A coalition of 16 states and the District of Columbia sued the Trump administration Friday over what they describe as an "unconstitutional pressure campaign" to stop doctors and hospitals from providing gender-affirming care to transgender youth.
"The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children," New York Attorney General Letitia James wrote in a statement. "We will never stop fighting for the dignity, safety, and basic rights of the transgender community."
The lawsuit, filed in federal court in Massachusetts, argues the Trump administration is trying to effectuate a de facto national ban on gender-affirming care for youth, even though there's no federal statute that prohibits the care.
"They are definitely trying to chill and coerce and bully and intimidate with threatened criminal prosecution," said California Attorney General Rob Bonta during a press conference Friday.
The complaint argues the White House and Justice Department have carried out the intimidation of both doctors and hospitals by issuing subpoenas, threatening criminal prosecution, launching investigations and demanding private patient data.
"The result is an atmosphere of fear and intimidation experienced by transgender individuals, their families and caregivers, and the medical professionals who seek only to provide necessary, lawful care to their patients," the lawsuit states.
The Trump administration is using a law that makes it a felony to perform female genital mutilation on anyone under 18 to threaten legal action against providers and hospitals; U.S. Attorney General Pamela Bondi wrote that it applies to certain types of gender-affirming surgery — even though it's extremely rare for transgender minors to have surgery.
The Department of Justice has also cited laws meant to stop Medicaid fraud, and food and drug safety laws. The reasoning being that hormone therapy is a drug, and it is being misused.
Bonta dismissed that legal reasoning out of hand.
"They are definitely waging the culture wars, they are definitely playing politics. What they're not doing is practicing law," Bonta added.
NPR reached out to federal officials for comment. In an emailed statement, the White House said President Trump has the authority to stop treatment that it describes as "mutilation and chemical castration of children."
The statement went on to say the administration expects "ultimate victory" on this issue.
Families of transgender young people sued Trump over access to care in early February in a case called PFLAG v. Trump. That litigation is ongoing.
The new complaint points out that professional medical organizations support the provision of this care, including the American Academy of Pediatrics and the American Medical Association.
Republican lawmakers and state attorneys general have challenged the basis of those recommendations, arguing that the evidence used to support them is insubstantial.
The Trump administration's Department of Health and Human Services published its own review of the evidence, which concluded that gender-affirming care for youth should be curtailed. The AAP and the AMA have stood by their positions.
Several prominent clinics offering gender-affirming care at children's hospitals have closed in recent weeks as a result of the Trump administration's actions, including one in Los Angeles and another in Washington, D.C.
Those closures are happening in places where the care is legal.
Since 2021, more than half of U.S. states have banned gender-affirming care for youth. The Supreme Court recently ruled that Tennessee's ban did not violate the Constitution.
In some rural states as well, hospitals are shutting down the clinical programs, forcing patients and their parents to travel much farther for care, if they can find it.
In Montana, Community Medical Center in Missoula was the last hospital offering care for transgender youth, until it closed its gender clinic in June. The hospital cited the state and federal regulatory environment.
Some private pediatricians are still offering this care, but the families NPR spoke to were unaware of who they were.
For some patients and families, the hospital's decision felt like a betrayal.
"I feel it's their job as health care providers, is to stand up to this and to say this is care that saves lives, which they didn't do," said Liz, 18, a patient from Missoula. NPR agreed to identify Liz by her first name only, because she fears for her safety because she's transgender.
Liz plans to drive to Seattle Children's for care, but doesn't assume she'll be able to continue treatment there.
"They're going to see even more of an influx of patients, and can they take that many people? How far out does their waitlist become?" she said.
Seattle Children's didn't respond to an interview request about its plans to continue serving transgender kids.
Community Medical Center's decision also hit hard for E's family in Missoula. E's daughter is transgender and about a year away from puberty. They had planned to start puberty blockers, and eventually use hormone replacement therapy.
NPR has agreed to identify E by her middle initial only because she worries about harassment and violence against her family.
It was hard to tell her daughter that the hospital had stopped treatment, E said.
"To her, it wasn't even a thought [that] it wouldn't happen. She was like, 'I'm a girl, so when I go through puberty, I'm going through girl puberty,'" E said.
President Trump and the Republican party campaigned on anti-trans messages in the last election.
On inauguration day in January, Trump declared through executive order that there are only two sexes, which are determined at conception and are unchangeable. He then signed another executive order entitled "Protecting Children From Chemical and Surgical Mutilation."
The executive order reads: "Across the country today, 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 trend, it continues, "must end."
The Trump administration has also targeted schools and hospitals that affirm transgender youth, limited the participation of trans people in sports and the military, required that passports reflect a person's sex at birth and canceled millions in funding for LGBTQ+ health research. Some of these efforts have been challenged or blocked in the courts.
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