Federal judge rebuffs Trump administration push to restrict gender-affirming care for minors

A federal judge has refused to lift a nationwide block on key portions of President Donald Trump’s effort to restrict gender-affirming care for minors, preserving access to treatment even as the case remains tied up in an appeals process.

Keep up with the latest in LGBTQ+ news and politics. Sign up for The Advocate's email newsletter.

On Wednesday, U.S. District Judge Brendan A. Hurson denied the administration’s request to stay a preliminary injunction that bars federal officials from conditioning or terminating funding for health care providers based on their provision of gender-affirming care to patients under 19.

The ruling keeps in place a March 2025 injunction secured by PFLAG, families, and medical organizations challenging two executive orders directing federal agencies to limit funding tied to what the administration has described as “gender ideology” and certain medical treatments for transgender youth.

Those directives, issued early in Trump’s second term, instructed agencies to review grants and take steps, “consistent with applicable law,” to ensure federal funds do not support gender-affirming care for minors, including puberty blockers, hormone therapy, and surgical interventions.

Related: Maryland judge: Trump's DOJ can’t have trans youth hospital records

Related: Federal judge in Maryland blocks Trump's anti-transgender gender-affirming care order

The policy’s rollout sent shock waves through the health care system. Hospitals across the country paused or reconsidered care amid uncertainty about whether continuing treatment could jeopardize federal funding, prompting legal challenges that framed the orders as both discriminatory and an overreach of executive authority.

To pause the injunction while appealing it, the government needed to show a strong likelihood of success and that it would suffer irreparable harm without immediate relief. The court found neither. It also pointed to the administration’s delay, noting officials waited months after the injunction was issued before seeking a stay, undermining its claims of urgency.

The case is now before the U.S. Court of Appeals for the Fourth Circuit, in Richmond, Virginia. The appeal was filed in March 2025 but was later placed in abeyance pending related litigation, leaving the underlying injunction in place indefinitely.

Related: Maryland lawmakers advance broad school protections, including for trans students

At the same time, the Justice Department has renewed its push to lift the injunction at the appellate level, arguing that the district court’s ruling rests on flawed legal reasoning and conflicts with recent precedent, including a 2025 U.S. Supreme Court decision upholding state restrictions on certain gender-affirming treatments for minors.

A filing submitted by the DOJ to the Fourth Circuit in April reiterates those arguments, asserting that the executive orders direct agencies only to act within existing law and that any future funding decisions could be challenged individually if and when they occur. The government also contends the nationwide scope of the injunction is overly broad, extending relief beyond the plaintiffs in the case.

The appeals court has ordered the plaintiffs to respond to that motion by April 10.

While more than 20 states have enacted restrictions on care for minors, major medical organizations continue to support gender-affirming treatment as evidence-based and medically necessary.