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No fewer than 11 states and a pair of regions have complied with a recent demand from the federal government to remove mentions of gender identity and the presence of trans and non-binary people from a federal sexual health program, authorities stated.

The government established a Monday deadline for removing these mentions, warning the withdrawal of millions in federal funds. Nearly all of the agreeing jurisdictions have GOP-led state legislatures and mostly Republican governors.

Court Battles and Financial Conflicts

An additional sixteen jurisdictions and Washington DC have initiated legal action against the government's requirement, claiming 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 state executives.

In a late Monday judicial ruling, a U.S. judge blocked the Department of Health and Human Services (HHS), which manages the program, from cutting funding to the Democratic states if they do not adhere.

“The agency does not demonstrate that the updated requirements are reasonable, let alone offer any valid reason, other than pretext, for its actions,” wrote the judge, a U.S. district judge in the state. “HHS provides no evidence that it made informed determinations or took into account the legal goals.”

Initiative Aims and Federal Review

The program aims to educate teenagers on positive interactions and how to prevent pregnancy and the spread of STIs.

In April, the Trump administration required all jurisdictions obtaining Prep funds to submit a copy of their educational materials to the department and its subsidiary, the ACF office, for a “medical accuracy review”.

By late summer, the administration dispatched notices to 46 states and territories, stating that, during the evaluation, it had discovered “content in the educational programs that fall outside the purview of Prep’s authorizing statute.”

Specifically, the administration said it had uncovered evidence of “gender ideology,” a phrase often used by conservative factions to refer to the notion that identity is a fluid social construct and that transgender individuals are real.

Notable Cases of Required Alterations

The government instructed Illinois to drop a lesson that said: “Young people may identify in ways that don’t conform with their biological sex.”

It instructed another state to delete a sentence from a middle school lesson that stated: “People of all sexual orientations and gender identities need to know how to avoid pregnancy and STDs.”

Additionally, health instructors in numerous states could no longer be told to “demonstrate acceptance and respect for all students, regardless of individual traits, including ethnicity, heritage, faith, economic status, sexual orientation or identity,” according to the notices sent to jurisdictions.

Official Statements and Jurisdictional Reactions

“Oversight is imminent,” said Andrew Gradison, acting assistant secretary of the ACF office, in a announcement. “Federal funds will not be used to negatively influence of the youth or promote dangerous ideological agendas.”

Multiple states and territories confirmed they would eliminate the references or had completed the process. These include eleven specific states, as well as the U.S. Virgin Islands and the Northern Mariana Islands.

Another pair of jurisdictions, the states, said their educational programs never included the terminology referenced in the government's notices.

Effects on Adolescents and Psychological Well-being

Together, these states are inhabited by more than 120,000 trans people between the ages of 13 and 17, based on estimates from a university department.

“When the aim is to support youth and give them a secure environment, I’m not sure why we are targeting the at-risk teenagers in the community,” commented Cindi Huss, who leads Rise that provides sex education in one state.

“If authorities state that there’s something incorrect about you and the educators aren’t allowed to provide information or they have to disclose your identity to family – when you know that that’s not safe – that’s detrimental to psychological well-being.”

Almost 50% of transgender adolescents seriously considered suicide in the past year, based on a 2024 survey from a mental health organization. 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 federal government instructed California to cut references to transgender topics from its educational program.

When the jurisdiction refused, the government revoked its funding, eliminating approximately $12m in government money and halting health initiatives in schools, youth centers and care facilities.

The state agency is challenging the withdrawal. So far, it has been unable to make up for the lost funding.

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

An early October judicial ruling prevented the government from changing one program, while the latest ruling prohibits it from changing SRAE in the Democratic states that sued over Prep.

The Administration for Children and Families did not immediately respond to a inquiry.