Trans youth and their families are suing Trump over canceled healthcare

Seven young transgender patients, providers of LGBTQ healthcare, and the advocacy organization PFLAG sued President Donald Trump and his administration on Tuesday over a pair of anti-trans executive orders that attempted to end gender-affirming medications and surgery for transgender people under age 19.

Trump can’t outlaw the treatments unilaterally, but his January 28 order threatened to end federal funding to hospitals and medical schools that provide pediatric transgender healthcare. Executive branch agencies, including the Department of Health and Human Services, were told to cut off their research and education grants, and potentially even disqualify these institutions from Medicare and Medicaid. The order also instructed the Justice Department to consider civil and criminal prosecution against providers, using laws that forbid consumer fraud and female genital mutilation.

Since then, a handful of major hospitals have suspended treatments, including NYU Langone Health in New York, Children’s Hospital of Richmond in Virginia, and Children’s National in Washington, DC. “The loss of this funding would critically impair our ability to provide care for the Denver community,” Denver Health, in Colorado, explained in a statement on its website.

Now, it’s becoming painfully clear how trans patients have been immediately affected. The new complaint, filed in a Maryland federal court, tells the stories of patients who have had their appointments canceled over the last week—including those whose families have already fled from states that outlawed gender-affirming care for minors.

“When the Tennessee legislature passed a law that banned gender-affirming medical care for transgender minors, I knew we had to leave the state so that my daughter could continue receiving the care she needs,” Kristen Chapman of Richmond, Virginia, mother to 17-year-old plaintiff Willow, said in a statement.  She described the family’s 2023 move to Richmond and struggle to find a provider who would accept their Medicaid insurance, finally opting to pay out-of-pocket. Then they faced the ordeal of trying to get an appointment for their daughter, which they finally managed at Virginia Commonwealth University. “The day before our appointment, President Trump signed the executive order at issue in this case,” she continued. “The next day, just a few hours before our appointment, VCU told us they would not be able to provide Willow with care. I thought Virginia would be a safe place for me and my daughter. Instead, I am heartbroken, tired, and scared.”

Another patient, an 18-year-old known as Dylan Doe in court papers, moved with his family from Tennessee to Massachusetts and has been receiving hormone therapy since he was 14. According to the complaint, Doe got a call from his clinic last week canceling his regular testosterone injection. “Access to health care makes Dylan’s life livable,” the complaint says. “When he thinks about losing it, he becomes too depressed to function.” 

Trump’s order has also cut off access to medication for trans children on the cusp of puberty, a deprivation that can bring severe mental and emotional distress to people with gender dysphoria. According to the lawsuit, NYU Langone canceled the appointment of non-binary 12-year-old, known as Cameron Coe, to receive a puberty-blocking implant. The Coe family had chosen to pursue a puberty blocker due to “Cameron’s escalating distress, blood testing show[ing] high levels of endogenous testosterone, the imminence of permanent physical changes, consultation with doctors, and the need for more time to consider whether to pursue further medical treatment without worrying about Cameron’s body right now.” 

But the appointment was canceled with two days’ notice. Since then, Cameron’s anxiety has spiraled, according to the lawsuit: “Cameron’s parents are worried about immediate severe distress and suicidality.”

While Trump’s executive order puts the wheels in motion for the federal government to cut off funding to trans healthcare providers, it doesn’t amount to a national ban. Hospitals that preemptively comply by canceling care for transgender patients may be running afoul of laws that require them not to discriminate. On Monday, New York State Attorney General Letitia James issued a letter reminding healthcare providers that New York law bans discrimination on the basis of sex as well as gender identity or expression. “Electing to refuse services to a class of individuals based on their protected status, such as withholding the availability of services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria, while offering such services to cisgender individuals, is discrimination under New York law,” James wrote.

The lawsuit, filed by the ACLU, Lambda Legal, and the law firms Hogan Lovells and Jenner & Block, argues that Trump does not have the authority to order agencies to withhold funds from hospitals. “Under our Constitution, it is Congress, not the President, who is vested with the power of the purse,” the complaint states. It argues that the executive orders “infringe on parents’ fundamental rights” by overriding their judgment, together with their children and doctors, about what kind of healthcare their children need. It notes that Trump’s executive order instructing federal agencies to “ensure grant funds do not promote gender ideology” violates the First Amendment’s right to free speech.

“The Executive Orders were issued for the openly discriminatory purpose of preventing transgender people from expressing a gender identity different from their sex designated at birth—and expressing government disapproval of transgender people, who by definition, have a gender identity that does not align with their sex designated at birth,” the lawsuit states.

Like other lawsuits challenging bans on gender-affirming care for minors, which have passed in about half of states, the complaint argues that the executive order denies people healthcare “on the basis of sex”—breaking federal law and violating the Constitution. After all, the same medical treatments remain available to cisgender children—puberty blockers for those who begin puberty too early, for instance, or testosterone or estrogen for those with a hormone deficiency. Meanwhile, only a small fraction of trans children ever receive gender-affirming treatments. One recent, large study of insurance claims found that .017 of people aged 8 to 17 were coded as trans and received puberty blockers, and 0.037 percent received hormone therapy.

“Critically, the Gender Identity and Denial of Care Orders do not seek to prohibit federal funding to entities that provide these treatments for all medical conditions,” the complaint filed Tuesday argues. “Rather, they prohibit federal funding to entities only when the gender-affirming medical care is for the purpose of gender transition—that is, to align a patient’s gender presentation with an identity different from their sex at assigned at birth”

As it turns out, that’s the same argument the Supreme Court is currently reviewing in L.W. v. Skrmetti, a lawsuit challenging Tennessee’s ban on gender-affirming care for trans minors. If the high court decides that Tennessee’s ban is a kind of sex discrimination, judges will have to closely examine the rationale and evidence behind the restrictions. Every time judges have looked at that evidence in the past, they’ve overturned bans on gender-affirming care.

But if the Supreme Court decides that a gender-affirming care ban is not a version of sex discrimination, courts will consider restrictions on trans healthcare—including, potentially, Trump’s executive orders—under a much looser standard. 

A decision in Skrmetti is expected in June, though the timing may be disrupted if the Department of Justice changes its position in the case, as it is expected to do. 

“It is clear from the executive orders that the reason for the healthcare restrictions is because of the government’s belief about how men and women should be,” says Harper Seldin, senior staff attorney at the ACLU’s LGBTQ & HIV Project. “That’s not a legitimate government interest, even under a lower bar.”

But as the new complaint makes clear, Trump’s trans healthcare order—and his other anti-trans executive orders—are having immediate and punishing effects on the lives of trans people and their families. “I think the point of these executive orders in this climate is to make people’s lives feel small and isolated and fearful,” Seldin says. “The way to push back against that and resist that is to be in community and to make our lives bigger.”