The House on Wednesday voted to pass a bill that could imprison health care providers for providing gender-affirming care for minors.
The bill — titled the “Protect Children’s Innocence Act” and sponsored by Rep. Marjorie Taylor Greene of Georgia — would make it a class C felony to treat minors with gender-affirming care like surgeries and puberty blockers. If enacted, the bill could imprison doctors who provide such care for up to ten years.
It’s unclear whether the GOP-led Senate will take up the measure, though it is unlikely it would get enough Democratic support to pass out of that chamber.
The House vote was 216-211. Three Democrats supported the measure, while four Republicans were opposed.
Greene said last week she secured floor consideration of her bill as part of a deal with leaders who wanted her to drop her opposition to advancing a critical defense policy bill.
Civil rights groups including the American Civil Liberties Union described Greene’s bill as “the most extreme anti-trans legislation ever considered by Congress.”
Ahead of the vote, Democratic Rep. Sarah McBride criticized congressional Republicans as being “obsessed with trans people.”
“I actually think they think more about trans people than trans people think about trans people,” said McBride, who is the first out transgender member of Congress.
“They are consumed with this, and they are extreme on it,” the Delaware Democrat added.
A second bill, sponsored by GOP Rep. Dan Crenshaw of Texas, prohibits federal Medicaid funding for “gender transition procedures for minors.” The House is expected to vote on that bill on Thursday.
McBride said Wednesday that Republicans were “trying to politicize a misunderstood community and misunderstood care.”
“No one’s healthcare should be politicized,” she said.
A federal judge has blocked a gender-affirming care ban for trans inmates in Georgia that has been in effect for several months. Judge Victoria Calvert agreed with the plaintiffs that the blanket ban violated the Eighth Amendment, which bars cruel and unusual punishment.
“The Court finds that there is no genuine dispute of fact that gender dysphoria is a serious medical need,” Judge Calvert wrote in her opinion. “Plaintiffs, through their experts, have presented evidence that a blanket ban on hormone therapy constitutes grossly inadequate care for gender dysphoria and risks imminent injury.”
Georgia Senate Bill 185 was signed into law in May by Governor Brian Kemp (R). The bill prohibited state funds and resources from being used to provide gender-affirming care to inmates in Georgia prisons. That included hormone replacement therapy (HRT), as well as “sex reassignment surgeries or any other surgical procedures that are performed for the purpose of altering primary or secondary sexual characteristics,” and even “cosmetic procedures or prosthetics intended to alter the appearance of primary or secondary sexual characteristics.”
The bill took effect in July, and five plaintiffs filed a lawsuit against it in August. In addition to arguing that SB 185 constituted cruel and unusual punishment, the lawsuit also claimed that it violated the Equal Protection Clause. HRT and other gender-affirming care treatments were not banned under the bill for all inmates, only for those who were trans. The bill also prohibited trans inmates from paying for the care themselves while incarcerated.
“We would never allow a state to decide that people in prison with diabetes should be cut off of insulin just because the state didn’t want to pay for it anymore,” said Celine Zhu, a Staff Attorney for the Center for Constitutional Rights, which is representing the plaintiffs. “So why would we allow Georgia to cut off medically required care for people with a similarly serious diagnosis of gender dysphoria?”
SB 185 was a blanket ban that overruled the opinions of judges, doctors, and the Georgia Department of Corrections, all of whom have previously acknowledged that gender-affirming care is medically necessary for incarcerated trans people.
While the judge’s ruling makes it clear that not every inmate is entitled to gender-affirming care, it puts those decisions back in the hands of medical professionals and the patients rather than having the legislature make medical decisions for trans people.
“The Court requires healthcare decisions for prisoners to be made dispassionately, by physicians, based on individual determinations of medical need, and for reasons beyond the fact that the prisoners are prisoners,” the judge said in her ruling.
Current estimates suggest that there are around 300 out trans people incarcerated in Georgia state prisons.
After the ruling, the Department of Corrections filed a notice of appeal with the 11th Circuit Court of Appeals.
This sort of case has been litigated for over twenty years now. In 2005, Wisconsin introduced a ban on doctors providing trans inmates with gender-affirming care, affecting inmates who had been on hormones since the early 90s. The law was overturned by the 7th Circuit Court of Appeals, and the Supreme Court declined to hear the state’s appeal in 2011.
A far-right party in New Zealand that is hostile to trans rights preempted a government announcement on Wednesday that the country will indefinitely ban the use of puberty blockers by trans youth.
The New Zealand First party, a minority member of Parliament’s coalition government, made the announcement three hours ahead of the government’s own health ministry, declaring a victory in its “war on woke,” Erin in the Morning reports.
“Today, sanity won another battle in the war on woke,” the surprise announcement read. “After years of dangerous ideological experimentation pushed by radical activists and rubber-stamped by weak politicians, the New Zealand Government has officially banned puberty blockers for children. This is what happens when you back a party that actually delivers.”
“While other parties can’t even define what a woman is, we’ve stood up for families, for truth, and for children.”
The preemptive declaration was one more indication of the politicization of healthcare for trans youth in New Zealand and around the world, and a clue to the party’s intimate involvement in crafting the government’s policy. The change adds New Zealand to a growing list of countries and U.S. states banning gender-affirming care for trans youth.
The government’s own announcement described the decision as “a precautionary approach” to gender-affirming care for transgender youth.
There is a lack of “high-quality evidence that demonstrates the benefits or risks” of puberty-blocking drugs for trans youth, Health Minister Simeon Brown said.
113 patients in New Zealand were using puberty blockers in 2023, according to the health ministry.
While the policy announcement didn’t mention the widely criticized Cass Report, the controversial document claiming a lack of evidence supporting gender-affirming care for young people that was released in the UK last year, it’s the basis of the UK’s own indefinite ban on puberty blockers, which New Zealand is following.
Both countries say they’ll wait for the results of a UK government-sponsored clinical trial on the efficacy of puberty blockers for trans youth before making a final determination on their use. The prohibition won’t affect trans kids currently taking the drugs.
“By pinning the resumption of prescribing to a UK trial result expected in 2031, the Government has effectively sacrificed a generation of trans youth,” said New Zealand civil rights organization Rights Aotearoa. “They are demanding a level of evidence for trans healthcare that they do not demand for hundreds of other treatments routinely used in pediatrics.”
Both bans make an exception for children experiencing early-onset puberty and other conditions, raising equal protection questions.
“This will undoubtedly end up in court – very quickly as the subject of a Judicial Review,” Rights Aotearoa’s Paul Thistoll posted after news of the decision. He called it a “blatant violation” of New Zealand’s Human Rights Act.
Transgender youth in Pennsylvania and their families are celebrating a significant legal victory. A federal court in Philadelphia has rebuffed the Department of Justice’s sweeping attempt to obtain highly personal medical records from the Children’s Hospital of Philadelphia about children receiving gender-affirming care.
On Friday, federal district Judge Mark A. Kearney in the Eastern District of Pennsylvania issued an order quashing DOJ subpoena demands for names, dates of birth, Social Security numbers, home addresses, and clinical notes covering minors treated since January 2020. The court found the government “lacks statutory authority for a rambling exploration of the Hospital’s files to learn the names and medical treatment of children.”
Families in Pennsylvania had filed separate motions to quash subpoenas issued by the Trump administration in July that alleged fraud in gender-affirming care. As The Advocatereported, the subpoenas demanded exhaustive data on minors, including “intake forms, consent paperwork, and parental authorizations for puberty blockers and hormone therapy.”
Kearney’s decision reaffirms that the records in question concern lawful medical treatment governed under Pennsylvania law, and that children’s and families’ constitutional privacy interests “far outweigh” the government’s asserted investigative needs. The ruling also criticizes the DOJ’s shifting justifications, noting that at one point the government “replaced” and reminding that “false statements may be subject to a perjury investigation.”
The ruling arrives amid a broader national crackdown on gender-affirming care by the Trump administration, which in July announced more than 20 subpoenas to clinics and hospitals across multiple states. The American Medical Association and other major professional organizations had already pushed back, affirming such treatments as evidence-based and lifesaving.
For advocates and legal counsel representing the children, the decision is a vindication of long-held concerns about governmental overreach. “This is a critical win for everyone who believes healthcare decisions should be made in doctors’ offices, not the White House,” Mimi McKenzie of the Public Interest Law Center said in a press release. Attorney Jill Steinberg of the law firm Ballard Spahr added that the decision signals to transgender youth and their families that they “do not have to fight these battles alone.”
A federal judge has quashed the Department of Justice’s subpoena for the records of QueerDoc, a telehealth service that prescribes medications and offers consulting for gender-affirming care in 10 states.
The DOJ subpoenaed QueerDoc June 11, requesting personnel information, documents identifying patients, patients’ medical records, billing records, insurance claims, communications with drugmakers, and more. It was among more than 20 such subpoenas issued.
The same day, the DOJ’s Civil Division issued a memo saying it would “prioritize investigations of doctors, hospitals, pharmaceutical companies, and other appropriate entities” for “possible violations of the Food, Drug, and Cosmetic Act and other laws” regarding medications used in gender-affirming care and False Claims Act violations by health care providers who “evade state bans on gender dysphoria treatments by knowingly submitting claims to Medicaid with false diagnosis codes.”
These investigations derived from Donald Trump’s executive order recognizing only male and female sexes as assigned at birth and another denouncing gender-affirming care for minors as “a stain on our Nation’s history” that “must end” and threatening federal funding that provide such care. He also directed the DOJ to investigate providers. In April, Attorney General Pam Bondi released a memo saying the DOJ would “act decisively to protect our children and hold accountable those who mutilate them under the guise of care.” She used the same language about mutilation in a later press release. That a day after QueerDoc filed motions with a U.S. District Court in Washington State to quash the subpoena and seal the court proceedings, according to the court.
“DOJ issued its inflammatory press release declaring that medical professionals have ‘mutilated children in the service of a warped ideology,’ one day after QueerDoc filed these motions, effectively destroying any claim to investigative confidentiality while attempting to sway public sentiment against healthcare providers like QueerDoc,” Judge Jamal Whitehead wrote in his ruling, which came out Monday. “Such conduct appears calculated to intimidate rather than investigate.”
“The question before the Court is whether DOJ may use its administrative subpoena power to achieve what the Administration cannot accomplish through legislation: the elimination of medical care that Washington and other states explicitly protect. The answer is no,” he continued. He noted that gender-affirming care is supported by major medical groups and many courts.
Whitehead added, “When a federal agency issues a subpoena not to investigate legal violations but to intimidate and coerce providers into abandoning lawful medical care, it exceeds its legitimate authority and abuses the judicial process.”
He denied the motion to seal the proceedings “because, despite legitimate safety concerns, transparency in judicial proceedings remains paramount when challenging executive power,” he wrote.
QueerDoc welcomed the ruling. “The court affirmed that government power cannot be used to intimidate providers or breach the confidentiality of patients seeking medically necessary care,” the organization said in a statement on its website. “This is a win not just for QueerDoc, but for every clinician and patient fighting for the right to safe, private healthcare.”
The subpoena was “a calculated attempt by the Trump administration and Attorney General Pam Bondi to weaponize the Department of Justice against transgender people and the clinicians who care for them,” the statement noted. QueerDoc did not surrender any patient information to the DOJ, and care was not disrupted, the group said.
Asked by Politico for comment on the QueerDoc ruling, the DOJ issued this statement: “As Attorney General Bondi has made clear, this Department of Justice will use every legal and law enforcement tool available to protect innocent children from being mutilated under the guise of ‘care.’”
Trump’s Department of Health and Human Services (HHS) seeks to end all Medicaid and Medicare funding for young people’s gender-affirming care (GAC), according to newly proposed rules shared by NPR. A trans activist said the rules would amount to a “de facto national ban” on GAC.
The proposed rules would prohibit all federal Medicaid and Medicare funding — as well as funding through the federal Children’s Health Insurance Program (CHIP) — for any services at hospitals that provide GAC for trans youth.
“These would be proposals that would go out for public comment, it would take months for the Trump administration to issue a final rule, and then, if past is prologue, we would see litigation over whatever the final rules are,” Katie Keith, director of the Center for Health Policy and the Law at Georgetown University, told NPR.
Terry Schilling, president of the American Principles Project, a right-wing think tank that has pushed national transphobia as an effective Republican political strategy, said of the proposed rules, “I think these restrictions are very good. It’s going to change the entire transgender industry, and it’s going to take away a lot of their funding streams.”
“This would be a de facto national ban,” wrote trans activist and civil rights attorney Alejandra Caraballo via Bluesky. “There would still be providers in blue states that don’t take federal funding but the large interdisciplinary teams of just a few years ago would be nearly impossible to maintain. The result is that the care that remains would largely be underground with worse support and likely outcomes.”
“They’ll never be able to fully ban this care,” Caraballo added. “There will always be providers willing to provide it like abortion. Even without access to providers, many trans youth will simply go DIY [do-it-yourself] like trans folks have done for decades. They’re not actually banning this care, they’re making it less safe.”
The administration’s “toxic” war on gender-affirming care
Though there is no federal law banning gender-affirming care, the current presidential administration has sought to eradicate the practice through a January executive order (that has since been blocked by several courts). The order instructed the DOJ to extend the time that patients and parents can sue gender-affirming doctors and to use laws against false advertising to prosecute any entity that may be misleading the public about the long-term effects of gender-affirming care (GAC).
In April, Bondi issued a memo to DOJ employees, telling them to investigate and prosecute cases of minors accessing gender-affirming care as female genital mutilation (FGM), even though hospitals don’t conduct such female genital surgeries. The memo threatened to jail doctors for 10 years if they provide gender-affirming care to young trans people.
The following June, the DOJ sent subpoenas to 20 medical providers who offer GAC to trans youth, demanding patients’ Social Security numbers, emails, home addresses, and information on the care they received, as well as other sensitive information dating back to January 2020. A federal judge blocked the subpoena in one instance and accused the DOJ of going on a “bad faith” “fishing expedition” to interfere with states’ rights to protect GAC within its borders, to harass and intimidate providers from offering such care, and to dissuade patients from seeking such care.
Fewer than 3,000 teens nationwide receive puberty blockers or hormone replacement therapy, according to a 2025 JAMA analysis of private insurance data. Gender-affirming care is supported by all major medical associations in the U.S., including the American Medical Association, the Endocrine Society, and the American Academy of Pediatrics, as safe and life-saving for young people with gender dysphoria.
One doctor interviewed by The Washington Post called the federal government’s crusade against gender-affirming care a “toxic plan” that will force some patients to detransition, potentially forcing them into adverse psychological and physical effects, including increased anxiety, depression, and the development of unwanted physical changes.
A Dallas pediatrician who became the first doctor to be sued under a Texas law banning gender-affirming care for minors has given up her license to practice in the state.
According to TownFlex, the Texas Medical Board confirmed that Dr. May Lau voluntarily surrendered her medical license. In a statement, Lau’s attorney, Craig Smyser, said that she has decided to move her practice to Oregon and sees no reason to maintain her license to practice in Texas.
Last year, Texas Attorney General Ken Paxton (R) filed a first-of-its-kind lawsuit against Lau for allegedly providing gender-affirming care to minors in violation of S.B. 14. The state law, which went into effect in September 2023, bans doctors from prescribing hormone replacement therapy and puberty blockers to minors, and from performing gender-affirming surgery on minors.
Paxton’s suit accused Lau of prescribing hormone replacement therapy to at least 21 minors between October 2023 and August 2024. It further alleged that Lau “used false diagnoses and billing codes to mask these unlawful prescriptions.”
Notably, Paxton’s suit falsely referred to gender-affirming care as “dangerous and experimental” and a press release from his office claimed that there is “no scientific evidence” to support the benefits of gender-affirming medication.
In fact, puberty blockers and hormone replacement drugs have for decades been used safely for the purposes of gender transition in trans minors and to treat other medical issues in cisgender children. Gender-affirming care, which encompasses a range of both surgical and nonsurgical treatments, has been endorsed by every major American medical association and leading world health authority as evidence-based, safe, and in some cases lifesaving for transgender minors. Gender-affirming surgical intervention is rarely performed on minors.
In his statement, Smyser said that Lau “continues to deny the Texas Attorney General’s politically- and ideologically-driven allegations,” according to TownFlex.
Paxton, meanwhile, said that Lau’s surrender of her medical license was “a major victory for our state.”
“Doctors who permanently hurt kids by giving them experimental drugs are nothing more than disturbed left-wing activists who have no business being in the medical field. We will not relent in holding anyone who tries to ‘transition’ kids accountable,” he said in a statement, according to TownFlex.
As the outlet notes, Paxton has filed similar lawsuits against two other Texas doctors. Last month, the Texas AG withdrew the state’s suit against Hector Granados after finding no evidence that he violated S.B. 14. However, a lawsuit brought against M. Brett Cooper is ongoing and expected to go to trial in May.
Equality Texas noted that the enforcement of S.B. 14 has led many doctors who provide gender-affirming care to leave the state — making it harder for trans adults to access care.
A federal judge on Wednesday struck down a former President Biden-era rule that extended federal health antidiscrimination protections to transgender health care.
Judge Louis Guirola Jr. of the U.S. District Court for the Southern District of Mississippi ruled in favor of a coalition of 15 GOP-led states that sued over the rule, which broadened sex discrimination by adding sexual orientation and gender identity to the list of protected characteristics in certain health programs and activities.
The Department of Health and Human Services “exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender identity discrimination,” Guirola ruled.
The decision is a significant loss for the transgender community, which is has faced a wave of state and federal policies and court decisions rolling back previously established rights.
The complaint centered on provisions in Section 1557 of the Affordable Care Act, which the Biden administration interpreted to bolster health care protections against discrimination for LGBTQ people.
The rule prevented covered entities from discriminating against certain protected groups in providing health care services, insurance coverage and program participation.
The challenged provision added gender identity to Title IX’s definition of discrimination “on the basis of sex,” which previously included discrimination based on sex characteristics, pregnancy and sex stereotypes.
The Biden administration’s final rule, which was released in 2024, said organizations receiving federal health funding and health insurers that do business through government plans cannot refuse to provide health care services, particularly for gender-affirming care, that would be provided to a person for other purposes.
The rule was first created under former President Obama in 2016. President Trump then reversed it during his first term before the Biden administration turned it back again.
The first Trump policy kept protections against discrimination based on race, color, national origin, sex, age or disability. But the administration narrowed the definition of sex to only mean “biological sex,” cutting out transgender people from the protections.
Guiroloa ruled that a statute “cannot be divorced from the circumstances existing at the time it was passed.”
The word “sex” is not defined in the statute, so the court said it must interpret the term according to its meaning in or around 1972, when the statute was enacted. At that time, the definition focused on the reproductive distinctions between males and females.
Guirola vacated the rule universally, meaning it’s not limited to the 15 red state plaintiffs. But the impact is likely limited because the rule had not taken effect.
In a statement, Tennessee Attorney General Jonathan Skrmetti celebrated the decision.
“Our fifteen-State coalition worked together to protect the right of health care providers across America to make decisions based on evidence, reason, and conscience. This decision restores not just common sense but also constitutional limits on federal overreach, and I am proud of the team of excellent attorneys who fought this through to the finish,” he said in a statement.
A federal judge in Arizona has ruled that transgender people are no longer required to get gender-affirming surgeries in order to update their birth certificates to align with their gender identity. The Arizona Department of Health Services has 120 days to comply with the ruling.
“We are grateful that the Court ruled in Plaintiffs’ favor and found that this outdated requirement violated Plaintiffs’ constitutional rights,” said Rachel Berg, a staff attorney for the National Center for LGBTQ Rights (NCLR), which filed the case on behalf of four trans youths. “We are thrilled that the Arizona Department of Health Services will be permanently enjoined from enforcing this irrational and overly burdensome requirement, and Plaintiffs will be able to amend their birth certificates to reflect who they are.”
The ruling instructs the Arizona Department of Health Services to ignore the state’s law that requires proof of surgery to be able to amend gender markers on a birth certificate. A correction of one’s gender marker on the document still requires a doctor to attest that the patient is living as a different gender from the one assigned at birth.
The Arizona Attorney General’s Office represented the state health department. The office told the Arizona Daily Star that they are studying the ruling while deciding whether to launch an appeal on the matter.
In August last year, the same federal judge, James Soto (who was appointed by former President Barack Obama), made a similar ruling recommending that the Department of Health Services reconsider the surgical requirement for amending a birth certificate.
Soto highlighted that the requirement risked forcing trans people into unnecessary surgeries in order to live authentically or risk outing themselves in potentially dangerous situations. After a failure to act from the Department of Health Services, this week’s ruling from Judge Soto takes the matter out of their hands.
Earlier this year, Arizona Republicans tried to pass legislation to ban gender marker changes on trans people’s birth certificates entirely. While that bill passed both the state’s House and Senate, it was vetoed by Democratic Gov. Katie Hobbs.
If the Arizona ruling withstands an appeal, it’ll leave only 10 states that require proof of surgery for trans people to correct their birth certificate gender markers. However, several states still refuse to allow trans people to update their gender markers in any way.
The requirement for trans people to receive surgery to update their gender markers is discriminatory, can force people to have surgeries they don’t want, and can cause particular issues for minors who cannot access gender-affirming care.
As Soto noted in his 2024 ruling, “Not every transgender person needs surgery to complete a gender transition. Starting social transitioning and other recommended therapy may eliminate the need for any potential surgical intervention.”
These requirements can mean that minors, regardless of whether they wish to pursue gender-affirming surgeries later in life, are stuck for many years with documentation that includes an incorrect marker. That can lead to situations where a trans person is forced to out themselves, which — aside from being mentally damaging — can also put them at risk for physical harm, given the current climate towards trans people.
In a statement, NCLR noted, “For young people, their birth certificate impacts everything from school records to camp registration. ”
Finally, in most cases the surgeries required for a trans person to update their birth certificate in these states result in sterilization. That forces them to either give up on having biological kids one day, go through expensive processes to preserve their sperm or eggs, or requires them to put off updating their documents until after having children.
California lawmakers passed legislation this week to prevent health providers from releasing transgender patients’ confidential medical records in investigations of gender-affirming care in states that ban treatment for minors.
Senate Bill 497, introduced in February by Sen. Scott Wiener, a Democrat representing San Francisco, builds upon a 2022 state law that established California as a state of refuge for transgender people. That law, also authored by Wiener, prevents states that have banned gender-affirming care for minors from taking legal action against trans youth, their families and their doctors over treatment administered in California.
The latest bill would require law enforcement requesting health information about transgender people in California to provide a warrant, according to Wiener’s office. It would also bar medical providers from complying with out-of-state requests, including subpoenas, for information related to gender-affirming care.
“California must do everything in our power to protect the transgender community, and I’m confident that the Governor will continue his longstanding leadership on trans issues,” Wiener said in a statement on Thursday after the bill passed.
The California Senate voted 30-10 on Wednesday to pass Wiener’s bill, which the state Assembly passed earlier this week. A spokesperson for California Gov. Gavin Newsom (D) declined to comment, saying the governor’s office does not typically remark on pending legislation.
Newsom must sign or veto the measure by Oct. 13.
The vote on Wiener’s bill comes after the Justice Department announced in June that it had sent more than 20 subpoenas to doctors and clinics “involved in performing transgender medical procedures on children” in investigations of alleged health care fraud and false statements. A subpoena sent to the Children’s Hospital of Philadelphia that was made public in a court filing last month requested patients’ birth dates, Social Security numbers and home addresses, as well as “every writing or record of whatever type” from doctors related to the provision of gender-affirming care to adolescents younger than 19 years.
The subpoena requested information dating back to January 2020, more than a year before transition-related care was banned anywhere in the U.S.
On Tuesday, a federal judge blocked an effort by the Trump administration to subpoena medical records of transgender patients who received gender-affirming care at Boston Children’s Hospital, calling the Justice Department’s investigation improper and “motivated only by bad faith.”
In an email on Friday, a spokesperson for Wiener said Senate Bill 497, if signed, would “strengthen the case for any medical provider who wishes to fight Trump’s vicious assault on the transgender community.”
President Trump and administration officials have broadly sought to ban gender-affirming care for minors. A Jan. 28 executive order states that the U.S. “will rigorously enforce” laws that ban transition-related care for anyone younger than 19.
Laws adopted by more than half the nation since 2021 ban gender-affirming care for minors, which major professional medical groups say is medically necessary and often lifesaving for transgender youth and adults. In June, the Supreme Court ruled that states can ban treatment for minors, finding that Tennessee’s prohibition on puberty blockers, hormones and rare surgeries for adolescents does not constitute sex discrimination.
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