HRT alleviates the intense discomfort (dysphoria) associated with incongruent physical characteristics
Research on hormone replacement therapy remains ongoing. HRT can be used for other medical conditions in addition to gender dysphoria.
The Trump Administration’s Stance
The Department of Health and Human Services (HHS) announced several measures that will have the effect of essentially banning gender-affirming care for transgender young people in every state.
Health Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, announced two proposed rules that would limit hospitals’ eligibility for Medicaid and Medicare reimbursements.
The first proposed change would prohibit doctors and hospitals from receiving Medicaid reimbursement for gender-affirming care provided to transgender patients younger than age 18. Medicaid is a joint state and federal health care program for low-income families.
The second proposal would end all Medicaid and Medicare funding for services at hospitals that provide pediatric gender-affirming care. Almost every hospital in the country accepts Medicare, which covers older Americans and people with disabilities.
Opponents argue that the proposed rules would exclude gender dysphoria not caused by physical impairment from civil-rights health care protections, reducing legal safeguards against discrimination in medical care. Courts have determined that gender dysphoria is a disability that is accorded the protections of the Americans with Disabilities Act.
The States
Gender affirming care services are widely considered medically necessary best practices for those that need them, including for youth. Most major U.S. medical associations support youth access to gender affirming care, including the AAP, the American Medical Association (AMA), the American Psychiatric Association, and the Endocrine Society, among others. Still, it remains a controversial topic, with multiple states placing bans or restrictions on gender-affirming medical care for youth.
As of January 2026 twenty-seven states (AL, AK, AZ, FL, GA, ID, IN, IA, KS, KY, LA, MS, MT, MO, NE, NH, NC, ND, OH, OK, SC, SD, TN, TX, UT, WV, WY) have passed laws or enacted policies that ban or severely restrict access to gender-affirming medical care for transgender youth. These bans generally prohibit puberty blockers, hormone therapy, and surgical care for individuals under 18.
A Mutual Concern
Central to both sides’ arguments is the protection of children’s health. However, given the broad divergence of positions, it is unlikely that a non-adversarial resolution to the GAC debate exists.
In the end, the future of children’s health may very well be decided in a courtroom, not a doctor’s office.
Related Resources
- LGBTQ+ Legal Resource Hub (FindLaw's Learn About the Law)
- Transgender Student Rights: The Basics (FindLaw's Learn About the Law)
- Multiple States Rebuked for Denying Transgender Health Care (FindLaw's Federal Courts)
