Federal Judge Deals Blow to Trump Administration's Stance on Gender-Affirming Care

A federal judge in Oregon has ruled that Health Secretary Robert F. Kennedy Jr. exceeded his authority by declaring gender-affirming care for minors as neither “safe nor effective.” This decision, made on Thursday, directly counters Kennedy’s assertion that such care does not align with “professionally recognized standards of health care.”

U.S. District Court Judge Mustafa Kasubhai sided with 21 states led by Democrats, who contested Kennedy’s attempt to impose a national standard against gender-affirming care for transgender and gender-nonconforming minors. The judge stated that the guidance from the Department of Health and Human Services (HHS) infringed upon the states' rights to regulate medical practices. Kennedy's controversial 12-page declaration was issued on December 18 of the previous year, claiming that it “supersedes” both state and national standards of care.

The HHS declaration raised questions about the validity of care standards endorsed by prominent medical organizations, including the American Medical Association and the American Academy of Pediatrics, which advocate for gender-affirming care as safe and effective. Coinciding with this declaration, HHS proposed three new rules aimed at restricting Medicaid and Medicare reimbursements for medical providers offering transition care to youth. Following this, HHS referred 13 medical institutions providing such care to the department inspector general’s office for investigation, as detailed in court documents.

Legal analysts predict that the government is likely to appeal this ruling. HHS has yet to respond to requests for comments regarding the case.

LGBTQ+ advocates have expressed relief over the ruling, which temporarily safeguards healthcare providers and families of transgender youth. Kelley Robinson, president of the Human Rights Campaign, emphasized the importance of allowing medical professionals to make decisions without political interference. “Politicians, including RFK Jr., do not get to tell doctors how to do their jobs or families what decisions are best for their children,” Robinson stated. “Health care for transgender people is just that — health care — and that care must continue — full stop.”

New York Attorney General Letitia James, one of the plaintiffs in the case, also praised the judge’s decision. “So much of the conversation around transgender health has lost sight of the real people harmed by the federal government’s attacks,” she remarked. “Today’s win breaks through the noise and gives some needed clarity to patients, families, and providers. Health care services for transgender young people remain legal, and the federal government cannot intimidate or punish the providers who offer them.”

The states involved in the lawsuit, including Oregon, California, New York, Colorado, and the District of Columbia, argued that Kennedy’s move to establish national standards on gender-affirming care violated the Administrative Procedure Act. This statute mandates that federal agencies adhere to specific standards for rulemaking as designated by Congress.

In contrast, the Trump administration contended that Kennedy’s declaration was merely a “non-binding” policy and claimed that states had not demonstrated how it harmed individual providers since none had been barred from receiving Medicare and Medicaid reimbursements at that time.

During a six-hour hearing in Eugene, Oregon, Judge Kasubhai concurred with the states’ position, noting that Kennedy’s declaration effectively eliminated options for healthcare providers treating patients seeking gender-affirming care. “There’s a theme of ‘Break it and see what others will do,’ and that’s not a system or method committed to the rule of law,” Kasubhai articulated during the trial. “That notion that ‘I will go forward, issue a declaration and see if we can get away with it,’ that is not a principle of governance that adheres to the overarching commitment to the democratic public that requires the rule of law to be regarded and respected and honored as sacred.”

This ruling represents another setback for the Trump administration's extensive efforts to restrict access to gender-affirming treatments such as puberty blockers and hormone replacement therapy for minors. Following President Trump’s executive order aimed at blocking access to transition care for youth, numerous hospitals and clinics receiving federal funding discontinued their services, complicating access to gender-affirming care for both youth and adults.

As of January, over 40 hospitals have either paused or ceased offering gender-affirming treatments to young people, even in states where such care is legally protected. Major institutions like New York University’s Langone and Children’s Hospital of Los Angeles have halted these services.

Additionally, the Justice Department has issued 20 subpoenas targeting doctors and hospitals involved in “performing transgender medical projects.” Since 2020, 27 Republican-led states have enacted bans on access to gender-affirming care. The Supreme Court granted states authority last June to determine how and if such care should be administered to minors.