Este artículo estará disponible en español en El Tiempo Latino.
On the first day of his administration, President Donald Trump signed an executive order directing the federal government to no longer consider a person’s gender and to recognize people as either male or female, as defined by the size of their reproductive cells.
The directive served as a basis for a series of subsequent orders that called for defunding medical or educational institutions that have protections for transgender students, provide gender-affirming medical care to transgender youth or allow transgender girls or women to participate in women’s sports. Another order attempted to ban transgender people from the military.
But some of those orders — and Trump’s later comments — lack context or include incorrect or misleading statements.
“For four long years, we had an administration that tried to abolish the very concept of womanhood and replace it with radical gender ideology,” Trump said on March 26 at a Woman’s History Month event at the White House.
“No matter how many surgeries you have or chemicals you inject, if you’re born with male DNA in every cell of your body,” he continued, presumably referring to the presence of a Y chromosome, “you can never become a woman — you’re not going to be a woman. And that’s why last month, I proudly signed a historic executive order to ban men from competing in women’s sports. … I also banned puberty blockers — can you believe I’m even saying this — and the sexual mutilation of minor youth.”
Trump’s first transgender-related order declared that people are either male or female at “conception.” But scientists say that excludes certain people and sex is not fully determined at conception.
His executive order targeting gender-affirming medical treatments for trans youth — which is not a ban — claimed that health care providers are “maiming and sterilizing” children and referred to gender-affirming care as “chemical and surgical mutilation.” That language is misleading and wrong. Gender-affirming care is supported by professional medical associations under specific guidance, and surgeries typically take place after age 18. Gender-affirming care is associated with improved mental health, and some medical interventions are reversible.
Trump’s policies were followed by a series of lawsuits across the country. Federal judges have already blocked some orders from taking effect while the cases move through the courts, or questioned the administration’s plans. Two separate restraining orders and a preliminary temporary injunction have been issued to prevent the government from withholding or conditioning funding for medical institutions providing gender-affirming care.
A transgender person identifies with a gender that does not match their sex assigned at birth. Nearly 1.6 million people over the age of 13, or about 0.5% of the U.S. population, identify as transgender, according to a 2022 report by the University of California, Los Angeles School of Law’s Williams Institute.
We reached out to the White House to ask for support for some of the statements in the executive orders, but we didn’t get a response.
‘Two Sexes, Male and Female’
In an order titled “defending women from gender ideology extremism,” signed by Trump on his first day in office, the administration declared that the U.S. will now officially only “recognize two sexes, male and female,” on all federal documents, statements, regulations, forms, communications or other messages. The order also called for banning transgender women, who are referred to as “men,” from “intimate single-sex spaces,” such as bathrooms, single-sex shelters, women’s prisons and sports.
Sex, the order dictated, should be understood as a person’s “immutable biological classification as either male or female,” and not as “a synonym for” gender. The order specifically directs agencies and federal employees acting in an official capacity to “use the term ‘sex’ and not ‘gender'” — yet Trump himself regularly conflates the terms, including in his inaugural address and his March 4 address to Congress.
Although one of the order’s stated purposes is to restore “biological truth,” it used a limited definition of how sex is understood by scientists, declaring that female means a person who “at conception” belongs “to the sex that produces the large reproductive cell” and male is someone who “at conception” belongs “to the sex that produces the small reproductive cell.”
Scientists told us that although biological sex can be defined by the size of a person’s reproductive cells, or gametes, that definition doesn’t always work given there are multiple factors that define sex in humans.
“Sex is a catch-all phrase that actually refers to a constellation of features, not just one as they’ve defined it here,” Margaret M. McCarthy, a neuroscientist and pharmacology professor at the University of Maryland School of Medicine, told us.
Sex definitions typically refer to a construct based on genetic, physiological and anatomic traits. The Centers for Disease Control and Prevention, referencing the American Psychological Association, has defined sex as a person’s “biological status as male, female, or something else,” which is “assigned at birth and associated with physical attributes, such as anatomy and chromosomes.” A 2022 consensus study report by the National Academies of Science, Engineering, and Medicine defined it as “a multidimensional construct based on a cluster of anatomical and physiological traits that include external genitalia, secondary sex characteristics, gonads, chromosomes, and hormones.”
In most cases, all facets of sexual development are congruent, McCarthy, who has studied sex differentiation for decades, told us. Typically, she said, an X and Y chromosome will lead to the development of testes, the production of testosterone, the development of a penis and the production of sperm. And typically, two X chromosomes will lead to ovaries, the production of estrogen and progesterone, the development of a uterus and a vagina, and the production of eggs.
But this is not always the case. According to the Pediatric Endocrine Society, about 4,500 people a year are born in the U.S. with a collection of medical conditions known as Differences of Sex Development that interfere with the typical male or female sex development described above. The definition in the executive order “should not and cannot apply” to people with a DSD, according to a statement from the organization. That’s because some people with a DSD, which is also called intersex, don’t produce sperm or eggs, produce both of them, or produce a reproductive cell that doesn’t match their biological sex development.
“Some people may have genitals that look typical for a male – with a penis – but have XX (‘female’) chromosomes and female body parts – a uterus and ovaries – due to medical conditions that affect the hormones. On the other hand, some people may have genitals that look typical for a female – with a vagina and no penis – but have XY (‘male’) chromosomes and testes on the inside of their bodies,” the statement reads.
Other professional and advocacy organizations, such as the American Society for Reproductive Medicine and interACT, which advocates for intersex people, have also said the definitions in Trump’s executive order are not accurate and exclude intersex people.
In addition, the inclusion of “at conception” in the executive order’s definition of female and male is “technically incorrect,” McCarthy said. (The Department of Health and Human Services’ definitions, created in response to the order, do not include that language.)
Sexual differentiation is not complete when the sperm fertilizes the egg, or at conception, as the order may suggest — it occurs progressively during gestation and beyond. “The only thing that’s happened at conception is a transfer of an X or a Y chromosome to the ova. The gonads haven’t differentiated yet,” McCarthy explained, referring to the glands that could eventually produce reproductive cells.
Experts also objected to the administration’s description and erasure of gender and gender identity. Gender identity, the order declared, can’t be used as “a meaningful basis for identification” and reflects a “fully internal and subjective sense of self” that’s “disconnected from biological reality and sex.”
“A person’s gender is associated with but cannot be reduced to either sex assigned at birth or specific sex traits,” the National Academies of Science, Engineering, and Medicine report says.
The CDC has defined gender as “cultural roles, behaviors, activities, and attributes expected of people based on their sex” and gender identity as a “person’s inner sense of being a boy/man/male, girl/woman/female, another gender, or no gender,” which comes about “as a result of a combination of inherent and extrinsic or environmental factors.”
“Nobody thinks that [gender] identity is ‘disconnected from biological reality,’” Anne Fausto Sterling, a professor emerita of biology at Brown University who is an expert in gender development, told us, adding that most scholars think it is “inborn and thus must have a biological origin.”
Finally, McCarthy said, the definitions in the executive order are not practical either. In our daily lives, when interacting with people, doing research or filling out a form, people are usually asked to self-identify. “You ask a person, are you male or female? You don’t say, show me your gametes or what size are your gametes,” she said. Sex assigned at birth, which ends up on birth certificates and passports, isn’t based on gamete size or “the biological function of their reproductive system,” as HHS guidelines recommend either, she said — it is typically assigned by doctors based on external genitalia.
Medical Gender Transition Treatments
In a separate executive order issued on Feb. 28, Trump directed the federal government to take a series of actions to no longer “fund, sponsor, promote, assist, or support” gender-affirming care for people under 19. The order used misleading language to refer to treatments that are supported by professional medical associations under specific guidance, and were previously considered beneficial by the federal government.
“Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions,” the order said. It later defined children as “individuals under 19 years of age.”
But experts have told us that gender-affirming surgeries typically take place after age 18, the legal age of adulthood in most states, and after a case-by-case assessment by a medical team.
The majority of transgender children do not receive any medical treatments to transition. Instead, they may change their name, pronouns, or hair and dress as part of a social transition. When medical treatments do occur, they’re rarely surgical and begin during adolescence or after, as we’ve explained. Families with a child who identifies with a gender that doesn’t match their sex assigned at birth are offered counseling.
Guidance from the American Academy of Pediatrics, the Endocrine Society and the World Professional Association for Transgender Health recommends care at different ages. Puberty blockers, or medications that delay the beginning of puberty, are the first medical intervention and are typically offered between ages 8 to 13 for girls and 9 to 14 for boys. Gender-affirming hormone therapy is typically offered around age 16, when adolescents are capable of making an informed decision that weighs the potential risks and benefits.
Trump’s executive order referred to gender-affirming care as “chemical and surgical mutilation” and said it does “blatant harm” to children. “Countless children soon regret that they have been mutilated,” it continued. The order directed the attorney general to enforce laws against female genital mutilation, or cutting, which is illegal in the U.S. and other countries and refers to a cultural practice of removing or injuring female genitalia for no medical reason. The order also called for “ending reliance on junk science,” directing agencies to stop using guidance from the World Professional Association for Transgender Health.
According to the World Health Organization and UNICEF, female genital mutilation has no health benefits and can lead to serious complications. It is considered a human rights violation. Practiced primarily in Africa and the Middle East, FGM is mostly performed on girls under 15 by people who are not health care providers. Gender-affirming surgery is always carried out in a medical setting, is consensual and is rarely performed on minors.
“[T]he Executive Order promotes misinformation, including that large shares of youth are seeking gender affirming medical care, which is not the case, that regret rates among those who do seek care are high, when regret rates are very low, and erroneously conflating ‘female genital mutilation’ and gender-affirming care,” Lindsey Dawson, associate director of HIV Policy and director of LGBTQ Health Policy at KFF, a health policy research organization, said in a report about the order.
In a cross-sectional study among insured people in the U.S., Harvard researchers and colleagues found that in 2019 there were no gender-affirming surgical procedures in transgender and gender diverse, or TGD, minors under 12 years of age — and that those in minors older than 12 “were rare and almost entirely chest-related.” Based on those findings, the researchers wrote, “concerns around high rates of gender-affirming surgery use, specifically among TGD minors, may be unwarranted.”
A separate study by some of the same Harvard researchers, published in JAMA Pediatrics in January, used insurance claims data and found that less than 0.1% of minors ages 8 to 17 with private insurance are transgender or gender diverse and received puberty blockers or hormones between 2018 and 2022. No child under 12 years of age received a hormone prescription.
“There’s not some massive wave of folks accessing care,” Landon D. Hughes, co-author of both Harvard studies and a fellow at Harvard University’s T.H. Chan School of Public Health, told NBC News earlier this year.
Studies suggest that gender-affirming care can improve the well-being and mental health of transgender youth, who have an increased risk of depression, anxiety and suicidal thoughts. While some of these findings have been criticized, there isn’t good evidence that gender-affirming care is harmful, as Trump’s executive order claimed.
“Although President Trump’s executive order describes gender-affirming care as ‘junk science,’ access to gender-affirming care for transgender youth is supported by a consensus of major medical associations in the U.S.,” Elana Redfield, federal policy director at the Williams Institute at UCLA’s School of Law, said in a brief following the order. “The order does not acknowledge any benefits of gender-affirming care, instead making unsubstantiated statements of widespread harm and disregarding decades of science that form the foundation of the services that are currently available to transgender youth.”
Not All ‘Irreversible’
It’s important to note that not all medical gender-affirming interventions are “irreversible” nor do they make it impossible for someone to “conceive children of their own,” as the executive order said.
As guidance from the AAP explains, only gender-affirming surgeries are fully irreversible and not all of them affect fertility. The effects of medications that suppress puberty are reversible, but the AAP notes that their impact on fertility is unknown and that fertility could be impacted if followed by the use of sex hormones.
The changes brought by gender-affirming hormone therapy can be reversed if hormones are stopped before these changes are fully developed, but they become irreversible after that happens, potentially impacting fertility, according to the guidance.
The guidance sets a number of steps and criteria to make sure that individuals offered gender-affirming care are not what the executive order refers to as “impressionable children.” A multidisciplinary team of medical and mental health providers should screen, assess and monitor patients and make sure they are capable of fully understanding the risks and benefits of each intervention and discuss, when applicable, options to preserve fertility.
There is very little reliable data on how often transgender people regret going through gender-affirming interventions or opt to “detransition.” Many studies have a short follow-up period and rely on patients reporting back to providers.
But the scientific literature doesn’t support the notion that “[c]ountless children soon regret that they have been mutilated,” as the order said.
As PolitiFact has reported, recent studies of medical gender-affirming interventions in adolescents show that rates of young people stopping or regretting treatment or detransitioning range from 1% to 9%, with most on the lower end.
A study by Princeton University researchers published in 2024 in JAMA Pediatrics that looked at the experiences of 220 young people using puberty blockers or hormones found that nine of them regretted the interventions, with four of them stopping treatment.
Another study looking at the outcomes of 1,089 young people who were assessed by the National Health Service Gender Identity Development Service in England from 2008 to 2021 found that 5.3% stopped treatment with puberty blockers or gender-affirming hormones and reverted to identifying with their birth gender.
As scientists have explained, people detransition for multiple reasons and not all people who stop treatment regret that care. Some stop due to undesired side effects of hormones or of transitioning, such as discrimination, and some stop when they’ve reached the results they wanted. Similarly, a person who regrets transitioning may still consider themselves transgender, and someone who stops identifying as transgender may not regret gender-affirming care.
Regret rates are typically even lower in adults, and studies show adults regret other plastic surgeries more often than gender-affirming surgery.
Editor’s note: FactCheck.org does not accept advertising. We rely on grants and individual donations from people like you. Please consider a donation. Credit card donations may be made through our “Donate” page. If you prefer to give by check, send to: FactCheck.org, Annenberg Public Policy Center, P.O. Box 58100, Philadelphia, PA 19102.