A coalition of states led by Democrats, including New York and California, sued Friday to stop the Trump administration from investigating doctors and hospitals who provide children with medical treatments for gender transition.
The lawsuit, filed in Federal District Court in Massachusetts, comes amid escalating efforts by the federal government to put an end to the availability of puberty blockers, hormones and gender-related surgeries for transgender adolescents.
In the past two months, the F.B.I. has asked the public to call its tip line about doctors “who mutilate” children “under the guise of gender-affirming care.” The Justice Department sent more than 20 subpoenas to doctors and clinics that perform transgender medical procedures on minors, demanding confidential patient information. And the Federal Trade Commission is examining whether “practitioners of ‘gender-affirming care’ may be actively deceiving consumers” by making unsubstantiated claims about the effectiveness of such care, or by omitting warnings about risks to pediatric patients.
Some medical experts have concerns about the long-term side effects of puberty blockers and hormones on brain development, bone density and fertility.
Federal agencies served at least two subpoenas to major New York hospital systems in recent weeks — Mount Sinai Health and NYU Langone Health — as part of the inquiries into pediatric transgender medicine, according to people familiar with the matter who spoke on the condition of anonymity because they were not authorized to disclose subpoenas or had been told about their existence in confidence. Representatives for Mount Sinai and NYU Langone declined to comment.
The Justice Department did not immediately respond to a request for comment.
The lawsuit, filed by attorneys general for 15 states and the governor of Pennsylvania, asks the federal court to declare that the government policies that prompted the investigations into pediatric transgender care were unlawful and must not be enforced. The lawsuit argues that the Justice Department’s actions “reflect an unconstitutional attempt to infringe on the states’ power to regulate medicine.”
The lawsuit places transgender care for children alongside other health services that have been engulfed in legal controversy amid federal efforts to restrict those services, even as some states are trying to allow them. This has happened in fights over abortion, medical marijuana and physician-assisted suicide.
More than half of U.S. states have passed laws restricting gender-transition treatments for minors. In some other states, those treatments have some protections under state law, according to the lawsuit. In New York, the attorney general, Letitia James, warned hospitals in February that they risked violating state anti-discrimination laws by denying gender-affirming care to trans youth — as the federal government was pressuring hospitals to do.
“Plaintiff states have enacted numerous laws to protect transgender residents and ensure access to medically necessary health care,” the suit states. “These enactments reflect the policy judgments by many plaintiff states that continued access to this care is vital to the health, well-being, dignity and autonomy of their residents.”
The lawsuit takes aim at an executive order that President Trump issued just over a week after taking office. Titled “Protecting Children From Chemical and Surgical Mutilation,” the order said: “Medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions.”
“This dangerous trend will be a stain on our nation’s history, and it must end,” it continued.
The executive order came amid intense debate in the United States and Europe about medical treatments for young people who are seeking to transition. The availability of such treatments, and the number of children seeking them, has risen sharply in recent years.
For some children with gender dysphoria — distress over the mismatch between their gender identity and their birth sex — starting treatments early in adolescence can help them navigate their feelings and identity and reduce depression and distress, experts say. Other experts question whether starting those treatments at such a young age might lock in life-altering choices before children truly understand who they are.
The lawsuit notes that the president’s executive order has already largely accomplished its goal. Since the order, some hospitals have stopped providing medical interventions to trans youth, while others have canceled appointments for puberty blockers or stopped taking new pediatric patients.
“Facing threats to their licenses, livelihoods and liberty, some providers in plaintiff states have announced that they will cease providing this longstanding, medically necessary, often lifesaving care to their patients,” the lawsuit states.
The executive order instructs federal agencies to bring pressure to bear on hospitals and doctors who prescribe puberty blockers or hormones to trans children. It threatens to cut off federal research funding to hospitals and medical schools. And it orders federal law enforcement authorities to consider whether some transgender medical procedures violate federal laws — and to prioritize enforcement.
The order singles out a federal law prohibiting female genital mutilation as a potential tool for prosecutors to use in criminal investigations of pediatric transgender care. That law was passed with the goal of outlawing female genital cutting — a common rite of passage in some cultures — among girls of immigrant families in the United States.
The lawsuit asks a federal judge to block prosecutors from using that law in cases involving clinicians who treat trans children.
“No federal law prohibits, much less criminalizes, the provision or receipt of gender-affirming care for transgender adolescents,” states the lawsuit, which names Mr. Trump, the Justice Department and Attorney General Pam Bondi as defendants.
The suit also asks a judge to declare a section of Mr. Trump’s executive order — which instructs the Justice Department to prioritize investigations into pediatric transgender medicine — “unconstitutional and unlawful.”
“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” Ms. James, the New York attorney general, said. “This administration is ruthlessly targeting young people who already face immense barriers just to be seen and heard, and are putting countless lives at risk in the process.”