Hospitals, clinics and medical schools that provide gender-affirming care to transgender youth are at risk of losing federal funding if they continue providing that care, according to a new executive order signed by President Donald Trump on Tuesday. The order would, if enacted as such, force those hospitals and clinics to choose between staying open or providing specialized care to a small number of patients — and could essentially impose a nationwide ban for youth care.

The order is likely to be quickly challenged in court. Like most executive orders, it lays out rule-making that federal agencies need to undertake within 30 to 60 days, meaning that it does not go into immediate effect. However, LGBTQ+ advocates are worried that any federal policy attempting to restrict gender-affirming care will cause a chilling effect among providers, causing people to lose care anyway. 

Trump’s order also directs the federal government to rescind protections for trans minors who receive gender-affirming care, including reviewing Medicaid benefits and insurance covered through Tricare, which is administered through the Department of Defense. And the order directs the Federal Health Employee Benefits Plan, which covers over 8 million people, to drop coverage of gender-affirming care for trans youth. It specifically targets puberty blockers and gender-affirming surgeries.

Trump’s order also directs the Department of Justice to target health care for trans youth, including encouraging it to prioritize investigations into medications prescribed and prosecutions against providers, citing laws that prohibit “female genital mutilation.” 

And it directs the Department of Health and Human Services to review existing laws — including the Affordable Care Act’s non-discrimination provision, known at Section 1557 — to see if they can be used to restrict access to gender-affirming care. Trump also directed the department to rescind previous guidance issued under former President Joe Biden, which was meant to protect access to trans care.

LGBTQ+ advocates quickly condemned the order.

“The order’s characterization of medical care for transgender minors bears no resemblance to reality,” said Shannon Minter, legal director of the Lesbian Center for Transgender Rights. “This is an attempt to impose an extreme ideological agenda through hyperbole and fear, not a responsible attempt to address this issue.”

Jennifer Pizer, chief legal officer at Lambda Legal, said the order directly contradicts nondiscrimination protections in the Affordable Care Act. 

Vanessa Ford, the mother of a trans teen, said the order will do nothing to erase her child. 

“My child exists, and, like all families, we deserve the right to make private medical decisions, alongside with our medical providers that impact our child’s life,” she said 

The order is part of a sweeping Republican effort to stop trans youth from accessing gender-affirming care. Trump campaigned aggressively on restricting medical care to trans youth, falsely and baselessly claiming on the campaign trail that schools were secretly performing gender-affirming treatments on children. 

In fact, gender-affirming care is very difficult for minors to access; studies show that surgeries are rarely performed and medications infrequently prescribed. 

The order argues that cutting off such care prevents children from a lifetime of costly surgeries and painful medical complications. The care in question is endorsed by all major medical associations including the American Medical Association and the American Psychological Association. Trump’s order also calls for the Department of Health and Human Services to review existing medical literature about trans health care and directs the government to abandon guidance from the World Professional Association for Transgender Health, an international organization of health care professionals with expertise in trans care.

Transgender health care has increasingly been under attack from coast to coast over the last four years. Twenty-four states already ban gender-affirming medical care for transgender minors, while 16 have passed laws protecting the rights of youth to access such care. LGBTQ+ policy organizations have prepped for months to oppose Tuesday’s order, and have vowed to fight it in court.