Federal funding for hospitals across the country that provide gender-transition treatments for people under the age of 19 will remain in place under a federal judge’s ruling in Baltimore on Tuesday.
The preliminary injunction issued by Judge Brendan A. Hurson, of the U.S. District Court for the District of Maryland, blocks a Trump administration effort to withhold funds from hospitals unless they stop providing gender-transition treatment to transgender youths.
A similar decision in a separate case had already blocked the administration’s plan but applied only to four states. The new ruling expands to all states the pause on the Trump efforts while the legal case proceeds.
Tuesday’s ruling came in a case brought by six transgender individuals between the ages of 12 and 18, along with parents and advocacy groups. Plaintiffs in the case, who live in Maryland, New York and Massachusetts, said that their access to treatment was threatened by two of Mr. Trump’s executive orders that seek to limit federal support for youth gender medicine.
One of the executive orders 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 the orders, several clinics canceled appointments, including for plaintiffs in the case. Judge Hurson, an appointee of former President Joseph R. Biden Jr., had issued a temporary restraining order in February, finding that Mr. Trump had likely exceeded his authority by directing the federal agencies to withhold funds appropriated by Congress. But the injunction issued on Tuesday signals that the government will need to overcome significant legal challenges to carry out its plans. The judge also found that the plaintiffs were likely to prevail on their claims that the executive orders violated existing laws prohibiting discrimination on the basis of sex, as well as the Fifth Amendment’s equal protection guarantees.
The ruling is the latest roadblock in a string of court challenges to Mr. Trump’s effort to stop taxpayer-funded institutions and government agencies from supporting gender transition and from recognizing people based on their gender identities.
“The Court cannot fathom discrimination more direct than the plain pronouncement of a policy resting on the premise that the group to which the policy is directed does not exist,” Judge Hurson wrote.
Last month, another federal judge blocked Mr. Trump’s directive to withhold gender-transition medical treatment for federal prisoners and to house transgender female inmates with men. The administration has sought to bar transgender women and girls from competing in women’s sports; to no longer reflect the gender identities of transgender people on passports; and to bar references to gender identity in executive departments and agencies. Next week, another federal judge will hear arguments in a lawsuit challenging the administration’s plan to bar openly transgender people from serving in the military.
The order on medical treatments, 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. The Trump administration, the order says, will enforce laws that “prohibit or limit these destructive and life-altering procedures.”
The question of when medical transition is appropriate for young people has been the subject of heated debate. Genital surgery is almost never performed on minors. Several European countries have limited puberty blockers and hormone therapy treatments after scientific reviews. Since 2021, 24 states in America have barred minors from receiving the treatments.
But the American Academy of Pediatrics and most major medical groups in the United States endorse youth gender medicine as effective in relieving the psychological distress that many young trans people say they experience when their bodies do not reflect their internal sense of gender. In court documents, plaintiffs and their families said they feared negative effects — including anxiety, depression and unwanted physical changes — if treatment were withheld.
Judge Hurson’s order focused largely on the fundamental issue of separation of powers. He cited another ruling related to a challenge to the administration’s sweeping freeze on trillions of dollars in federal grants and loans, writing that the government in this case has “likewise ‘attempted to wrest the power of the purse away from the only branch of government entitled to wield it.’”
