The Trump Administration Executive Order on Gender Continues to Reverberate

Much has been written about the Trump Administration’s early effort to suppress data collection, presentation, and research related to LGBTQ – and particularly transgender – people’s health. A day one executive order (and subsequent HHS guidance and an OPM memorandum) on “gender ideology” laid out the administration’s approach to sex and gender, defining sex as an immutable binary biological classification and removing recognition of gender identity. While they have each been challenged in court, together, these and other policies have underpinned the removal of a range of websites, cancellation of federal grants, and led to changes to federal survey instruments, including those related to health and well-being, actions that continue to be expanded upon.

Earlier this year, court orders required the restoration of certain webpages, datasets, and resources needed to provide medical care (and in a separate case, the government agreed to restoration of pages), yet data collection related to LGBTQ people remains limited and removal of information reportedly continues. ¹ In at least some cases where it was required to restore websites, the administration plainly states it is doing so only because of its legal obligation. By way of example, a Centers for Disease Control and Prevention (CDC) page on transgender people and HIV now includes a banner stating that it has been restored per court order and that “any information on this page promoting gender ideology,” including reference to transgender people “does not reflect biological reality and therefore the Administration and this Department rejects it.” Additionally, new reporting found that more pages relating to sexual health, LGBTQ people, and other topics have been removed from the CDC site, as recently as September. These actions stand to limit understanding of LGBTQ people’s experiences and challenge the ability of stakeholders to shape responsive policy.

Also in September, the CDC updated its “about” page to include a new set of agency priorities, with a section on “gender ideology and protecting children.”  This section references the HHS guidance and states that it is an agency “priority to recognize that a person’s sex as either male or female is unchangeable and determined by objective biology, and to ensure CDC programs accurately reflect science, including the biological reality of sex.” Removing acknowledgment of transgender people from agency materials has implications for public health messaging and services related to the population’s health needs, posing challenges for a community that has elevated health risks, including for some communicable diseases, like HIV. This could lead to gaps in individual, community, and scientific knowledge and, depending on what is removed, the ability to monitor, and ultimately, respond to outbreaks or health disparities. This priority shift could also negatively influence the LGBTQ community’s trust in the agency – which has historically been important when CDC has responded to certain events, like the mpox outbreak of 2022, necessitating community collaboration. Further, if CDC, aligns funding opportunities with this priority area, it could jeopardize CDC grants going to those working to engage gender diverse communities, thereby limiting service provision. Tailoring public health approaches to communities experiencing high unmet needs or not otherwise being reached is a basic public health approach and requires acknowledging their existence and approaching needs in culturally competent ways.

Additionally, recent CDC clinical guidelines, used to inform providers about the evidence and clinical recommendations related to public health interventions, omit mention of transgender people, seemingly reflecting administrative priorities. A new twice-yearly injectable pre-exposure-prophylaxis or PrEP (HIV prevention) drug, lenacapavir, was approved in June and holds significant promise in helping to bend the curve on the HIV epidemic by addressing adherence and clinical capacity issues. However, the clinical recommendations from the CDC do not reference transgender or non-binary people, who, because they experience HIV at disproportionate rates, were specifically included in “PURPOSE 2”, one of the clinical trials that led to the drug’s FDA approval. The PURPOSE 2 trial assessed lenacapavir’s efficacy in cisgender men, transgender men and women, and non-binary people. The trials found that lenacapavir was 96%-100% effective at preventing HIV transmission and the final drug label issued by the FDA specifies that “there were no clinically significant differences in the pharmacokinetics of lenacapavir based on…gender identity”, among other variables. This marks a departure from CDC’s 2021 PrEP guideline, released prior to approval of the new drug, which included a section on PrEP and transgender people. It also represents a departure from the approach taken by the World Health Organization (WHO) in their lenacapavir guidelines, which identified gender diverse people as a key population and discusses prescribing lenacapavir to those also taking gender affirming hormone therapy. While providers may look elsewhere for detailed information (such as to the WHO or the trial data), the exclusion could impact willingness to prescribe among those less experienced with PrEP or in working with transgender patients. In addition, given that an earlier PrEP drug (emtricitabine/tenofovir alafenamide), was not approved for people engaged in “receptive vaginal sex because the effectiveness in this population has not been evaluated,” providers may be especially cautious about reviewing sex and gender based indications for new PrEP drugs. Indeed, this earlier exclusion is a key reason that led to the more inclusive – of both cisgender women and gender diverse people – trial design and ultimate broad approval of lenacapavir. This follows the removal of detailed information on proving antiretrovirals to transgender people for HIV treatment from the HHS treatment guidelines, an action that took place sometime between March and April 2025.   

As with other changes, the exclusion of transgender people from treatment and prevention recommendations likely reflects and is consistent with the administration’s stance on sex and gender with the Executive Order directing agencies to “remove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology.”   

Looking across these actions, barriers to providing complete treatment and prevention information could impact individual health (HIV is a life-long chronic condition when treated, and a deadly one when untreated), as well as public health if ongoing HIV transmission continues. It also has implications for private and public budgets with the estimated lifetime cost of HIV treatment per person in the United States now over $1 million.

1. The Court in this case vacated the OPM Memo and the HHS Guidance, remanding them to the agencies. However, the remedy was limited to website and data restoration and “vacatur does not require the HHS defendants to undo every action taken pursuant to the OPM Memo or HHS Guidance” and the court “will not prevent the defendants from heading back to the drawing board and attempting to craft a lawful policy with similar objectives.” Other cases challenge the gender Executive Order itself. ↩︎