GRIST FOR ADVOCATES’ MILL:

Since January 2025, judges throughout the country have taken the unusual step of issuing rulings that not only address the technical issues involved but also lambast the administration for the ineptitude of its lawyers and the patent illegality and heartlessness of its policies. Cases related to public health represent some of the most striking examples. Here are some in support of gender affirming care:

On January 20, 2025, Trump’s first day back in office, he issued Executive Order 14168, “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” The order stated, “It is the policy of the United States to recognize two sexes, male and female” and directed the Executive Branch to “enforce all sex-protective laws to promote this reality.” One section of the order prohibited the Bureau of Prisons (BOP) from using federal funds for “any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.” In February the administration issued two memoranda implementing the order. Soon after, the BOP denied incarcerated, transgender people access to hormone treatment and “social accommodations,” including undergarments, hair removal devices, and chest bands. The American Civil Liberties Union filed a suit challenging the order on behalf of two transgender men and one transgender woman in prison.

On June 3, Judge Royce Lamberth, a Reagan appointee to the District Court for the District of Columbia, granted a preliminary injunction, writing that “the memoranda are arbitrary and capricious because they provide no reasoned explanation for the denial of gender-affirming care [and] treat gender dysphoria different than other medical conditions with no justification.” Lamberth continued, “Nothing in the thin record before the Court suggests that either the BOP or the President consciously took stock of—much less studied—the potentially debilitating effects that the new policies could have on transgender inmates.” Lamberth concluded, “The BOP may not arbitrarily deprive inmates of medications or other lifestyle accommodations that its own medical staff have deemed to be medically appropriate without considering the implications of that decision.”

On January 28, Trump issued Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation.” This new order called gender-affirming care “the maiming and sterilizing of impressionable young children” and a “stain on our Nation’s history” that “must end.”

On April 22, Attorney General Pam Bondi issued a memorandum, “Preventing the Mutilation of American Children,” which suggested that being transgender is a harmful medical condition, that a high proportion of youth regret seeking gender affirming care, and that such care is comparable to female gender mutilation.

A number of states already had banned gender affirming treatment. On June 18, Supreme Court Justice Sonia Sotomayor (joined by Justices Ketanji Brown Jackson and Elena Kagan, in part) filed a dissent to the Supreme Court’s ruling upholding Tennessee’s ban on gender-affirming care to minors. “If left untreated, gender dysphoria can lead to severe anxiety, depression, eating disorders, substance abuse, self-harm, and suicidality,” Sotomayor explained. “Suicide, in particular, is a major concern for parents of transgender teenagers. . . When provided in appropriate cases, gender-affirming medical care can meaningfully improve the health and wellbeing of transgender adolescents, reducing anxiety, depression, suicidal ideation, and (for some patients), the need for more invasive surgical treatments later in life. That is why the American Academy of Pediatrics, American Medical Association, American Psychiatric Association, American Psychological Association, and the American Academy of Child Adolescent Psychiatry all agree that hormones and puberty blockers are ‘appropriate and medically necessary’ to treat gender dysphoria when clinically indicated.” She concluded that the Court “authorizes, without second thought, untold harm to transgender children and the parents and families who love them.” Sotomayor read the 31-page dissent from the bench, an unusual move taken only when a justice sharply disagrees with the majority.

On July 7, Bondi announced that she had sent “more than 20 subpoenas to doctors and clinics involved in performing transgender medical procedures on children,” requesting as many as 15 different documents. Those included some with the names, Social Security numbers, and home addresses of youth who had received gender affirming care as well as those of their parents. Bondi stated that the subpoenas targeted “medical professionals and organizations that mutilated children in the service of a warped ideology.”

Several judges have quashed the subpoenas, arguing that members of the administration know little about gender dysphoria and the importance of treating it and that Bondi sought the documents under false pretenses. On September 9, Judge Myong J. Juon of the District Court for the District of Massachusetts, ruled in favor of Boston Children’s Hospital (BCH), because “doctors have described GAC [gender-affirming care] as a medical necessity.” He continued, “The Administration has been explicit about its disapproval of the transgender community and its aim to end GAC.” Although Bondi claimed that the purpose of the subpoenas was to investigate fraud or unlawful off-label use of medications, it was “abundantly clear” that the “true purpose…is to interfere with the Commonwealth of Massachusetts’ right to protect GAC within its borders, to harass and intimidate BCH to stop providing such care and to dissuade patients from seeking such care.”

On October 27, Judge Jamal Whitehead of the District Court for Western District of Washington at Seattle, ruled in favor of QueerDoc, a small telehealth provider offering gender affirming care in ten western states. Following Juon, he argued that although the Government asserted it wanted the documents to conduct an investigation, the “intended effect” was to “downsize or eliminate…all gender-affirming care. No clearer evidence of improper purpose could exist than the Government’s own repeated declarations that it seeks to end the very practice it claims to be investigating.”

On November 21, Judge Mark Kearney of the District Court for the Eastern District of Pennsylvania, blocked the subpoena issued to the Children’s Hospital of Philadelphia, writing, “The Hospital has treated children facing. . . gender identity issues for the last eleven years consistent with Pennsylvania citizens approving the legality of gender-affirming medical care.” Using words from Bondi’s July 7 press release, he concluded, “The children’s and their families’ privacy interests in their highly sensitive and confidential medical and psychological treatment in a charged political environment, which considers their medical treatment a warped ideology, far outweigh the Department of Justice’s shifting need for the information in the challenged requests.”

On December 18, Health Secretary Robert F. Kennedy, Jr. issued the Kennedy Declaration, stating that gender affirming treatments for minors, such as puberty blockers, cross-sex hormones, and surgeries, “fail to meet professional[ly] recognized standards of care”; as a result, he would remove Medicare and Medicaid funding from hospitals that provide such procedures. On April 14, 2026, Judge Mustafa T. Kasubhai of the District Court for the District of Oregon ruled in favor of a coalition of 19 states and the District of Columbia which sued to invalidate the declaration. Kasubhai began by pointing to the need to protect US democracy in these perilous times: “Unserious leaders are unsafe. There is nothing more serious than our leaders’ dedication to the rule of law so that we might maintain the integrity of our constitutional democracy. . .This case demonstrates how disregard for the rule of law does not merely result in an abstract infraction. . .This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty.” Like other judges, Kasubhai pointed to the administration’s ignorance about gender affirming treatment, adding, “The Kennedy Declaration amounts to nothing more than one man’s musings on gender-affirming care.”

In January 2026, the Federal Trade Commission (FTC) issued Civil Investigative Demands (CIDs) to three nonprofit organizations, the Endocrine Society, the World Professional Association for Transgender Health (WPATH), and the American Academy of Pediatrics, ostensibly to investigate their unfair marketing practices. All three organizations immediately sued. The cases regarding the Endocrine Society and WPATH were assigned to Chief Judge James E. Boasberg of the District Court for the District of Columbia. On May 7, 2026, he granted temporary restraining orders to both. Because he discussed the issues most fully in the Endocrine Society case, I concentrate on it.

His opinion began with a question: “How can we know when an agency’s use of its investigative tools shifts from legitimate to retaliatory?” He then proceeded to explain why the FTC’s demand was not legitimate. “One premise of the Society’s work is acceptance of the scientific and medical proposition that some individuals feel incongruence between their gender identity and their designated gender,” Boasberg wrote. “Such incongruence can lead to gender dysphoria, a hormone-related condition included in the Diagnostic and Statistical Manual of Mental Disorders.” Trump, by contrast, “has made no secret of his disdain for the concept of gender dysphoria,” issuing “a flurry of executive orders during the first few weeks of his second term.” Those orders “did not merely lambast the view that gender dysphoria is a medical condition and the proponents of treating it. They exhorted federal agencies to put a stop to any acknowledgment of gender dysphoria or that some individuals are transgender.”

Boasberg continued by noting that the FTC’s record “reflects acrimonious statements of Commission staff and leadership toward proponents of gender-dysphoria treatment that echo the Trump Administration’s characterizations.” He pointed in particular to a workshop held by the FTC in the summer of 2025 titled “The Dangers of ‘Gender-Affirming Care’ for Minors.” The FTC later hired one participant who recommended “’conducting thorough investigations’ of medical associations because such investigations would cause groups to ‘start losing members’ and ‘lose revenue streams.’” And, in fact, the “Society contends that it is experiencing deleterious effects on its speech and work as a rest of ongoing government scrutiny, culminating in the issuance of the CID.”

Some of these cases have been overturned, but that is not the point. In these scary days, it is especially important to focus on judgments defending gender affirming care, most of which garners little media attention. Future posts will address cases in other fields of public health.

Cases:

Kingdom v Trump, DDC Lamberth (6/3/25)

In re Subpoena, ED Pa K (WPATHearney (11/21/25)

Oregon v. Kennedy, D Or Kasubhai (4/18/26)

QueerDoc v. U.S. Department of Justice, WD Wa Whitehead (10/27/25)

In re Administrative Subpoena, D Ma Juon (9/9/25)

U.S. v. Skrmetti, Supreme Court (6/18/25) (Sotomayor dissenting)

Endocrine Society v. FTC, DDC Boasberg (5/ 7/ 26)