On Jan. 20, 2025, President Donald Trump issued Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” Commonly known as the “Two Sexes” executive order, the directive outlines a series of policies that claim to defend women’s rights by erasing the concept of gender identity. The order’s opening policy states: “Accordingly, my Administration will defend women’s rights and protect freedom of conscience by using clear and accurate language and policies that recognize women are biologically female, and men are biologically male.”
Beyond asserting a binary understanding of biological sex, the order ends the use of gender identity as a form of identification on passports, visas, and Global Entry cards; proposes freezing grant funding for programs supportive of “gender ideology”; and aims to rescind all Biden-era executive orders that affirm gender identity. While the language of the order promises a return to more “scientific” terminology, what truth—if any—lies within this promise, and what greater consequences might it have for both science and healthcare?
Meredithe McNamara, a practicing pediatrician and assistant professor of pediatrics at Yale School of Medicine, makes clear that any binary definition of biological sex or gender identity erases the complexity of the human experience. Biological sex encompasses a group of traits—chromosomes, hormones, anatomy—that don’t always align neatly into “male” or “female” categories. Gender identity, meanwhile, refers to a person’s internal sense of belonging in a gendered social group. While distinct, both biological sex and gender identity are multidimensional aspects of identity with firm biological underpinnings.
McNamara likens the reality of sex and gender identity to an impressionistic painting with a variety of colors and brush strokes—a collection of nuanced patterns that appear different when viewed from far away or at a certain angle.
“And then imagine if you create an image that’s just black and white and it’s a couple concrete shapes on a page,” McNamara said. “That’s the difference between reality and the way this political determination of sex and gender plays out.”
In addition to scientific inaccuracies, the order also threatens access to gender-affirming care. According to the Columbia University Department of Psychiatry, gender-affirming medical and psychosocial care has been shown to improve the mental health and well-being of transgender and gender-nonconforming youth. Trump’s order seeks to roll back this care, which would endanger the well-being of individuals who benefit from these treatments.
Another critical concern is the erasure of intersex individuals. By mandating that “male” and “female” are the only acceptable forms of self-identification, the executive order denies the existence of people with variations in sex characteristics. As McNamara emphasizes, both intersex and transgender people deserve equitable healthcare—but the “Two Sexes” order constructs new barriers through a rigid, anti-science framework. She notes that while intersex individuals comprise a small portion of the population, their needs are often misunderstood by politicians lacking clinical experience.
To McNamara, this executive order is symptomatic of a larger, alarming trend: the growing encroachment of policymakers into the practice of medicine. She argues that policies affecting people’s health should be treated as healthcare interventions—ones that are being imposed without consent or input from medical professionals and patients. In other words, the “Two Sexes” executive order’s endorsement of a binary system of identity has the power not only to influence healthcare but also to dictate it. The administration’s policymakers are not healthcare practitioners and lack the knowledge or qualifications to prescribe and restrict medical treatments.
The result is a profound intrusion into science and medicine—one that McNamara fears could signal what’s to come. “If the federal government is going to distort reality through policy and deeply interfere with scientific truth through borders and edicts, then basically anything else that we hold dear is on the table and is at risk,” McNamara said.