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At least 11 states and a pair of regions have complied with a recent demand from the Trump administration to eliminate references of transgender issues and the presence of transgender and non-binary individuals from a federal sexual health program, officials confirmed.

The government set a Monday deadline for removing these mentions, warning the loss of substantial government funding. Nearly all of the complying states have GOP-led lawmaking bodies and predominantly GOP state leaders.

Court Battles and Financial Disputes

Sixteen other states and the nation's capital have filed a lawsuit challenging the government's requirement, claiming it infringes on legislative power, which created the $75m sexual health initiative, known as the PREP initiative.

All states involved in the lawsuit are led by Democratic governors.

In a late Monday judicial ruling, a U.S. judge prevented the Department of Health and Human Services (HHS), which oversees Prep, from cutting financial support to the Democratic states if they do not adhere.

“The agency does not demonstrate that the updated requirements are justified, let alone offer any valid reason, other than pretext, for its decisions,” wrote Ann Aiken, a federal jurist in Oregon. “The department offers no proof that it made factual findings or considered the statutory objectives.”

Program Goals and Government Scrutiny

Prep seeks to inform teenagers on positive interactions and how to avoid pregnancy and the transmission of sexually transmitted infections.

In April, the Trump administration demanded all states and territories obtaining Prep funds to submit a copy of their curriculum to HHS and its agency, the ACF office, for a health content assessment.

By late summer, the administration dispatched notices to 46 states and territories, stating that, during the evaluation, it had found “material in the educational programs that fall outside the purview of the program's legal framework.”

Specifically, the administration claimed it had uncovered evidence of “gender ideology,” a term often used by rightwing factions to describe the notion that identity is a fluid social construct and that transgender individuals exist.

Specific Examples of Required Alterations

The government instructed one state to drop a lesson that stated: “Adolescents may express themselves in ways that differ from their biological sex.”

It instructed another state to eliminate a line from a middle school lesson that read: “People of all sexual orientations and gender identities need to know how to avoid unplanned pregnancy and infections.”

Moreover, health instructors in numerous states could no longer be instructed to “show tolerance and understanding for all students, irrespective of personal characteristics, including race, cultural background, faith, economic status, orientation or gender identity,” according to the notices dispatched to jurisdictions.

Official Statements and State Responses

“Oversight is imminent,” declared Andrew Gradison, interim leader of the Administration for Children and Families, in a statement. “Government money will not be used to poison the minds of the youth or promote dangerous ideological agendas.”

Several states and regions confirmed they would remove the content or had already done so. These include eleven specific states, as well as the U.S. Virgin Islands and the Northern Mariana Islands.

Another pair of jurisdictions, Alabama and South Dakota, said their Prep curricula never included the terminology referenced in the government's notices.

Effects on Adolescents and Mental Health

Together, these states are home to more than 120k trans people between the ages of 13 and 17, according to projections from a university department.

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

“If authorities state that there’s something wrong with you and the educators aren’t allowed to provide information or they have to out you to your parents – 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 reduced numbers of attempted suicide, the organization found.

Earlier Incidents and Ongoing Disputes

Previously, the Trump administration ordered California to remove mentions to transgender topics from its educational program.

When the Democratic-led state refused, the government withdrew its Prep grant, cutting about $12 million in government money and halting health initiatives in schools, juvenile detention facilities and group homes for foster children.

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

The government has also informed educators who receive funding from additional national programs, the $50 million Sexual Risk Avoidance Education (SRAE) and the $101 million Teen Pregnancy Prevention Program (TPPP), that they cannot teach about “gender-related concepts.”

An recent judicial ruling prevented the administration from changing one program, while the Monday court order prohibits it from changing the other program in the Democratic states that challenged Prep.

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