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Society for Evidence-Based Gender Medicine: 2022 HHS meeting

by Andrea James Reviewed October 13, 2026 10 min read

On April 25, 2022, Society for Evidence-Based Gender Medicine leaders arranged a meeting with US government officials on healthcare for trans and gender diverse youth. Their goal was to oppose a proposed nondiscrimination provision in the Affordable Care Act, which would have defined “sex discrimination” against patients to include gender identity and sexual orientation.

Background

In 2020, the Supreme Court’s Bostock ruling held that firing someone for being transgender is sex discrimination. In January 2021, President Biden’s Executive Order 13988 directed agencies to extend this precedent to other federal sex-discrimination laws. In May 2021, HHS issued a notification that it would read Section 1557 of the Affordable Care Act, which bars federally funded health programs from discriminating on the basis of sex and other characteristics, to cover gender identity and sexual orientation. In March 2022, HHS’s Office for Civil Rights issued a notice and guidance [original] stating that denying transgender healthcare could violate Section 1557. HHS issued proposed rule RIN: 0945-AA17 to formalize this reading of Section 1557.

During its development, 15 anti-trans organizations formally opposed RIN 0945-AA17, including SEGM:

HHS’s 2024 Section 1557 Rule barred covered providers and insurers from categorically excluding gender-transition care, but Tennessee and 14 other states sued and won a nationwide preliminary injunction in July 2024. After the Trump Administration dropped HHS’s appeal in March 2025, the district court vacated the rule’s gender-identity provisions in October 2025, and in June 2026 HHS announced that OCR and CMS will not enforce them.

Proposed Rule RIN 0945-AA17 was published in August 2022. It would have barred covered providers and insurers from categorically refusing or excluding gender-transition care, but it would not have required doctors to provide any specific treatment, so long as an individualized clinical judgment was not a pretext for discrimination. In May 2024, HHS issued the new rule. That month, Tennessee and 14 other states sued (State of Tennessee v. Becerra), and on July 3, 2024, the judge issued a nationwide preliminary injunction. HHS filed a notice of appeal soon after and filed its opening brief in November 2024.

In March 2025, after the Trump Administration took over HHS, the parties jointly stipulated to dismissal of the appeal, and the Fifth Circuit dismissed the appeal. On October 22, 2025, the district court entered a final judgment vacating the rule’s gender-identity provisions. In June 2026, HHS published a notice in the Federal Register telling the public that the court vacated parts of the 2024 rule on October 22, 2025, and that HHS Office for Civil Rights and Centers for Medicare & Medicaid Services will not enforce the vacated provisions. This was a victory for SEGM and other opponents.

Attendees of the SEGM HHS meeting

Government

  • Office of Management and Budget (OMB)
    • Josh Brammer – Office of Information and Regulatory Affairs (OIRA)
    • Vanessa Duguay – OMB/HD [Health Division]
  • Department of Health and Human Services (HHS)
    • Dylan de Kervor – Office for Civil Rights (OCR)
    • Alissa Stoneking – Office for Civil Rights (OCR)
    • Audrey Wiggins – Office of the General Counsel (OGC)

SEGM

“Self”

Remarks

Malone submitted prepared remarks arguing against the proposed HHS rule. They believed the rule would pressure physicians to provide puberty blockers, cross-sex hormones, and surgery to trans and gender diverse minors. SEGM’s central claim is that the evidence for these interventions in youth is too weak to justify their risks.

Opening (William Malone)

Malone described a hypothetical 10-year-old boy moving from puberty blockers through to surgery, to illustrate what the group sees as the irreversible consequences of “affirmative care”: infertility, lifelong hormone dependence, and surgical complications. Malone argued that systematic reviews in several countries have found no lasting benefit, and that no true standard of care exists. Malone stated WPATH and Endocrine Society documents describe themselves as guidelines rather than standards. Malone compares the situation to the opioid crisis, where physicians were pushed toward a treatment that later caused widespread harm.

United Kingdom (Richard Byng, Richard Stephens)

Byng and Stephens summarize the Cass Review’s interim report. It found that the patient population has shifted from mostly young birth-registered males to mostly adolescent females, many with autism or mental health issues. It also found little evidence, especially for that group, and concerns about how puberty blockers affect brain development. Cass called for broader differential diagnosis and an exploratory rather than automatically affirming approach. They expected the final report to favor talking therapies, with medical treatment reserved for a narrow subgroup.

Finland (Riittakerttu Kaltiala)

Kaltiala stated Finland’s systematic review found the evidence of very low quality, with no demonstrated mental health improvement from adolescent medical transition. Its guidelines make psychosocial support and treatment of psychiatric conditions the first line. Hormones are allowed only after centralized assessment, case by case, and surgery is not permitted under 18.

Sweden (Hildur Hjaltadottir)

Hjaltadottir said Sweden’s 2022 guidelines concluded that the risks of hormonal treatment currently outweigh the benefits. These treatments are now limited to clinical trials at specialized centers, and only for youth with childhood-onset dysphoria. Adolescent-onset and non-binary youth are offered psychiatric care and exploratory therapy instead, and autistic youth get additional evaluation.

Therapist perspectives (Sasha Ayad, Lisa Marchiano)

Ayad stated that slowing down and treating co-occurring problems first often leads teens to change course. Ayad gives the example of an autistic client who later felt having a trans identity had reflected body shame. Marchiano described a detransitioned client who had testosterone, a mastectomy, and a hysterectomy by 21, and now attributes this transition to internalized homophobia and untreated mental illness. Marchiano cited UK data suggesting regret is rising. Both warn that if declining to provide medical treatment is treated as discrimination, clinicians won’t be able to exercise caution.

References

Notice of Vacatur Regarding Certain Provisions of the 2024 Nondiscrimination in Health Programs and Activities Final Rule, 91 Fed. Reg., page 32887 (June 2, 2026) (FR Doc. 2026-11015). https://www.govinfo.gov/content/pkg/FR-2026-06-02/pdf/2026-11015.pdf

Final Judgment, Tennessee v. Kennedy, No. 1:24-cv-161-LG-BWR (S.D. Miss. Oct. 22, 2025), ECF No. 80, https://litigationtracker.law.georgetown.edu/wp-content/uploads/2024/06/State-of-Tennessee_2025.10.22_JUDGMENT.pdf; see also Tennessee v. Kennedy, No. 1:24-cv-161-LG-BWR, 2025 WL 2982069 (S.D. Miss. Oct. 22, 2025) (memorandum opinion granting summary judgment) https://cases.justia.com/federal/district-courts/mississippi/mssdce/1:2024cv00161/125067/79/0.pdf

Tennessee v. Kennedy, No. 24-60462 (5th Cir. Mar. 13, 2025) (order dismissing appeal pursuant to Fed. R. App. P. 42(b)), https://litigationtracker.law.georgetown.edu/wp-content/uploads/2024/09/State-of-Tennessee-v.-Kennedy-Docket-No.-24-60462-5th-Cir.-Sep-05-2024-Court-Docket-1.pdf

Joint Stipulation to Dismiss Appeal, Tennessee v. Kennedy, No. 24-60462 (5th Cir. Mar. 2025), https://millerchevalier.com/sites/default/files/resources/General_Alerts/2025-03-13_Tennessee-v-Kennedy.pdf

Brief for Appellants, Tennessee v. Becerra, No. 24-60462 (5th Cir. Nov. 21, 2024), https://litigationtracker.law.georgetown.edu/wp-content/uploads/2024/09/State-of-Tennessee_2024.11.21._BRIEF-FOR-APPELLANTS.pdf

Notice of Appeal, Tennessee v. Becerra, No. 1:24-cv-161-LG-BWR (S.D. Miss. Aug. 30, 2024), ECF No. 42, https://litigationtracker.law.georgetown.edu/wp-content/uploads/2024/06/State-of-Tennessee_2024.08.30_NOTICE-OF-APPEAL-1.pdf

Tennessee v. Becerra, No. 1:24-cv-161-LG-BWR, 2024 WL 3283887 (S.D. Miss. July 3, 2024), ECF No. 29 (memorandum opinion and order granting § 705 stay and preliminary injunction), https://www.ag.ky.gov/Press%20Release%20Attachments/ECF%2029%20-%20Memorandum%20Opinion%20and%20Order.pdf

Complaint, Tennessee v. Becerra, No. 1:24-cv-161 (S.D. Miss. May 30, 2024), ECF No. 1, https://www.alabamaag.gov/wp-content/uploads/2024/05/ECF-1-Complaint.pdf

Nondiscrimination in Health Programs and Activities, 89 Fed. Reg. 37,522 (May 6, 2024) (codified in scattered sections of 42 and 45 C.F.R.), https://www.govinfo.gov/content/pkg/FR-2024-05-06/pdf/2024-08711.pdf

Nondiscrimination in Health Programs and Activities, 87 Fed. Reg. 47,824 (proposed Aug. 4, 2022), https://www.govinfo.gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf

US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) (April 25, 2022). EO 12866 Meeting 0945-AA17. Nondiscrimination in Health Programs and Activities https://mobile.reginfo.gov/public/do/viewEO12866Meeting?viewRule=true&rin=0945-AA17&meetingId=131923&acronym=0945-HHS/OCR

Roster of meetings

US Office of Information and Regulatory Affairs (reginfo.gov)

Proposed rule stage

Ethics & Public Policy Center (April 6, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=127873&acronym=0945-HHS/OCR

U.S. Conference of Catholic Bishops (April 7, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=129573&acronym=0945-HHS/OCR

The Leadership Conference on Civil & Human Rights (April 6, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=130423&acronym=0945-HHS/OCR

Alliance Defending Freedom (April 11, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=129224&acronym=0945-HHS/OCR

National Women’s Law Center (April 14, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=131274&acronym=0945-HHS/OCR

National Center for Lesbian Rights (April 14, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=131073&acronym=0945-HHS/OCR

International Federation for Therapeutic and Counselling Choice (April 18, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=132123&acronym=0945-HHS/OCR

Our Duty (April 19, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=131824&acronym=0945-HHS/OCR

National Council of Jewish Women (April 20, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=132374&acronym=0945-HHS/OCR

Society for Evidence-based Gender Medicine (April 25, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=131923&acronym=0945-HHS/OCR

Genspect (April 26, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=132173&acronym=0945-HHS/OCR

First Liberty Institute (April 28, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=129624&acronym=0945-HHS/OCR

Catholic Health Association (April 29, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=131123&acronym=0945-HHS/OCR

Charis et Veritas L.L.C. (May 13, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=132473&acronym=0945-HHS/OCR

The Heritage Foundation (May 16, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=131473&acronym=0945-HHS/OCR

Family Research Council (May 17, 2022). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=132873&acronym=0945-HHS/OCR

Final rule stage

Ethics and Public Policy Center (February 2, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=248723&acronym=0945-HHS/OCR

U.S. Conference of Catholic Bishops (February 8, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=250073&acronym=0945-HHS/OCR

Catholic Health Association (March 1, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=303673&acronym=0945-HHS/OCR

The Heritage Foundation (March 18, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=336823&acronym=0945-HHS/OCR

Center for Christian Virtue (March 28, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=346524&acronym=0945-HHS/OCR

Whitman-Walker Institute (April 9, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=373824&acronym=0945-HHS/OCR

Center for Christian Virtue (April 12, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=376373&acronym=0945-HHS/OCR

Partners for Ethical Care and Transition Justice (April 15, 2024). https://www.reginfo.gov/public/do/viewEO12866Meeting?viewRule=false&rin=0945-AA17&meetingId=384073&acronym=0945-HHS/OCR

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