President Donald Trump signed a broad executive order targeting transition-related medical care for minors Tuesday. 

The order, titled “Protecting Children From Chemical and Surgical Mutilation,” intends to restrict access to gender-affirming medical care — including puberty blockers, hormone therapy and surgery — for minors, which it defines as those younger than 19. 

It prohibits federal funding from covering such care for minors, restricts research and education grants to medical schools and hospitals and directs the secretary of Health and Human Services to issue regulations to end such care for minors.

The order also directs all federal agencies to rescind guidance from the World Professional Association for Transgender Health, or WPATH, a nonprofit association dedicated to transgender medical care that issues guidance that is widely used by health care professionals.

“Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions,” the executive order states, using inflammatory language to describe transition-related medical care.

The order states that more children will come to regret receiving such care and that they are “often trapped with lifelong medical complications” and sterilization.

“Accordingly, 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 states.

Lambda Legal, an LGBTQ legal advocacy group, promised to fight the executive order in a statement Tuesday.

“This broadside condemns transgender youth to extreme and unnecessary pain and suffering, and their parents to agonized futility in caring for their child — all while denying them access to the same medically recommended health care that is readily available to their cisgender peers,” said Lambda Legal attorney Omar Gonzalez-Pagan, alluding to the fact that the order does not appear to bar puberty blockers, hormone therapy or similar surgeries for minors who are not transgender. 

Transition-related care for minors has dominated headlines in recent years, with 26 states passing laws restricting such care. However, recent research has shown that a small number of minors actually access this type of care. A study published in JAMA Pediatrics in January found that less than 0.1% of adolescents with private insurance in the U.S. are transgender or gender-diverse and are prescribed puberty blockers or gender-affirming hormones.

Trans minors are treated on a case-by-case basis and are legally required to receive their parents’ or guardian’s consent to receive any medical intervention. Before a child starts puberty, medical standards developed by WPATH and other medical organizations recommend that a child receive therapy and social transition, or changing their hairstyle, clothing, name and pronouns.

Once a child begins puberty, they may start puberty blockers if they have persistent gender dysphoria, which is the medical term for the severe emotional distress caused by the misalignment between one’s gender identity and birth sex. Teenagers might start cross-sex hormones, and, in rare cases, some older teens may receive a double mastectomy, where both breasts are removed. 

Most major medical associations, such as the American Medical Association, the American Academy of Pediatrics and the American Psychological Association, support access to transition care for minors and oppose restrictions on it. 

One section of Trump’s executive order, “Ending Reliance on Junk Science,” specifically takes aim at WPATH, arguing that it “lacks scientific integrity,” and directs the secretary of HHS to “publish a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion.”

“The Secretary of HHS, as appropriate and consistent with applicable law, shall use all available methods to increase the quality of data to guide practices for improving the health of minors with gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion, or who otherwise seek chemical or surgical mutilation,” the order states. 

WPATH did not immediately return a request for comment.

Half a dozen studies in recent years have found that transition-related care improves minors’ mental health and reduces suicidality. However, in December, the United Kingdom indefinitely banned new prescriptions of puberty blockers to treat minors for gender dysphoria. The ban followed an independent study commissioned by England’s National Health Service that found that medical evidence for transition-related care for minors was “remarkably weak.” The study has faced criticism from some researchers and activists.