In a decisive vote that criminalizes widely accepted medical practice, the U.S. House of Representatives has moved to imprison physicians for providing certain forms of gender-affirming care to minors.
The legislation, championed by Republican members and granted a floor vote through procedural maneuvering, marks an unprecedented federal intrusion into regulated medical care and private family decisions.
Just before her resignation in January, Rep. Marjorie Taylor Greene struck a deal to guarantee a vote on her signature anti-trans bill in the House.
The so-called “Protect Minors Act” makes it a felony, punishable by up to 10 years in prison, for doctors to prescribe puberty blockers or hormone therapy to transgender adolescents. It further prohibits federal funding for such care and restricts its coverage in health plans.
The American Civil Liberties Union says it is the most extreme anti-trans legislation ever considered by Congress: It would put doctors in jail for up to 10 years if they provide gender-affirming care to minors, including prescribing hormone replacement therapy to adolescents or puberty blockers to young kids.
The bill also aims to halt gender-affirming surgeries on minors, which is rare.
Eleven states already explicitly exclude transgender health care coverage for patients of all ages in their Medicaid policy, according to the Movement Advancement Project. Three other states exclude Medicaid coverage only for minors.
In 26 states and Washington, D.C., state Medicaid covers trans health care needs.
In a sweeping expansion, the bill bars non-U.S. nationals from providing this care and prohibits instruction on the subject in higher education programs. Exceptions are carved out only for treatments related to certain biological conditions, such as differences in sex development.
Supporters, framing the bill as a protection of children, argue they are halting irreversible procedures on minors. They cite controversial and disputed claims about long-term outcomes. “We are stopping the mutilation of children,” declared one proponent during floor debate, language directly conflating established medical protocols with abuse.
Yet every major medical association in the United States—including the American Academy of Pediatrics, the American Medical Association and the American Psychiatric Association—stands in direct opposition.
These organizations define gender-affirming care as a spectrum of personalized, often lifesaving treatments for gender dysphoria, the clinically significant distress caused by a mismatch between one’s gender identity and sex assigned at birth.
“One of the problems with these sorts of bills is that medical communities, medical organizations, tend to over-enforce them,” said Kenneth Haller, a professor and St. Louis pediatrician. Haller said anti-abortion bills have had a chilling effect on reproductive care. “These bills are so sweeping that they’re afraid that anybody could do anything to drag an obstetrician or a hospital into court or put them in jail,” he said.
This care is not a single procedure. For minors, it is primarily psychological support, social transition like name and pronoun changes, and, in later adolescence, possibly reversible puberty suppression.
Cross-sex hormones may be considered for older teenagers after extensive evaluation. Surgical interventions on minors are exceedingly rare and not performed on pre-pubescent children.
“What Congress has criminalized today is not surgery on toddlers, but the consensus standard of care for a vulnerable patient population,” said Dr. Evan McLean, an endocrinologist speaking on background due to fears of legal retribution. “We are being told to ignore our training, our ethics and the evidence, which shows this care drastically reduces depression, anxiety and suicidality.”
The legislative action arrives amid a coordinated national campaign targeting transgender rights. Over two dozen states have enacted similar bans, many now facing active legal challenges. The Supreme Court’s recent decision to uphold one such state law has emboldened congressional efforts.
Access to gender-affirming care has been linked to lower rates of depression and suicidality for young trans and nonbinary people, as well as for trans adults.
“Our counselors regularly hear from trans and nonbinary youth who express fear and anxiety and deep concern over the anti-transgender politics they’re hearing about in the news,” said Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns with the Trevor Project, an LGBTQ+ youth crisis organization. “So many young people have expressed that this care made their lives better and allowed them to lead healthy, happy, successful lives.”
The impact extends beyond penalties for doctors.
The bill’s broad language concerning “facilitating” care raises concerns that parents seeking treatment for their children across state lines could be prosecuted.
Greene’s bill still permits the nonconsensual genital cutting of intersex infants, or people born with variations in their reproductive anatomy.
Surgeries performed on intersex infants, including vaginoplasty and clitoral reductions, cause lifelong complications and are often kept secret from the children, who have no ability to consent.
This creates a paradoxical exemption, explicitly permitting non-consensual surgeries on intersex infants—procedures widely condemned by human rights groups as medically unnecessary and harmful.
For years, state laws banning gender-affirming care around the country have explicitly allowed this practice to continue.
“Intersex infants and young kids who are being subjected to these nonconsensual surgeries are suffering the exact harm that is being falsely claimed about gender-affirming care, and meanwhile, no one in the administration cares to do anything about it,” said Sylvan Fraser Anthony, legal and policy director for interACT, a nonprofit advocating for intersex rights.
Constitutional scholars note the bill raises severe questions regarding the equal protection clause, the right to privacy and the federal government’s authority to regulate medical practice. “It is a blunt instrument aimed at erasing a recognized form of healthcare,” argued constitutional law professor Lena Hadid. “The courts will likely find it conflicts with both medical autonomy and prohibitions on sex-based discrimination.”
On the steps of the Capitol on Wednesday, Rep. Sarah McBride — the first transgender member of Congress — rebuked Republicans for advancing anti-trans bills while letting Affordable Care Act tax credits expire, which is expected to raise health care costs for millions of Americans.
“They would rather have us focus in and debate a misunderstood and vulnerable one percent of the population, instead of focusing in on the fact that they are raiding everyone’s health care,” the Delaware Democrat said. “They are obsessed with trans people … they are consumed with this.”
As the bill moves to the Senate, where its fate remains uncertain, the vote has sent a chilling message. In clinics across the country, providers now face an untenable choice: follow the standard of care endorsed by their profession, or risk becoming a felon under federal law. For transgender youth and their families, the message from their government is one not of protection, but of profound rejection. The precise cost of this political statement, experts warn, will be measured in the mental health and very lives of some of the nation’s most at-risk children.
