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US rollout

Between 2010 and 2024, the United States experienced explosive growth in transgender care — a rapidly growing number of pediatric clinics, and federal support under Biden. By June 2025, 27 states had banned medical gender transition for minors. The "consensus" of WPATH, the Endocrine Society, and AAP rests largely on each other's guidelines, not on an independent systematic review of the evidence.

Clinics and revenue: from a few centers to industry

In February 2007, Norman Spack co-founded the Gender Management Service at Boston Children's Hospital, one of the first pediatric gender clinics in the US, modeled on the Dutch approach, the Dutch Protocol (source). Other centers followed, including Lurie Children's (Chicago), Seattle Children's, Children's Hospital Los Angeles and Vanderbilt. Since January 2025, 42 hospitals and health systems have paused or stopped some gender-affirming care for young people, according to a STAT analysis of February 2026 (source).

The professional backing came from WPATH (see SOC versions ), the Endocrine Society, and the American Academy of Pediatrics. A 2024 systematic review of international guidelines found that few guidelines were based on a systematic review of the evidence and that the WPATH and Endocrine Society guidelines formed the basis for most others (source). In its 2025 review, HHS concluded that the apparent consensus of US medical associations is driven mainly by a small number of committees influenced by WPATH (source).

Federal policy under Biden (2021–2024)

The Biden administration supported gender-affirming care. The Department of Justice challenged Tennessee's ban on such care for minors in court, which led to United States v. Skrmetti (source). According to unsealed court documents described by The New York Times in June 2024, staff of Assistant Secretary for Health Rachel Levine urged WPATH to drop proposed age limits for surgeries on minors from its guidelines (source). The 2025 HHS review states that WPATH eliminated nearly all recommended age minimums under political pressure (source).

Setback at state level (2022+)

Arkansas, Tennessee, Texas, Alabama, Mississippi, Florida and other states have enacted bans on gender-affirming care for minors. By June 2025, 27 states had such a ban, of which 25 remained in force; the bans in Arkansas and Montana are blocked by court order (source). On 18 June 2025 the Supreme Court ruled 6 to 3 in United States v. Skrmetti that Tennessee's ban on puberty blockers and hormones for minors with gender dysphoria does not violate the Equal Protection Clause of the Fourteenth Amendment (source).

The HHS Review 2025

The Trump administration published an evidence review (HHS) on 1 May 2025, followed in November 2025 by a final version with peer reviews (source). Its overview of systematic reviews found that the overall quality of evidence on the effects of any intervention on psychological outcomes, quality of life, regret or long-term health is "very low". That is in line with the conclusions of Cass , SBU , NICE , and COHERE Finland ; Cass called this "an area of remarkably weak evidence" (source).

Detransition and legal liability

Chloe Cole (source) and Layla Jane (source) sued Kaiser Permanente entities and treating doctors, and Soren Aldaco sued her treatment providers in Texas in 2023 (source). These are the plaintiffs' claims; whether courts uphold them remains to be seen. On detransition and regret, see detransition rates and regret research ; according to the HHS review, the true rate of regret is not known and better data collection is needed (source). The comparison with the European turnaround and the Dutch tenacity ( Dutch rollout ) is stark: the US is actively rolling back, while the Netherlands is dragging its feet.

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