On January 20th, 2025, President Trump issued Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”. With this executive order, Trump has made it the policy of the United States to recognize only two sexes, male and female. On February 19th, 2025, the U.S. Department of Health and Human Services took action to support this executive order and provided a list of definitions the federal government must use regarding sex-based legislation and policy. HHS guidance now defines sex as “a person’s immutable biological classification as either male or female”, a female as “of the sex characterized by a reproductive system with the biological function of producing eggs (ova),” and a male as “a person of the sex characterized by a reproductive system with the biological function of producing sperm.”
Trump intends for this executive order and associated policy changes within HHS and other areas of the federal government to restrict ideas of fluid sex and gender expression that were embraced by the prior administration. Theexecutive order states, “This unhealthy road is paved by an ongoing and purposeful attack against the ordinary and longstanding use and understanding of biological and scientific terms, replacing the immutable biological reality of sex with an internal, fluid, and subjective sense of self unmoored from biological facts.” However, this executive order may be further from biological reality than the Trump administration asserts. District Judge Ana Reyes recently questioned Trump’s legal team regarding the order and its effect on transgender people serving in the military, arguing that the order fails to acknowledge that some people are born intersex due to various biological differences in their chromosomes, hormone expression, and hormone metabolism. On this point, Trump’s lawyers admitted they lacked knowledge of how chromosomes can differ among individuals and struggled to answer questions on the motive behind the executive order.
Judge Reyes’ criticism of the order highlights the main issues of Trump’s order not only from a medical and biological perspective but also from a policy perspective. First, the order does not make any mention of naturally occurring conditions that would put someone outside the male/female gender binary. Some individuals are born with chromosomes other than XY or XX, such as XXX (Trisomy X), XXY (Klinefelter Syndrome), or XO (Turner Syndrome). Some individuals may also have conditions that affect their ability to express or metabolize hormones including androgens and estrogens (such as congenital adrenal hyperplasia or complete androgen insensitivity syndrome), which then influences how their sex organs develop internally and externally. This wide range of biological differences provides scientific support to the idea that biological sex naturally falls along a spectrum rather than being solely restricted to two options.
Second, Trump’s attempt to make policies in the name of biological facts that are not based on real medical science may create more problems than it solves. Judge Reyes highlighted the issues this executive order creates with the ability of transgender people to serve our country in the military, but the order will likely affect the ability of transgender and intersex people to participate in competitive sports and will cause problems for female transgender prisoners who will now need to be moved from women’s prisons to male prisons. Although transgender and intersex individuals make up a small portion of athletes or prisoners, these changes will cause a significant disturbance in their lives and send a message to all Americans who fall outside the male/female gender binary that the government has no interest in acknowledging the struggles they face that stem from sex and gender identity. This decision sets a dangerous precedent in federal policymaking that the current administration will commandeer science in order to engrain conservative ideals into society. This strategy may also be used to tackle other controversial health law issues, such as hindering federal approval for certain vaccines. Although this executive order is already facing numerous legal challenges with several different plaintiffs moving for preliminary injunctions, the decision to use science as a guise to pursue cultural change is a bold step during Trump’s first several months in office this term.