A federal judge ordered the Trump administration on Thursday to keep federal funding in place for hospitals nationwide that offer gender-transition treatments for people under the age of 19.
The temporary restraining order issued by Judge Brendan A. Hurson, of the U.S. District Court for the District of Maryland, came in a case brought by six transgender individuals between the ages of 12 and 18, along with parents and advocacy groups. They sued to block President Trump’s executive orders targeting medical treatments for trans youths.
The order is not a final decision on the legal issues but presents a setback for the Trump administration — and a second legal roadblock to Mr. Trump’s broad effort to prohibit the government and taxpayer-funded institutions from recognizing transgender Americans according to their gender identities. Earlier this month, another federal judge blocked Mr. Trump’s directive to withhold gender-transition medical treatment for federal prisoners and to house transgender women inmates with men.
“The goal is protection,” the judge, an appointee of former President Joseph R. Biden Jr., said. “But this seems to put these children at extreme risk.”
Judge Hurson said that it seemed likely that the plaintiffs would prevail in their argument that the specific provisions of Mr. Trump’s efforts exceed his authority by directing the federal agencies to withhold funds appropriated by Congress. The judge added that the plaintiffs have “unassailable documentation” that they are suffering irreparable harm, “beyond the violation of the separation of powers.”
Plaintiffs in the case, who live in Maryland, New York and Massachusetts, say that their access to gender-transition treatment is threatened by two executive orders that Mr. Trump announced after his inauguration last month.
One order directs federal agencies to ensure that grant funding for research or education does not support “gender ideology,” which it defines as the idea that “males can identify as and thus become women and vice versa.” The second order specifically directs agencies to withhold funds from medical providers that offer puberty blockers, hormone therapies and surgeries to people younger than 19 for the purpose of gender transition. After Mr. Trump issued that order, the lawsuit says, several clinics canceled appointments. The plaintiffs noted a White House news release from earlier this month, which stated that the order is “already having its intended effect,” and cited several announcements from hospitals.
The order, titled “Protecting Children From Chemical and Surgical Mutilation,” states that the goal is to protect young people from long-term effects that may cause them to regret undergoing the treatments. But on Thursday, Judge Hurson said that stopping patients’ care abruptly “really casts doubt of whether, in fact, the goals are to protect the recipients of care.”
The lawsuit names as defendants officials at the Department of Health and Human Services and several agencies that provide medical research and education grants, including the National Institutes of Health, the Health Resources and Services Administration and the National Science Foundation. The individual plaintiffs are not named in court filings, and they are described using pseudonyms.
In court documents, plaintiffs and their families said they feared negative effects, including anxiety, depression and unwanted physical changes, if treatment were withheld. A 14-year-old who lives in Maryland, known in the lawsuit as Gabe Goe, had planned to start hormone therapy in late January, court documents say, but his provider told him that it had paused gender-transition treatment for patients younger than 19.
Withholding the funds, the plaintiffs argue, violates equal protection guarantees and conflicts with federal protections against sex discrimination in the Affordable Care Act and other statutes. Four parents of transgender minors who are also plaintiffs in the case say that Mr. Trump’s orders violate due process rights under the Fifth Amendment when it comes to their decisions on medical care for their children. Two other plaintiffs — a national L.G.B.T.Q. rights group called PFLAG and G.L.M.A., an L.G.B.T.Q. medical association — sued on behalf of their members.
The government argued that the lawsuit was premature because the agencies named as defendants had not yet carried out Mr. Trump’s order. The government also argued that its interest in protecting young people from regret that some people experience after transitioning was sufficient grounds to enact Mr. Trump’s policies. Little research exists on how often that regret happens or why. Over the last several years, a group of individuals who have “detransitioned” have testified in favor of Republican-led state bans on gender medicine for minors.
In a series of executive orders targeting transgender Americans, Mr. Trump has sought to withhold federal funds from schools that allow trans girls and women to play on girls’ and women’s sports teams, to bar trans people from serving in the military and to prevent trans people from designating their gender identities on passports.
The topic of when treatments like puberty blockers, hormone therapies or surgery are appropriate for young people who want their bodies to better reflect their internal sense of gender has been hotly debated. Several European countries have limited the treatments after scientific reviews and, since 2021, 24 states in this country have barred minors from receiving the treatments.
The American Academy of Pediatrics has said it is conducting its own review. But the academy and most major medical groups in the United States continue to endorse them as effective in relieving the psychological distress many transgender youths experience as a result of the incongruence between their sex and their gender identities. Before Thursday’s hearing, about 50 people gathered outside the courthouse holding signs that said, “Protect Trans Youth.”
In his order on youth gender medicine, Mr. Trump used terms like “maiming,” “mutilation” and “chemical castration” to describe the treatments. Judge Hurson raised a question of whether Mr. Trump’s orders were motivated by “animus,” which could factor into the arguments over the orders’ constitutionality. The same question was raised earlier this month by another federal judge, in a case challenging Mr. Trump’s order authorizing a ban on trans people serving in the military.
The language Mr. Trump used “seems to deny that this population exists, or even has the right to exist, and I’m struggling with how that can’t be animus,’’ Judge Hurson said.
A second federal lawsuit challenging Mr. Trump’s orders on gender-transition care was filed last week in Seattle by the state attorneys general of Washington, Oregon and Minnesota. A hearing in that case is scheduled for Friday.
Judge Hurson said that his order would be in effect for 14 days but might be extended. He directed the government to provide the court with written notice of its compliance by Feb. 20.
