The rule contains an explicit definition of gender identity that states a person can claim to be male, female, neither, both, or some combination of the two, said Roger Severino, director of the DeVos Center for Religion and Civil Society at the Heritage Foundation.

“It’s now federal policy that you could be both male and female in some combination,” he said. “That’s a pretty radical statement, and impossible to know what it really means.”

If a medical doctor, based on biological evidence, sees a male patient, but the patient claims to be a female, the doctor must treat the patient as a female. Failure to do so could leave the doctor vulnerable to lawsuits, lost federal funding, and federal investigation by the Office of Civil Rights, the HHS arm implementing this policy.

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The regulations provide an example of how a doctor could discriminate against a transgender patient, Severino said. If two people are both candidates for a hysterectomy, one a woman with uterine cancer and the other a woman who wants fewer woman parts to look more like a man but is otherwise perfectly healthy, the doctor could be found to be discriminating against the second woman by choosing to treat the woman with cancer instead. The rule states all the second woman would need to attempt to force the surgeon to perform an elective hysterectomy is a note from a psychologist affirming her desire to become a man, Severino said.


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