The Centers for Medicare and Medicaid Services, headed by Mehmet Oz, has sent a letter to some hospitals demanding information on their provision of gender-affirming care to transgender youth.

The CMS, like all of Donald Trump’s administration, is opposed to this care, falsely claiming it is experimental and is not supported by evidence.

The letter, dated Wednesday, expresses “urgent concerns with both the quality standards adherence and profits related to these harmful procedures,” says a CMS press release. The release quotes Oz as saying, “These are irreversible, high-risk procedures being conducted on vulnerable children, often at taxpayer expense. Hospitals accepting federal funds are expected to meet rigorous quality standards and uphold the highest level of stewardship when it comes to public resources — we will not turn a blind eye to procedures that lack a solid foundation of evidence and may result in lifelong harm.”

“The United States government has serious concerns with medical interventions for gender dysphoria in children,” the letter reads. “These interventions include surgical procedures that attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt, for purposes of treating gender dysphoria, to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions. These interventions also include, but are not limited to, the use of puberty blockers, including GnRH agonists and other procedures, approaches, or modalities, to delay the onset or progression of normally-timed puberty for purposes of treating gender dysphoria, as well as the use of sex hormones, such as estrogen, progesterone, or testosterone, and androgen blockers to align an individual’s physical appearance with an identity that differs from his or her sex. … CMS believes that these interventions were initiated with an underdeveloped body of evidence, lack reliable evidence of benefits for minors, and are now known to carry serious risks of long-term and irreparable harm.”

In reality, the procedures are not harmful and are often lifesaving. Studies by the Trevor Project, which assists LGBTQ+ youth in crisis, and other researchers have found that access to gender-affirming care reduces the risk of suicide among young trans people. Also, such care is endorsed by every major medical association, including the American Academy of Pediatrics, the American Medical Association, and the American Psychiatric Association.

Also, genital surgery is almost never performed on minors, although some undergo top surgery or facial surgery. The effects of puberty blockers are reversible, and the effects of cross-sex hormones usually are as well. Regret about transition is rare.

The letter goes on to ask about “the adequacy of informed consent protocols for children with gender dysphoria, including how children are deemed capable of making these potentially life-changing decisions and when parental consent is required.”

The answer about consent, from a Human Rights Campaign document: “If medications or surgery are part of their gender journey, they are only prescribed after further assessments to ensure they meet prescribing criteria. This can include but is not limited to documentation and referral letters, parental consent, and ongoing mental health support. At all stages, gender-affirming care is only delivered after patients and their families have been counseled, and informed consent has been given.”

The letter further asks for billing codes for gender-affirmation procedures, how much revenue these procedures generate, and what the profit margins for this care are — as if doctors and hospitals are providing it out of greed.

Dr. Kellan E. Baker, executive director of the Institute for Health Research and Policy at Whitman-Walker, an LGBTQ-focused clinic, issues a statement denouncing the letter. “This ‘request’ is a blatant attempt to intimidate providers into betraying their professional obligation to care for their patients,” Baker said. “It is vitally important that hospitals, states, elected officials, and courts stand up to these strong-arm tactics and protect patients’ right to care. And it is vital that providers recognize this document has no legal force or effect and that they continue to provide the care their patients need.”

The letter is one of many steps the Trump administration has taken to target gender-affirming care, as the administration professes not to believe trans people even exist. Trump has issued an executive order threatening to withhold federal funds from any health care provider offering gender-affirming care to people under 19; through the CMS, has advised states to stop paying for this care for young people through Medicaid, which is jointly managed by states and the federal government; and directed the National Institutes of Health to study transition regret, which, again is rare.

A recent study from the Department of Health and Human Services, headed by Robert F. Kennedy Jr., who is anti-trans, went so far as to recommend conversion therapy for trans youth rather than gender-affirming care. Conversion therapy has been shown to cause harm to young people and has been repudiated by all major medical and mental health organizations. Many states have barred licensed professionals from subjecting minors to it.

The “Big Beautiful Bill” on the federal budget, which was passed narrowly by the House of Representatives and is pending in the Senate, would attack gender-affirming care even further. It would bar Medicaid and the Children’s Health Insurance Program from covering any gender-affirming services for people of any age. It also would no longer classify gender-affirming care as an “essential health benefit” under the Affordable Care Act, explicitly excluding transition-related care from private insurance plans regulated by federal standards.