The Biden administration’s move to add gender identity as a protected category to anti-discrimination rules in healthcare has prompted concerns that physicians will be subject to government pressure to administer gender transition care despite their own medical judgment.

The Department of Health and Human Services issued a new proposed rule this week to revise anti-discrimination guidelines for every health entity that receives financial assistance directly or indirectly through HHS, which can include state or local health agencies, hospitals, health insurers, physician’s practices, pharmacies, and nursing facilities. The new proposed rule would return to the 2016 version’s definition of sex discrimination to include gender identity and sexual orientation. The Trump administration had rewritten the 2016 rule to exclude protections for transgender people, considering only biological sex, not gender identity.