The Trump administration has cleared the way for people to report doctors who provide gender-affirming care to minors — and now says they can do so without violating federal medical privacy laws.

In new guidance issued Monday, the U.S. Department of Health and Human Services announced that health care workers, clinic staff, and even third parties may file complaints against providers offering gender-affirming care and, in many cases, even disclose protected patient information under HIPAA’s whistleblower provisions. Under HIPAA, the Health Insurance Portability and Accountability Act, medical professionals must keep a patient’s health information confidential. The guidance, issued under President Donald Trump’s January 28 executive order titled “Protecting Children from Chemical and Surgical Mutilation,” establishes a new federal portal to collect these reports.

Civil rights and LGBTQ+ health advocates say the move weaponizes patient privacy law against the very people it was designed to protect — and targets providers in a sweeping campaign to scare them out of delivering medically necessary care.

“At a time when trans health is already becoming more and more difficult for patients to access, this guidance is a page out of the anti-abortion activism playbook,” said Adrian Shanker, a national LGBTQ+ health policy expert and senior HHS official under the Biden administration. “That’s the clear goal: to instill fear among providers of best-practice transgender medicine. That’s unfortunate — but it’s also dangerous for the needs of transgender patients who rely on qualified providers with specializations and training to provide that care.”

The new policy doesn’t stand alone. It follows a sweeping federal letter issued just days earlier by the Centers for Medicare and Medicaid Services advising state Medicaid agencies that they may restrict or eliminate coverage of gender-affirming care for minors. The CMS letter explicitly referenced federal sterilization regulations — originally created to protect against coerced sterilization—as justification for blocking puberty blockers and hormone therapy. Advocates called it a dangerous distortion of the law.

The online complaint form from HHS invites users to name doctors, identify hospitals or clinics, and describe the alleged “mutilation of children” — a term the administration uses to refer to evidence-based gender-affirming care. The department encourages people to cite the executive order and offers guidance on reporting providers to multiple federal agencies.

Shanker said the real consequence isn’t theoretical — it’s already happening. “It’s two sides of the same coin because it’s diminished access to care — period,” he told The Advocate. “If providers become fearful of providing the care, fewer providers will offer it.”

For those on the front lines, that fear is palpable. A pediatric gender-affirming care provider at a major children’s hospital in the Midwest told The Advocate that they’re seeing the trust that underpins medicine unravel in real time.

Related: New Trump Medicaid directive attacks trans people’s access to gender-affirming care

“It feels very chilling,” the provider said, speaking on the condition of anonymity due to security concerns. “We’ve been under the microscope for a long time, but now it feels like they’ve got a free pass to do whatever they want. It’s terrifying for our patients, and it’s terrifying for us as providers.”

The provider said colleagues were asked where their “line in the sand” was at a recent staff meeting—what it would take to stop practicing.

“All of the prescribing providers said, ‘Jail, I guess,’” they said. “That’s my line in the sand. And it feels like we’re inching closer to that every day, especially with this new hotline to report things.”

Even inside their own hospital, they no longer feel safe.

“I know there are people who work here who don’t support the gender program. I’ve heard them say things like, ‘This is over the top — why don’t these kids just get therapy?’ And now they could call this hotline and report me. What does that do to my license? To my safety as a provider?”

The guidance, legal experts say, is both sweeping and unlawful.

“This is blatantly unlawful for multiple reasons — because it discriminates against transgender people because it violates statutory and constitutionally protected medical privacy rights, and because it has no legal basis and is therefore arbitrary and capricious,” Shannon Minter, legal director of the National Center for Lesbian Rights, told The Advocate.

He added that the policy deliberately distorts the concept of whistleblower protection. “This is stretching the definition of a whistleblower to absurd lengths and is plainly designed to encourage the harassment of doctors and others providing needed medical care to transgender people.”

The provider said the guidance only deepens patients’ mistrust of the medical system. Many already wait a year or more to be seen.

“Our waitlist has never been shorter than a year,” they said. “By the time patients get to me, they’ve often had multiple suicide attempts. Nobody walks in and gets hormones. And I’ve never had a minor patient undergo genital surgery—ever.”

Still, the damage is done. “I don’t tell people what I do anymore. I used to say I worked in pediatrics and gender health. Now, I just say pediatrics. I’ve scrubbed all my public social media. The network of providers I refer to has gotten smaller — I only trust people I know personally. That’s what it’s come to.”

When asked what they wanted the public to understand about the care they provided, the provider didn’t hesitate.

“These medical treatments are lifesaving. I’ve seen adolescents go from depressed and suicidal to just thriving and living their best selves. If anyone saw what I see in clinic every day, they’d know this is care that works.”

The guidance claims whistleblowers are protected under several federal laws, including the False Claims Act and the Church Amendments, and outlines how HIPAA’s whistleblower provisions can shield those who report providers to oversight agencies or law enforcement.

However, medical experts and legal advocates point to a glaring omission: gender-affirming care is supported by every major medical association, including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society.

“Evidence-based policymaking would rectify this,” Shanker said. “Instead, they’re using political rhetoric around so-called mutilation rather than following the science.”

Minter is confident that if enforced, the policy would be struck down. “This is yet another example of this administration overreaching and seeking to dictate private medical decisions that belong to families and individuals — not the government.”