Editor's note: Since this version of the story was published on March 3, Judge Brandan Hurson joined Judge Lauren King in granting a preliminary injunction against the administration. Additionally, in a March 4 address, President Donald Trump called on Congress to codify his blocked executive orders on gender-affirming care restrictions into law.
A hold on President Donald Trump's effective ban on gender-affirming care was extended on Feb. 28 when a federal judge granted state plaintiffs an indefinite preliminary injunction.
U.S. District Judge Lauren King, of the United States District Court for the Western District of Washington, had previously granted a two-week preliminary injunction against portions of two Trump executive orders, which was set to expire on Friday.
After hearing arguments the day prior, she largely sided with plaintiffs that the executive orders violated the Constitution's separation of powers by directing revocation of funds appropriated by Congress away from medical institutions that provide gender-affirming care. The judge also said the federal government was violating the equal protection guarantee under the Fifth Amendment.
“The president’s disregard for the Constitution is obvious and intentional,” Washington Attorney General Nick Brown, who argued for the plaintiffs, said in a celebratory release. “But once again, states and the courts have stepped up to affirm the rule of law and the values that hold us together as a nation.”
Washington, Minnesota and Oregon and three anonymous physicians brought their case against the administration on Feb. 7, and were later joined by Colorado.
Trump's executive orders instructed agencies to cut off federal funding to any organizations providing gender-affirming care services to patients aged 19 years or younger, and to eliminate grant funds that "promote gender ideology." The orders had led several health systems to reportedly pause or reassess their research and gender-affirming care services, interrupting the care for transgender plaintiffs and others.
In her order, King noted that language in the executive order against gender-affirming care for youth's extends beyond its purported goal. As written, it "would prevent federally funded medical providers from providing necessary medical treatments to transgender youth that are completely unrelated to gender identity. For example, a cisgender teen could obtain puberty blockers from such a provider as a component of cancer treatment, but a transgender teen with the same cancer care plan could not."
The second executive order "denies the very existence of transgender people and instead seeks to erase them from the federal vocabulary altogether and eliminate medical care for gender dysphoria at federally funded medical institutions. Such '[a] bare desire to harm a politically unpopular group cannot constitute a legitimate governmental interest,'" she wrote, citing precedent.
The Trump administration is required to provide written notice of the preliminary injunction to all its agencies, employees, contractors and grantees by March 6, King ordered. The preliminary injunction is in effect until further developments in court.
King was the second federal judge to have granted a temporary restraining order against the president's gender-affirming care restrictions.
U.S. District Judge Brendan Hurson had granted a short-term block in a case filed by the American Civil Liberties Union, Lambda Legal, an LGBTQ+ civil rights organization; PFLAG National, an LGBTQ+ advocacy group; and GLMA, an association of health professionals focused on LGBTQ+ equality, jointly filed their lawsuit on Feb. 4 in the U.S. District Court for the District of Maryland on behalf of transgender young adults and adolescents and their families.
Hurson is also considering a preliminary injunction in that case, where a temporary restraining order is set to expire on March 5.
"Across the country, this unlawful order from the president has sown fear among transgender youth and confusion among their providers,” said Joshua Block, senior staff attorney for the ACLU's LGBTQ & HIV Project, in a statement. “...Providers who’ve suspended healthcare for their transgender patients should be left with no doubt that they can lift those suspensions and continue to provide healthcare and act in their best medical judgment without risking their funding or worse."
A coalition of 15 blue state attorneys general have also voiced their intent to protect gender-affirming care and challenge the Trump administration's authority to restrict it via an executive order.
Executive orders cast providers, transgender patients in limbo
The president's day-one orders restricted the federal government from funding, sponsoring, promoting, assisting or supporting “the so-called ‘transition’ of a child from one sex to another,” and applied to those younger than 19 years old.
They empowered the Department of Justice to help enforce existing restrictions on the gender-affirming care services (currently active in 26 states) and threatened an end to research funding and expulsion from the Medicare program for healthcare providers who provide these services, among other measures.
The orders forced swift changes among several major hospitals and health systems that had been providing the care—which is supported by major medical groups and comprise a range of social, behavioral and medical interventions, the latter of which include puberty-blocking medications, hormone treatments and, in rarer cases, surgical procedures.
Among those reported to have begun canceling, suspending or pausing such services are NYU Langone Health, the Children’s National Hospital, the Northwest Washington Hospital, Denver Health, UC Health, UVA Health and the VCU Health/Children’s Hospital of Richmond. The Lurie Children’s Hospital and the Children’s Hospital of Philadelphia are reportedly “reviewing” their gender-affirming care services in light of the order.
In a statement announcing its policy change, Denver Health said the loss of federal program funding “would critically impair our ability to provide care for the Denver community.” It also recognized that Trump’s order “will impact gender-diverse youth, including increased risk of depression, anxiety and suicidality.”
The order has garnered condemnation from groups supporting LGBTQ+ rights and liberal politicians. Meanwhile, a celebratory press release from the White House outlined reports of these providers’ service closures, saying the EO was “already having its intended effect.”
Some providers in deeply blue states, such as Mass General Brigham in Massachusetts, told press their gender-affirming care will continue for now but could change their policies “should agencies issue regulations implementing these changes and/or legal challenges are exhausted.”
Legal opposition takes shape
The advocacy groups' lawsuit seeks a declaration that the portion of Trump's executive order pertaining to gender-affirming care be declared unconstitutional and unlawful.
It argues that the order and others issued by the president "are part of a government-wide effort ... to restrict legal protections and essential services for the transgender community."
It alleges discrimination against the transgender individuals on the basis of sex and disability, as well as a violation of the Equal Protection Clause of the Fifth and Fourteenth Amendments, the plaintiffs allege.
The order also infringes upon "parent's fundamental rights by overriding the aligned judgment of parents, adolescents and their doctors regarding medically necessary care," violates healthcare institutions' freedom of speech by discriminatorily revoking their grants, and exceeds the president's authority by cancelling Congressional appropriations, they alleged.
“Good and decent parents of transgender kids should never be in the frightening position of having their child’s prescribed, medically necessary care canceled at the whim and threat of a politician. But that’s exactly what President Trump’s executive order did to PFLAG families with trans youth and young adults nationwide,” said Brian K. Bond, CEO of PFLAG National, said in a statement celebrating the temporary restraining order. “Today’s decision rights a grievous wrong to our nation's families and children, and PFLAG families will be vigilant to ensure our transgender loved ones receive the healthcare they need—as this legal ruling demands.”
Their lawsuit filing followed reports of a brewing head-to-head in New York. As reported by The New York Times, the state’s attorney general, Letitia James, sent a warning letter to providers and other organizations at the top of the week saying that “regardless of the availability of federal funding” they could risk violation of New York anti-discrimination laws should they deny care to pediatric transgender patients.
“Anyone who seeks healthcare in New York should be able to receive it,” James wrote of her stance on X. “Our state laws are clear that no one can be discriminated against based on sex, gender identity or sexual orientation.”
Shortly after, a coalition of 15 blue state attorneys general voiced their intent to protect gender-affirming care and challenge the Trump administration's authority to restrict it via in executive order. Citing the recent court orders that temporarily halted a sweeping government funding freeze, they said the administration is required to continue funding organizations that provide these services.
"If the federal administration takes additional action to impede this critical funding, we will not hesitate to take further legal action," the attorneys general wrote in a joint letter. "State attorneys general will continue to enforce state laws that provide access to gender-affirming care, in states where such enforcement authority exists, and we will challenge any unlawful effort by the Trump Administration to restrict access to it in our jurisdictions."
Conversely, Virginia Attorney General Jason Miyares reportedly cited Trump’s order in a memo to VCU and UVA Health telling the organizations to immediately end their gender-affirming care services.
Of note, a case addressing a Tennessee bill prohibiting gender-related medical treatments for minors is currently being considered by the Supreme Court. A decision is expected by June.