Update on Policies Affecting Gender-Diverse Populations

Updated: May 1, 2025

Background

Recent months have seen a series of federal actions and policy directives that impact the health, well-being, and human rights of gender diverse individuals.


Most recently, on May 1, 2025, the Department of Health and Human Services (HHS) released a 409-page review of medical interventions for gender dysphoria* in children and adolescents which aims to evaluate existing medical treatments for minors with gender dysphoria. HHS did not disclose who authored or reviewed the report. As stated in the report, “This review of evidence and best practices was commissioned pursuant to Executive Order 14187, signed on January 28, 2025. It is not a clinical practice guideline, and it does not issue legislative or regulatory policy recommendations.”


This report follows the issuance of a series of Executive Orders, and recission of several EOs from the previous administration, that could impact policies related to biological sex, sexual orientation, and gender diversity. These orders mandated 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. These actions collectively represent a significant shift in how federal entities address gender diversity. 


Multiple legal challenges are pending to these Executive Orders and agency policy changes, 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 the military and federal prisons.


These Executive Orders are beginning to spill over in Congress and state legislatures. Federal legislative efforts have included a focus on redefining "sex,” and removing terms like "gender identity" and "sexual orientation" from federal regulations, directly impacting historic anti-discrimination laws. Congressional initiatives are also targeting specific areas such as healthcare and education, with attempts to restrict or ban federal funding for gender-affirming care. 


Furthermore, there are ongoing debates regarding federal oversight of school curricula, with some lawmakers pushing to limit discussions of LGBTQ+ issues. This legislative activity creates a precarious environment for LGBTQ+ rights, with the potential for widespread rollback of federal protections, though these efforts face ongoing debates and legal challenges.

 

Conversely, some states are reinforcing and expanding protections for LGBTQ+ individuals. States like California, are working to codify nondiscrimination policies that encompass sexual orientation and gender identity. This creates a patchwork of legal frameworks across the country, with significant variations in how these issues are addressed.



As with the federal efforts to change policies in this area, many legal challenges have been filed against the new state level laws. This further contributes to the complexity of the current legal landscape in this area.


*Gender dysphoria: discomfort or distress related to incongruence between a person’s gender identity, sex assigned at birth, and/or primary and secondary sex characteristics.

APA/APASI Assessment

APA is deeply concerned about recent federal actions that not only challenge the scientific understanding of gender identity but also potentially jeopardize the human rights, psychological health, and well-being of transgender and nonbinary individuals. These policy changes create significant challenges for both the individuals affected and the psychologists who serve these communities. 


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.
  • Scientific integrity and evidence-based policymaking: The lack of transparency regarding authorship, expertise, and methodology in the recent HHS report undermines scientific rigor and contradicts standards for evidence-based policymaking. Policies should be developed through open scientific discourse rather than opaque processes that prevent proper evaluation of potential biases.


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 supports access to evidence-based psychological care 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