Trump signs executive order to restrict transgender care access for people under 19

President Donald Trump signed an executive order Tuesday seeking to restrict gender-affirming care for people under the age of 19.

The order would move to restrict medical institutions that receive federal funding from providing such care -- including puberty blockers, hormone therapies, and surgeries -- calling on the secretary of the Department of Health and Human Services to "take all appropriate actions to end the chemical and surgical mutilation of children." The executive order does not appear to restrict these procedures for non-transgender people under 19.

It's the latest action from Trump that impacts the transgender community -- which is estimated to make up less than 1% of the population over the age of 13. Trump also recently signed executive orders restricting transgender participation in the military, ending federal legal recognition of transgender people, and restricting gender marker changes on federal documents.

Major national medical associations, including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and more than 20 others argue that gender-affirming care is safe, effective, beneficial, and medically necessary.

Amid an increase in states moving to ban gender-affirming youth care, the American Psychological Association said in February it opposes state bans, "which are contrary to the principles of evidence-based healthcare, human rights, and social justice, and which should be reconsidered in favor of policies that prioritize the well-being and autonomy of transgender, gender-diverse, and nonbinary individuals."

Trump's executive order states that "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 also moves to exclude transgender-related coverage for young people from federal health insurance policies, including the Department of Defense's TRICARE benefits, the Federal Employee Health Benefits and the Postal Service Health Benefits.

Trump's order expressed concerns that gender-affirming care sterilizes children, saying: "countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding."

Medical experts previously told ABC News that they have not yet seen widespread, long-term fertility issues in puberty-aged youth who temporarily use puberty blockers while undergoing puberty and that hormone therapy does not necessarily make transgender people permanently sterilized, but that it does affect fertility. National guidelines state that physicians should thoroughly warn patients about the potential for reduced fertility before administering hormone therapy.

Gender-affirming surgeries for transgender youth older than 12 are extremely rare, and those that are performed are almost entirely chest-related procedures, according to research in JAMA Network.

Researchers at the Harvard T.H. Chan School of Public Health additionally found little to no usage of gender-affirming surgeries by transgender and gender-diverse minors in the U.S., instead finding that cisgender minors and adults had substantially higher utilization of such gender-affirming surgeries -- such as breast-reduction surgeries for cisgender boys and young men -- than their transgender counterparts.