Federal judge blocks Trump order on health care for transgender youth

A federal judge on Thursday blocked executive orders signed by President Donald Trump that target transgender people and their health care, giving temporary relief to LGBTQ individuals and their families, who braced for legal battles to continue.

U.S. District Judge Brendan A. Hurson, who was appointed in 2023 by President Joe Biden, granted a temporary restraining order effective for at least 14 days after a hearing in federal court in Baltimore. The government is expected to appeal the decision, which legal experts said could ultimately go to the Supreme Court.

“This is a population with an extremely higher rate for suicide, poverty, unemployment, drug addiction,” Hurson said during the hearing. Abruptly stopping their health treatments, he said, would be “horribly dangerous for anyone, for any care, but particularly for this extremely vulnerable population.”

Despite the ruling, patients and their families remained in limbo as it was unclear whether hospitals that had suspended care planned to resume treatment. A judge in Seattle is also set to hold a hearing Friday on a similar challenge to the transition care order.

Transgender minors and advocacy groups sought an injunction to roll back orders Trump signed to officially recognize only male and female sexes and to attempt to end federal support for providers of gender transition care for people under the age of 19.

The latter order prompted some hospitals to suspend or scale back gender transition care, leaving patients and parents reeling. Trump’s orders are part of a broader effort by the administration to bar transgender people from everyday life, including sports and military service.

Seven anonymous transgender individuals younger than 19 sued the Trump administration on Feb. 4, along with advocacy groups PFLAG, which represents parents, families and friends of LGBTQ+ people, and GLMA, which supports LGBTQ+ health care providers. Lambda Legal and the American Civil Liberties Union filed the lawsuit on behalf of the groups in federal court in Baltimore. One of the plaintiffs has since dropped out of the suit, leaving six.

The judge said that several members of Congress have introduced bills to pull funding for gender-affirming care but that those bills have not been passed. Supreme Court precedents say the president cannot unilaterally withhold funding that Congress has approved.

“This is the president imposing these restrictions in defiance of the democratic process,” said Joshua Block, senior attorney for LGBTQ and HIV projects at the ACLU, who argued on behalf of the transgender plaintiffs and their families.

The Trump administration’s moves have created a crisis for health care providers across the country, Block said, because officials are threatening to pull funds “immediately” for any provider who provides gender-affirming care. It is forcing some to choose between treating transgender patients and other classes of patients, he said.

“What makes these orders so pernicious is the terrorizing effect they’re having on hospitals,” Block said, describing the administration’s moves as “holding a gun to their heads.”

Justice Department attorney Harry S. Graver said the transgender patients’ arguments were “too abstract,” because Trump was not imposing a nationwide ban on gender-affirming care or instituting a freeze on all federal funding for such procedures.

“The president is charging the executive branch with exploring a policy goal,” he said. “It simply cannot be unlawful for the president to tell the executive branch, ‘I want you to do X,’ ” in a lawful way.

The judge disagreed. Hurson called the administration’s arguments that the orders were merely asking agencies to explore policy changes – and not pulling their funding – “almost disingenuous.”

“We have a clear-cut issue, and we have plaintiffs who are suffering because of it,” Hurson said.

In a separate lawsuit, attorneys general in Washington state, Oregon and Minnesota argue the Trump order on gender-affirming care represents an attack on transgender youths and their families, as well as on doctors and medical institutions providing critical care. A hearing on that case is set for Friday in Seattle.

In a court filing, the Justice Department argued that the president has legal authority “to condition certain federal grant funding on his policy preferences” and that the federal agencies being sued “have not finally implemented the (executive order] directives, let alone revoked any particular grants relied upon” by the plaintiffs. It also argued that “many states and other countries have gone further and enacted laws and policies to restrict gender-affirming care for minors.”

The gender transition care order seeks to cut federal funding, including public insurance payments from Medicare and Medicaid, for health providers that offer such care to people under 19. A loss of federal dollars could jeopardize care not just for transgender young people, LGBTQ+ advocates say.

Within days of the order, hospitals in the D.C. region and beyond paused care. Some halted all treatment, while others blocked prescriptions of puberty blockers and hormone therapy or gender-affirming surgeries. The moves drew protests, including a rally in Baltimore ahead of Thursday’s court hearing.

Hospitals that suspended care, including Children’s National Hospital in D.C. and clinics affiliated with the University of Virginia in Charlottesville and Virginia Commonwealth University in Richmond, did not immediately respond to requests for comment.

In the past five years, more than half of states have banned doctors from offering transition health care to minors, including medication. Yet most transgender children do not take medication to assist with their transition.

State attorneys general issued dueling guidance on Trump’s order for hospitals and health-care providers, leaving health-care administrators to sift through the political and legal directives.

Virginia Attorney General Jason S. Miyares (R) wrote in a Jan. 30 memo to the University of Virginia and Virginia Commonwealth University that any hospital or state agency that “continues to perform chemical and surgical mutilation of children” risks losing all federal medical and research grants. Clinics affiliated with those institutions also suspended care after the Trump order.

Attorneys general in 15 states, including Anthony G. Brown of Maryland (D) and Letitia James of New York (D), later issued a joint statement last week saying they would enforce state laws that provide access to gender-affirming care and challenge efforts by the Trump administration to restrict access to the care.

“The Trump Administration’s recent Executive Order is wrong on the science and the law,” they said in a joint statement. “Despite what the Trump Administration has suggested, there is no connection between ‘female genital mutilation’ and gender-affirming care, and no federal law makes gender-affirming care unlawful. President Trump cannot change that by Executive Order.”

The lawsuit from the attorneys general of Washington state, Oregon and Minnesota alleges that the order violates the Fifth Amendment by singling transgender people for discrimination and the 10th Amendment by unilaterally trying to “regulate or criminalize the practice of medicine” in the states.

In affidavits filed as part of the states’ lawsuit, academic leaders said the order may force them to choose between “providing needed medical care to its students, and receiving research and education funding critical to its mission.”

The University of Washington School of Medicine, for instance, received nearly $500 million in federal grants last fiscal year that went toward researching a wide range of conditions such as Alzheimer’s disease, cancer, diabetes, autism and organ transplantation.

Other universities also stand to lose large sums of grants, officials wrote in court documents. Oregon Health & Science University was awarded more than $413 million in federal research grants and contracts in 2023. The hospital is Portland’s largest employer, and a loss of federal money could force the hospital to close at least 500 research programs and cut 2,000 staff positions, said interim CEO Tim Goldfarb.

“The Executive Order places OHSU in an impossible position of putting hundreds of millions of dollars of research funds at risk or agreeing to stop providing critical, lifesaving care to an underserved and marginalized population,” Goldfarb wrote in an affidavit.

Families and doctors of transgender adolescents say gender transition care, including medications, can be lifesaving and help young people who may already be struggling for acceptance to live happier lives.

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Casey Parks contributed to this report.