Children are the “low-hanging fruit” in a longer effort to end gender-affirming care for all Americans, an official at a Trump administration-aligned thinktank recently said.

Bans on medical transition comprise just one part of the larger, unprecedented assault on transgender rights mounted by a coordinated campaign of mostly conservative activists and policymakers in the US in recent years. So far, these restrictions have primarily affected minors. But leaders in the emboldened movement have begun to more openly admit their desire to attempt to end gender-affirming care for adults, too.

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The American First Policy Institute (AFPI) held an event in Washington DC last month focused on transgender policy “accountability and reform”. Toward the end of the evening, a mother with two children who medically transitioned as adults asked about AFPI policy on “adult transition and whether we can protect all people from being medically harmed by transition”.

Jennifer Bauwens, who leads research and policy priorities on “family issues” at the AFPI, responded: “At AFPI, we care about this issue from no matter what age you are. I think sometimes in policy, we pick the low-hanging fruit and we get the win where we can so that we can keep forging ahead so that ultimately we can protect all people because that is the goal.”

She concluded: “We’re not going to quit until we see this thing totally and completely overturned.”

An AFPI spokesperson provided a statement on behalf of Bauwens, saying, in part: “AFPI prioritizes ‘first, do no harm’ and research-backed healthcare over a model that rests on weak evidence that long-term studies have revealed have persistently poor outcomes for all people. We protect children first, because they are the most vulnerable and cannot provide informed consent to permanent, sterilizing procedures.”

The spokesperson did not provide a statement on behalf of the organization as a whole.

The AFPI’s goals matter. The thinktank wields significant power in terms of policy and personnel. Last year, the AFPI claimed to have at least 73 staffers working for Donald Trump in his second term, including at least eight in cabinet-level positions. In a press release, the AFPI boasted the Trump administration had implemented, at least partially, “more than 90%” of its policy agenda.

Formed by Trump alumni between his terms, the AFPI is just one of several conservative organizations that have trained their considerable influence and budgets on transgender Americans. The movement has helped Republican state lawmakers pass bills targeting trans youth in at least half the country. The bills ban young trans people from accessing puberty blockers or cross-sex hormones or from playing on sports teams or using private facilities in line with their identity.

Trump seized on that momentum on the campaign trail and in office. Within weeks of his second term, he signed five executive orders restricting the rights of transgender people in the military, schools, sports, doctors offices and legal documents such as passports. Restrictions on medical transition have so far extended to children, defined as under 19, and adults incarcerated in federal prison.

Asked over email whether the White House intended to seek a ban on medical transition for adults, spokesperson Kush Desai said: “The administration will continue to defend girls’ sports and block unscientific and irreversible child transition procedures.”

At the Washington event, a former Trump staffer gave insight into the president’s thinking in the early days of his second term. Scott Centorino spent last year serving as a special assistant on Trump’s Domestic Policy Council, where gender was part of his portfolio. He joined the council from Do No Harm, an organization that advocates against medical transition care for minors.

The president, Centorino told the crowd, gave him “pretty much a blank check”.

“I’m a little hesitant to even say that, but it was very clear that I could not be too aggressive,” Centorino said, according to the recording. “There was essentially no leash. I had endless runway to work with, and that is a credit, 100%, to the president of the United States.”

During the AFPI event, Centorino pointed to two proposed rules from the Center for Medicare and Medicaid Services (CMS) as examples of that “aggression” in action. One of these would ban every hospital in the country that participates in the programs from providing gender-affirming care to young people.

“That is a nuclear weapon,” he told the audience. “Only in an administration as willing to rock the boat and be disruptive as this one would that have ever happened.”

Both of the proposed CMS rules pertain to minors, but one of them, like Trump’s earlier executive order, defines “children” as people under 19 – a designation which in all but a few states includes legal adults.

Centorino said in an interview that when it came to restrictions on medical care, the White House was “laser focused” on youth. He said there was internal disagreement regarding adults.

“There are, of course, different views in the administration about how much to prioritize or make policy changes that are relevant to adults, because there’s disagreement in the public about that,” Centorino said. “The writ, when it comes to medical intervention, was very clear: until and unless kids are fully protected – which they’re still not fully protected – until that happens, that’s our priority.”

Bauwens appeared to share a different perspective with the audience at the AFPI event: “As we forged ahead with those who are younger than 18, it’s helped change the public opinion. And as we keep shifting that belief system, it’s going to make more room to protect more people.”

On the day of the event, the AFPI published a model state bill authored by Bauwens that escalates efforts to ban another element of the transition process: social transition.

In recent years, states and school boards across the US have implemented rules and policies preventing teachers from using transgender children’s chosen name or pronouns without parental consent.

But Bauwens’ model bill targets licensed mental-health professionals. Under the bill, therapists or counselors could not “initiate, recommend, or facilitate social transition for a minor” – even if a parent requests it. Simply referring to a transgender child by their chosen name could cost a therapist their license or civil penalties.

Meanwhile, the supreme court last month ruled against a law banning talk “conversion therapy” for LGBTQ+ children in Colorado, arguing that the law violates the first amendment.

Following that ruling, Bauwens said in a press release: “Therapists have a sacred duty to protect the best interests of the clients entrusted to their care, and that duty requires the freedom to listen, ask hard questions, and speak truthfully without fear of government punishment … When the state imposes authoritarian speech restrictions on counseling, it undermines the therapeutic relationship and makes real clinical care impossible.”

• This article was produced in partnership with Documented, an investigative watchdog and journalism project. Phoebe Petrovic is a senior democracy researcher with Documented