HHS Has Been Using Anti-Trans Language From a Christian Right Think Tank

The department refers to gender-affirming care as “sex-rejecting procedures,” a term coined by the Ethics and Public Policy Center.

This piece has been updated from its original email version.

Last week, the Department of Health and Human Services issued a press release praising the American Society of Plastic Surgeons for being the first major medical organization in the country to come out against gender-affirming surgeries for anyone under the age of 19.

“HHS Leaders Commend the American Society of Plastic Surgeons for Disavowing Pediatric Sex-Rejecting Procedures,” the release read, employing terminology absent from the ASPS position statement.

HHS has been referring to gender-affirming care for transgender and non-binary Americans as “sex-rejecting procedures” since November. The term has appeared in at least three separate press releases from the department, including the announcement of its final 410-page peer-reviewed report on gender dysphoria. ASPS relied on the report to inform its position on gender-affirming surgeries—though multiple reviewers criticized it as unscientific and political.

The term has no basis in medical or clinical practice. It originates instead from a conservative Catholic group called the Ethics and Public Policy Center (EPPC), which has been advocating for its usage for nearly a year, including through a direct appeal to HHS.

In a statement provided to Important Context, the group said it was pleased to see its language used in official HHS briefings.

“Public policy needs to be grounded in reality, not ideology,” the statement read. “We are very pleased that the Department of Health and Human Services has adopted our language, which accurately describes the procedures in question.”

Over the last year, the department has moved to curtail access to gender-affirming care by transgender and non-binary Americans and slashed related research. Secretary Robert Kennedy Jr. has claimed that he is restoring “gold-standard” and “evidence-based” science. But HHS’s adoption of terminology from the Christian Right underscores the extent to which ideology dictates policy under the Trump administration.

Founded in 1976, EPPC has a stated goal of promoting Judeo-Christian values in law, culture, and politics. The group was formed as a sort of alliance between ultraconservative Christians and Jews to advance religiously motivated social policies, which often target the LGBTQIA+ community. It previously published the non-peer-reviewed, religious journal The New Atlantis, and was identified by the Southern Poverty Law Center as part of an anti-LGBTQIA+ pseudoscience network.

EPPC was on the advisory board of Project 2025—the policy roadmap crafted by the far-right Heritage Foundation that appears to be guiding the Trump administration. In May 2025, President Trump appointed EPPC president Ryan Anderson, previously a Heritage fellow, to his Religious Liberty Commission.

The group’s former president, legal activist Edward Whelan, came under fire for his defense of Brett Kavanaugh amid sexual assault allegations in which he suggested a case of mistaken identity.

EPPC’s board of directors includes names like Robert George, a Princeton professor and leading voice of the Christian right, as well as right-wing legal activist Leonard Leo. Leo’s The 85 Fund funneled $5.3 million to EPPC between 2020 and 2024, according to federal tax filings. Other major right-wing donors include the Lynde and Harry Bradley Foundation, which gave $1.8 million between 2019 and 2024, and the Sarah Scaife Foundation, which gave nearly $1.9 million over the same period.

EPPC’s attempt to rebrand gender-affirming care goes back to last April. In a public comment submitted that month to Kennedy in support of an HHS proposal to eliminate “sex-trait modification” from the Affordable Care Act’s list of essential health benefits, the group urged HHS to use its term.

“We suggest that HHS adopt the term ‘sex-rejecting procedures’ to avoid several significant problems inherent with the term ‘sex-trait modifications,’ which we outline below,” the comment read.

The following month, EPPC published a report on why “gender-affirming care” and “gender-affirming treatment” ought to be replaced with its preferred term. The group claimed that the medically accepted terms were “biased in favor of gender ideology.”

In its statement, EPPC credited the authors of this report for HHS’ adoption of its language, “It is a testament to the quality of Rachel Morrison’s, Eric Kniffin’s, and Mary Hasson’s work that a growing number of officials, experts, and organizations are putting biological truth first when considering how best to respond to people who express discomfort with their sex.”

“Sex-rejecting procedures” is not the only anti-trans Christian Right term HHS has adopted. The department also uses “gender ideology” to refer to the recognition of transgender existence—a phrase that traces back to conservatives in the Catholic Church in the 1990s.

The medical consensus recognizes transgender and non-binary identities as legitimate. The American Medical Association, which this week followed ASPS in walking back support for gender-affirming surgery for minors, has previously noted that “Empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression.”

EPPC’s attempt to stigmatize transgender medical care is part of a larger right-wing campaign targeting transgender people. Last month, several genocide scholars warned that escalating right-wing efforts to marginalize transgender people—both legally and rhetorically, including actions by the Trump administration—meet the criteria of genocidal processes.

The transgender population already has a higher rate of suicidality than the general population and there is evidence suggesting anti-trans policies make the problem worse.

While “sex-rejecting procedures” is a new term, the idea that transgender individuals are either rejecting or denying their biological sex goes back years. A 2016 Heritage Foundation commentary argued that “many [people] have strong grounds to hold that one’s sex is an immutable characteristic that should be respected, not rejected or treated as a disease.”

In his January 2023 testimony before the Montana Senate Judiciary Committee, Jay Richards, today the vice president of social and domestic policy at Heritage and senior fellow at the Discovery Institute, declared that “gender affirming is in fact sex-denying.”

EPPC’s May 2025 report advocating for the use of “sex-rejecting procedures” argued that “sex denial” was imprecise, as "those who pursue a ’gender transition’ might not ‘deny’ their biology; indeed, the term ‘transgender’ itself concedes that the person’s asserted identity conflicts with the person’s sex.”

Correction 2/10/26: A previous version of this article said that EPPC currently publishes The New Atlantis. The journal has been independent since December 2017.