President Donald Trump Tuesday issued an executive order that bans federal support for gender-affirming care for Americans under the age of 19, his third executive order restricting the rights of transgender people since he took office last Monday.

The order, titled “Protecting Children From Chemical And Surgical Mutilation,” bans federal dollars from funding gender transition, including affirming counseling, puberty blockers, hormones, and rare surgical interventions, for children and 18-year old adults nationwide. The order asserts that this evidenced-based care, which is effective in preventing depression, anxiety, and suicide, and is supported by major medical organizations in the US and elsewhere, is “junk science” that cloaks “blatant harm done to children by chemical and surgical mutilation.”

The administration’s claims are not based in fact, and Trump’s order will likely prompt a lawsuit, or lawsuits, that may delay its implementation. (The Supreme Court of the United States is already considering the constitutionality of gender-affirming care bans in the Skrmetti case, which it is expected to rule on this year).

According to the order, by April 28, the new Health and Human Services Secretary (likely Robert F. Kennedy Jr., if approved by the Senate), shall use “all available methods to increase the quality of data to guide practices for improving the health of minors with gender dysphoria, rapid-onset gender dysphoria”—a disproven medical “contagion” myth that sprang from online anti-trans parents groups distressed with their child’s identity—“and other identity-based confusion.”

If Kennedy, a vaccine skeptic and peddler of hack medicine, is charged with this task, he will not conduct a real scientific evaluation because he is simply incapable of one. The administration is clearly not concerned with the quality of research or evidence anyhow, as the order also ensures both hospitals and research institutions that receive federal dollars “end the chemical and surgical mutilation of children.”

The order also directs the HHS to take other actions to end gender-affirming care for children and 18-year-old adults. To that end, the order suggests  employing the conditions for participation in Medicare and Medicaid, the definitions of “clinical-abuse” and “inappropriate-use” as relevant to state Medicaid programs, and mandatory reviews of drugs used for gender-affirming care, which include medications regularly prescribed to cisgender children like puberty blockers.

The order also points HHS to  the latest editions of the International Classification of Diseases and other federally funded manuals, which includes the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. While many consider it limited and reductive of trans experience, gender dysphoria, as defined in the DSM, is the basis on which all trans care is considered medically necessary. Transgender care specialists worldwide also rely on medical standards set by the World Professional Association for Transgender Health. The order directs the HHS to rescind or amend policies that rely on its guidance. It's unclear who or what HHS will look to instead.

Importantly, the order directs the HHS to review section 1557 of the Affordable Care Act, a non-discrimination provision that protects transgender Americans’ right to gender-affirming care. It is unclear if the HHS review would result in an attempt to change that. (This too would likely prompt an immediate court challenge with multiple plaintiffs).

Outside of HHS, the order excludes trans kids from receiving gender-affirming care through their parents’ government-funded healthcare plans including Medicaid and the Department of Defense’s TRICARE for military families.

It also directs the Department of Justice, with the aid of State Attorneys General and other law enforcement agencies, to apply laws banning female genital mutilation to gender-affirming care. The DOJ is ordered to investigate any entity that may be “misleading the public about the long-term side-effects” of gender-affirming care under the Food, Drug, and Cosmetic Act, and challenge sanctuary state policies that protect trans children from abusive homes. The order suggests the DOJ apply a law against child kidnapping, which was one of the inflammatory accusations the right levied against a 2023 Washington law (SB5599), which expanded protections for child runaways seeking gender-affirming and reproductive care.

According to the order, the DOJ and Congress will jointly develop laws that make it easier for trans patients to sue their doctors for malpractice. Despite extremely low regret rates for gender-affirming care, state legislatures across the US have introduced similar bills. The specter of liability is meant to discourage doctors from practicing, a tactic developed by the anti-abortion crowd, who learned threatening doctors with punishment is more politically palatable than threatening patients.

This is the third order concerning transgender people Trump has issued in eight days. All use intense rhetoric and dehumanize trans people.

The first promised to “defend women” and “restore biological truth” to federal policy.

The second prioritized “military excellence” by suggesting trans people were the result of an ideology that had infected its ranks, asserting that the “adoption of a gender identity inconsistent with an individual’s sex conflicts with a soldier’s commitment to an honorable, truthful, and disciplined lifestyle, even in one’s personal life.”

This third order calls evidence-based medicine mutilation, and a “dangerous trend” that “will be a stain on our Nation’s [sic] history, and must end.”

This language, similar to the “criminal” and “illegal” epithets Trump uses for migrants, are not just racist or transphobic. They’re meant to trick the reader, or listener, into believing his government is not really infringing on the civil rights of “people,” by referring to them as abstract concepts and objects that are not entitled to rights. Therefore, no moral line could be crossed.

When trans people are reduced to “radical political theories and social experiments,” as Trump referred to them in his inaugural address last Monday, he intentionally obscures reality for the benefit of political spectacle.

Trans people in reality are not experiments, ideological, medical, or otherwise, but patients whose medical care is based in sound science and people who want basic legal recognition and equal treatment under the laws of this country, which, in reality, do not allow a president to rule like a king.

This is a developing story. Challenges to this executive order are likely.