“It is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” the order says.

The order directs that federally-run insurance programs, including TRICARE for military families and Medicaid, exclude coverage for such care and calls on the Department of Justice to vigorously pursue litigation and legislation to oppose the practice.

Medicaid programs in some states cover gender-affirming care. The new order suggests that the practice could end, and targets hospitals and universities that receive federal money and provide the care.

The language in the executive order — using words such as “maiming,” “sterilizing” and “mutilation” — contradicts what is typical for gender-affirming care in the United States. It also labels guidance from the World Professional Association for Transgender Health as “junk science.”

On his Truth Social platform, Trump called gender-affirming care “barbaric medical procedures.”

Major medical groups such as the American Medical Association and the American Academy of Pediatrics support access to care.

Young people who persistently identify as a gender that differs from their sex assigned at birth are first evaluated by a team of professionals. Some may try a social transition, involving changing a hairstyle or pronouns. Some may later also receive puberty blockers or hormones. Surgery is extremely rare for minors.

“It is deeply unfair to play politics with people’s lives and strip transgender young people, their families and their providers of the freedom to make necessary health care decisions,” said Human Rights Campaign President Kelley Robinson.

The order encourages Congress to adopt a law allowing those who receive gender-affirming care and come to regret it, or their parents, to sue the providers.

It also directs the Justice Department to prioritize investigating states that protect access to gender-affirming care and “facilitate stripping custody from parents” who oppose the treatments for their children. Some Democratic-controlled states have adopted laws that seek to protect doctors who provide gender-affirming care to patients who travel from states where it’s banned for minors.

Lambda Legal promised swift legal action.

Michel Lee Garrett, a trans woman whose teenage child only partially identifies as a girl and uses they/them pronouns, said such policies aim to erase trans people from public life but will never succeed. Her child has not elected to pursue a medical transition, but the mother from State College, Pennsylvania, said she won’t stop fighting to preserve that option for her child and others.

“I’ll always support my child’s needs, regardless of what policies may be in place or what may come … even if it meant trouble for me,” Lee Garrett said.

For Howl Hall, an 18-year-old freshman at Eastern Washington University, taking testosterone not only changed his body but dramatically improved his experience with depression. With that treatment now under threat, Hall said he’s concerned that getting off testosterone would hurt his mental health.

“I would be alive, but I wouldn’t be living,” Hall said. “I wouldn’t be living my life in a productive way at all. I can guarantee that I would be failing all of my classes if I was even showing up to them.”

The push is the latest by Trump to reverse Biden administration policies protecting transgender people and their care. On Monday, Trump directed the Pentagon to conduct a review that is likely to lead to them being barred from military service. A group of active-duty military personnel sued over that on Tuesday.

Hours after taking office last week, Trump signed another order that seeks to define sex as only male or female, not recognizing transgender, nonbinary or intersex people or the idea that gender can be fluid. Already that’s resulted in the State Department halting issuing passports with an “X” gender marker, forcing transgender people to apply for travel documents with markers that don’t match their identities.

Trump said he would address these issues during his campaign last year, and his actions could prove widely divisive.

In the November election, voters were slightly more likely to oppose than support laws that ban gender-affirming medical treatment, such as puberty blockers and hormone therapy, for minors under the age of 18 who identify as transgender, according to AP VoteCast. About half of voters, 52%, were opposed, but 47% said they were in favor.

Trump’s voters were much more likely to support bans on transgender care: About 6 in 10 Trump voters favored such laws.

“It’s very clear that this order, in combination with the other orders that we’ve seen over the past week, are meant to not protect anyone in this country, but rather to single-mindedly drive out transgender people of all ages from all walks of civic life,” said Harper Seldin, a staff attorney for the American Civil Liberties Union’s LGBTQ & HIV Project.

Seldin said the ACLU is reviewing the order “to understand what, if anything, has immediate effect versus what needs to go through continued agency action.”

Even as transgender people have gained visibility and acceptance on some fronts, they’ve become major targets for social conservatives. In recent years, at least 26 states have adopted laws restricting or banning gender-affirming medical care for transgender minors. Most of those states face lawsuits, including one over Tennessee’s ban that’s pending before the U.S. Supreme Court.

Republican-controlled states have also moved to keep transgender women and girls from competing in women’s or girls’ sports and to dictate which bathrooms transgender people can use, particularly in schools.

“These policies are not serving anyone,” said Shelby Chestnut, executive director of the Transgender Law Center. “They’re only creating confusion and fear for all people.”