New Policies Affecting Gender-Diverse Populations

Mar. 6, 2025

Background

Several executive orders have been issued that could impact policies related to biological sex, sexual orientation, and gender diversity. These orders mandate federal agencies and federal contractors to interpret “sex” solely as a binary biological classification determined at birth, restrict gender-affirming medical treatments for people under the age of 19, and withdraw federal funding from educational programs that allow transgender women to participate in women’s sports.

Additionally, multiple executive orders from previous administrations, which were intended to protect and advance the rights of gender diverse individuals, have been rescinded.

In response to the new executive orders, numerous federal agencies have issued various directives. The Office of Personnel Management has instructed agencies to use only binary sex options on forms, and the Equal Employment Opportunity Commission no longer allows "X" gender markers. The Department of State has suspended passport applications seeking sex-marker changes or nonbinary designations, and the Department of Defense has issued guidance to update policies related to sex-based designations. Several agencies, including the National Park Service, have revised terminology on official websites and in official communications to align with the administration's binary sex classifications.

Multiple legal challenges to these executive orders have been filed, with several cases advancing through the courts. These include challenges on restrictions to gender-affirming care, policies affecting transgender athletes, passport gender marker restrictions, and regulations impacting transgender individuals in federal prisons.

While courts are reviewing the legality of these executive orders and what, if any, provisions will survive, the executive orders do not have the same authority as laws passed by Congress. Learn more about EOs here. Nonetheless, the federal government and many federal contractors are complying with these executive actions.

APA/APASI Assessment

APA and APA Services, Inc. are concerned by the apparent erasure of the construct of gender identity in recent executive orders, memoranda, statements, and policies. These policy changes have already created significant challenges for psychologists and the communities they serve.

APA’s assessment highlights several key areas of concern:

• Ethical and professional dilemmas for psychologists: Federal policies increasingly conflict with established professional guidelines for working with transgender and gender nonconforming people. This is potentially forcing those who receive federal funds or grants or who work in systems that prohibit this work to choose between complying with restrictive regulations and adhering to evidence-based, ethical practices.
• Barriers to gender-affirming care: Transgender and nonbinary individuals may avoid seeking necessary treatment due to fears of discrimination, while changes in federal definitions could prompt insurers to deny coverage for gender-affirming care. In some jurisdictions, psychologists might face penalties or legal risks when providing or referring patients to appropriate services, particularly for youth.
• Impacts on psychological research and training: Restrictions on recognizing gender identity may result in reduced federal funding for studies on gender dysphoria and LGBTQ+ mental health. Instructors across the educational spectrum, including continuing education courses, might need to adjust their curricula, limiting training in areas critical to understanding and supporting transgender and nonbinary populations.

The proposed elimination of gender identity in U.S. policies and programs limits psychologists' ability to carry out their work to promote mental health for gender diverse individuals through research, practice, and education. These actions contradict established psychological science and risk perpetuating harm to people whose gender identity is different from their biological sex assigned at birth.

APA’s Position

Psychological science provides the foundation for APA’s policies affirming evidence-based care for individuals with differences in sex development (DSD), transgender, gender diverse, and nonbinary children, adolescents, and adults. APA is deeply concerned that the recently proposed federal policy changes may cause harm to entire groups of individuals. APA supports access to psychological and medical interventions for all people.

What the Science Says

APA’s organizational assessment and position are grounded in the best available science.

Sex is a biological characteristic determined by chromosome and reproductive anatomy (American Medical Association, 2021), and the assertion that only two sexes exist is not scientifically accurate. Approximately 1.7% of the world population is born with genital variations, known as differences in sex development (DSD) or variations in sex characteristics (VSC) (Esteban et al., 2023).

Everyone has a gender identity, defined as a person's deeply felt, inherent sense of being a girl, woman, or female; a boy, man, or male; a blend of male or female; or an alternative gender (Institute of Medicine, 2011). Gender as a non-binary construct has been described and studied for decades across cultures and has been present throughout history (Gill-Peterson, 2018). Physiologically, neuroimaging research has suggested that cortical brain volume in transgender individuals appear to be more like their preferred gender (see Mueller et al., 2021; Nguyen et al., 2019).

Those whose gender identity differs from their biological sex at birth may face discrimination, stigma, prejudice, and violence that negatively affect their health and well-being (Bradford et al., 2013). Research demonstrates that gender-related discrimination appears to be the most

documented risk factor for poor mental health among transgender individuals. Conversely, self-esteem, pride, transitioning, respecting and supporting transgender people in authentically articulating their gender identity can promote resilience, improve their health, well-being, and quality of life (Mezza et al, 2024; Witten, 2003).

APA Resources on Gender Diversity

From policies, reports, and continuing education to books for adults and children, APA has a wide range of resources and guidance to aid psychologists in supporting gender-diverse individuals.

References

American Medical Association (2021), Association of American Medical Colleges. Advancing health equity: a guide to language, narrative and concepts. https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf

Bradford, J., Reisner, S. L., Honnold, J. A., & Xavier, J. (2013). Experiences of transgender-related discrimination and implications for health: Results from the Virginia Transgender Health Initiative Study. American Journal of Public Health, 103, 1820 –1829. http://dx.doi.org/10.2105/AJPH.2012.300796

Esteban, C., Ortiz-Rodz, D. I., Muñiz-Pérez, Y. I., Ramírez-Vega, L., Jiménez-Ricaurte, C., Mattei-Torres, E., & Finkel-Aguilar, V. (2023). Quality of life and psychosocial well-being among intersex-identifying individuals in Puerto Rico: An exploratory study. International Journal of Environmental Research and Public Health, 20(4), 2899. https://doi.org/10.3390/ijerph20042899

Gill-Peterson, J. (2018). Histories of the transgender child. University of Minnesota Press.

Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academy of Sciences.

Mezza, F., Mezzalira, S., Pizzo, R., Maldonato, N. M., Bochicchio, V., & Scandurra, C. (2024). Minority stress and mental health in European transgender and gender diverse people: A systematic review of quantitative studies. Clinical Psychology Review, 107, 1–16. https://doi.org/10.1016/j.cpr.2023.102358

Mueller, S. C., Guillamon, A., Zubiaurre-Elorza, L., Junque, C., Gomez-Gil, E., Uribe, C., Khorashad, B. S., Khazai, B., Talaei, A., Habel, U., Votinov, M., Derntl, B., Lanzenberger, R., Seiger, R., Kranz, G. S., Kreukels, B. P. C., Cohen Kettenis, P. T., Burke, S. M., Lambalk, N. B., Veltman, D. J., Kennis, M., Sánchez, F. J., Vilain, E., Fisher, A. D., Mascalchi, M., Gavazzi, G., Orsolini, S., Ristori, J., Dannlowski, U., Grotegerd, D., Konrad, C., Schneider, M. A., T’Sjoen, G., & Luders, E. (2021). The neuroanatomy of transgender identity: Mega-analytic findings from the ENIGMA Transgender Persons Working Group. The Journal of Sexual Medicine, 18(6), 1122–1129. https://doi.org/10.1016/j.jsxm.2021.03.079

Nguyen, H. B., Loughead, J., Lipner, E., Hantsoo, L., Kornfield, S. L., & Epperson, C. N. (2019). What has sex got to do with it? The role of hormones in the transgender brain. Neuropsychopharmacology, 44(1), 22–37. https://doi.org/10.1038/s41386-018-0140-7

Witten, T. M. (2003). Life Course Analysis-The Courage to Search for Something More: Middle Adulthood Issues in the Transgender and Intersex Community. Journal of Human Behavior in the Social Environment, 8(2-3), 189–224. https://doi.org/10.1300/J137v08n02_12