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No fewer than 11 states and two territories have agreed to a recent directive from the federal government to eliminate mentions of transgender issues and the existence of transgender and non-binary individuals from a national sexual health program, authorities stated.

The administration established a Monday deadline for removing these references, threatening the loss of millions in federal funds. Nearly all of the agreeing jurisdictions have GOP-led lawmaking bodies and predominantly GOP state leaders.

Court Battles and Funding Disputes

An additional sixteen jurisdictions and the nation's capital have initiated legal action challenging the administration's demand, arguing it infringes on legislative power, which established the $75 million sexual health initiative, known as the PREP initiative.

All states participating in the legal challenge are governed by Democratic governors.

In a late Monday court order, a federal judge prevented the HHS agency, which oversees the program, from cutting funding to the Democratic states if they do not adhere.

“HHS fails to show that the new grant conditions are justified, nor does it offer any valid reason, other than an excuse, for its actions,” wrote the judge, a U.S. district judge in the state. “The department offers no proof that it made informed determinations or considered the legal goals.”

Program Goals and Government Scrutiny

Prep aims to inform adolescents on positive interactions and how to avoid unplanned parenthood and the transmission of sexually transmitted infections.

In the spring, the Trump administration required all states and territories obtaining Prep funds to submit a version of their educational materials to HHS and its subsidiary, the ACF office, for a health content assessment.

Four months later, the government sent letters to 46 states and territories, stating that, during the evaluation, it had found “material in the curricula that fall outside the scope of Prep’s authorizing statute.”

In particular, the administration said it had identified evidence of “gender ideology,” a term often used by conservative factions to describe the notion that gender is a changeable social construct and that trans and non-binary people are real.

Notable Cases of Required Alterations

The administration instructed one state to remove a lesson that stated: “Young people may express themselves in ways that differ from their biological sex.”

It told North Carolina to eliminate a line from a educational module that stated: “People of all sexual orientations and gender identities need to know how to prevent unplanned pregnancy and infections.”

Moreover, sex educators in many jurisdictions could no longer be told to “demonstrate acceptance and respect for all participants, regardless of personal characteristics, including race, heritage, religion, social class, sexual orientation or identity,” based on the letters dispatched to states.

Government Comments and Jurisdictional Reactions

“Accountability is coming,” said a federal official, interim leader of the Administration for Children and Families, in a statement. “Government money will not be used to poison the minds of the next generation or promote harmful political doctrines.”

Several jurisdictions and territories confirmed they would eliminate the references or had completed the process. These include Alaska, Georgia, Iowa, Kentucky, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, West Virginia and Wyoming, as well as the two territories.

Two other states, the states, said their educational programs never included the terminology referenced in the government's notices.

Effects on Adolescents and Mental Health

Together, these jurisdictions are home to over 120k transgender individuals between the ages of 13 and 17, according to estimates from a research institute.

“When the aim is to support youth and give them a safe space, I’m not sure why we are targeting the most vulnerable youth in the population,” commented Cindi Huss, who heads Rise that provides sex education in one state.

“When the government says that there’s something wrong with you and the teachers aren’t allowed to tell you things or they have to disclose your identity to family – when you know that that’s not secure – that’s horrible for mental health.”

Nearly half of trans and non-binary youth contemplated self-harm in the past year, based on a 2024 survey from a suicide-prevention group. Educational backing for these youths is associated with lower rates of self-harm attempts, the group found.

Earlier Incidents and Ongoing Disputes

Earlier this year, the Trump administration instructed California to cut references to gender identity from its educational program.

When the Democratic-led state refused, the government revoked its funding, eliminating about $12 million in government money and halting health initiatives in schools, juvenile detention facilities and care facilities.

The California health department is appealing the withdrawal. So far, it has been unable to replace the lost funding.

The government has also told educators who receive funding from two other federal sex education initiatives, the $50 million SRAE program and the $101m TPPP initiative, that they may not teach about “gender-related concepts.”

An recent judicial ruling prevented the administration from altering one program, while the latest ruling stops it from modifying SRAE in the Democratic states that sued over the initiative.

The Administration for Children and Families did not provide a prompt reply to a request for comment.