President Donald Trump listens during a news conference with Japanese Prime Minister Shigeru Ishiba in the East Room of the White House, Friday, Feb. 7, 2025, in Washington (AP Photo/Alex Brandon).
A coalition of three states and three doctors is suing the Trump administration to block the implementation and enforcement of a proposed ban on federal support for transgender medical care.
Under the terms of Executive Order 14187, which is fashioned as an effort to protect “Children from Chemical and Surgical Mutilation,” President Donald Trump intends to cut off all federal funding for institutions that offer pediatric gender transition services or provide any kind of gender-affirming care for people under the age of 19.
The plaintiffs, in their 36-page lawsuit filed Friday in the U.S. District Court for the Western District of Washington, take issue with the nomenclature employed by the 47th president in the order.
“[T]hat title is false and repugnant,” the filing reads.
Led by Washington Attorney General Nicholas Brown, a Democrat, the lawsuit requests both a temporary restraining order as well as a preliminary and permanent injunction over two sections of the order.
The first section targeted by the litigation is the funding provision.
The plaintiffs allege Trump’s threat to block funding for state-run medical institutions that continue to serve transgender children and teenagers is an “unconstitutional usurpation of the spending power of Congress, an unconstitutional effort to amend Congressional appropriations by attaching conditions not contemplated by Congress, and a violation of the separation of powers.”
Moreover, the lawsuit argues, the practical import of clawing back already-allocated federal funds will have a substantial and negative impact on medical services entirely unrelated to transgender issues.
“Absent an injunction, the Order will terminate over one billion dollars of federal funding to the Plaintiff States’ medical schools and hospitals that is used to research and treat hundreds of conditions having nothing to do with gender-affirming care, including cancer, AIDS, diabetes, substance use disorder, mental health conditions, autism, aging, cardiovascular diseases, maternal health, and so much more,” the lawsuit reads.
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The second section the plaintiffs want the court to block is a law enforcement provision. This section mulls “weaponizing” a federal law against female genital mutilation — a practice largely occurring outside of the Americas — to threaten compliance with the administration’s anti-transgender medical care policy, according to the lawsuit.
On its own terms, the enforcement section anticipates using attorneys general “and other law enforcement officers to coordinate” the enforcement of the 1996 federal ban on female genital mutilation.
To hear the plaintiffs tell it, this section of the executive order “threatens baseless criminal prosecutions against providers” because “transgender minors do not receive gender-affirming genital surgery.”
“The Executive Order attempts to redefine non-surgical treatments for minors as ‘mutilation,’ but this is frivolous,” the filing reads. “The statute has no possible bearing on gender-affirming care. Rather, the Order invokes it solely to sow fear among providers and bully them out of providing gender-affirming care at all.”
The filing elaborates:
To be clear, genital surgery is not performed on transgender minors. But the Order threatens to weaponize this federal statute against puberty blocking medication and hormone therapy, which it defines as “chemical mutilation.” In doing so, the Order attempts to redefine these medically necessary treatments as federal crimes.
In public policy terms, the lawsuit takes issue with the executive order’s basic premise as well.
“The Order purports to ‘protect’ youth, but the Order harms them,” the filing continues. “The Order has already, and will continue, to limit physicians’ ability to treat patients’ gender dysphoria, as well as the unavoidable, grave harm to the health and wellbeing of transgender youth if they are prohibited from receiving necessary medical care, including debilitating anxiety, severe depression, self-harm, and suicide that can accompany untreated dysphoria.”
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And, in a full-circle argument, the plaintiffs also criticize the Trump administration’s controversial use of new definitions — which are sourced from a previous executive order that set out the broad outlines of the GOP’s anti-transgender agenda.
From the lawsuit at length:
It defines “sex” to mean “an individual’s immutable biological classification as either male or female. ‘Sex’ is not a synonym for and does not include the concept of ‘gender identity.’” It further defines “Gender Ideology” as a theory which asserted the “false claim that males can identify as and thus become women and vice versa.” In so doing, the order attempts to define out of existence transgender and gender-diverse people, whose gender is not the sex they were assigned at birth. These definitions must “govern all Executive interpretation of and application of Federal law and administration policy.”
The complaint alleges three distinct causes of action.
The plaintiffs say the executive order violates the Fifth Amendment’s guarantee of equal protection under the law due to “mistreatment” of and “malice” toward transgender and “gender-diverse” individuals based on their status — which is a form of “unlawful” discrimination.
“[The executive order] singles out for restriction and criminalization medical treatments that affirm a patient’s gender if inconsistent with that patient’s sex,” the filing reads.
Washington, joined by Minnesota and Oregon — and three unnamed professors at the University of Washington School of Medicine — also allege a separation of powers violation. The lawsuit says Trump is attempting to “usurp” Congress’ “legislative powers and exclusive power of the purse” by conditioning federal funds on promises to “deny gender-affirming care to their patients under 19 years of age.”
“None of the funds received by the Plaintiff States’ medical institutions have a congressionally authorized condition requiring them to refrain from the provision of gender-affirming care,” the lawsuit goes on. “In fact, federal law prohibits the Plaintiff States’ medical institutions from discriminating against individuals on the basis of their gender dysphoria for the purposes of participating in the services provided by these institutions and funded with federal financial assistance.”
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Finally, the plaintiffs allege a 10th Amendment violation for attempting to “seize” the states’ “historic police powers” in service of a federal regulation on the practice of medicine.
The case has been assigned to U.S. District Judge Lauren King, a Joe Biden appointee. Activity on the docket has been swift and voluminous. As of this writing, the plaintiffs filed over 70 declarations from transgender patients, parents of such patients, and medical providers in support of their motion to stop the policy from taking effect; a list anticipates that nearly 120 such declarations will be filed.
