A significant legal battle has erupted in the United States over transgender healthcare for young people. A coalition of 19 states and the District of Columbia filed a federal lawsuit on Tuesday, 23 December 2025, against the U.S. Department of Health and Human Services (HHS), its Secretary Robert F. Kennedy Jr., and its inspector general.
The Core of the Legal Challenge
The lawsuit centres on a declaration issued by HHS on Thursday, 19 December 2025. This document labelled treatments such as puberty blockers, hormone therapy, and surgeries as "unsafe and ineffective" for children and adolescents experiencing gender dysphoria. The declaration also warned doctors they could be excluded from federal health programmes like Medicare and Medicaid if they provide such care.
The legal action, filed in the U.S. District Court in Eugene, Oregon, argues the HHS declaration is both inaccurate and unlawful. It seeks a court order to block its enforcement. New York Attorney General Letitia James, who is leading the multi-state coalition, stated, "Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices."
Accusations of Procedural Failure and Wider Context
The plaintiffs allege that HHS failed to follow required legal procedures. They claim federal law mandates public notice and an opportunity for comment before substantively changing health policy, steps which they say were bypassed. The declaration is portrayed as an attempt to coerce providers into stopping care and to circumvent established rulemaking processes.
This lawsuit represents the latest clash between the Trump administration, which is cracking down on such care citing potential harm, and advocates who argue it is medically necessary and should not be inhibited. The HHS declaration was based on a peer-reviewed departmental report from earlier in 2025, which advocated for greater reliance on behavioural therapy over broad gender-affirming care for youths and raised concerns about adolescent consent and future infertility.
However, this report has been sharply criticised as inaccurate by major medical groups and clinicians who treat transgender youth. Most major U.S. medical organisations, including the American Medical Association, continue to oppose restrictions on transgender care for young people.
Proposed Rules and the National Landscape
Concurrently with the declaration, HHS unveiled two proposed federal rules aimed at further curtailing care. One would cut off federal Medicaid and Medicare funding from hospitals providing gender-affirming care to children, while another would prohibit federal Medicaid dollars from being used for such procedures. These proposals are not yet final and must undergo a lengthy rulemaking process.
The legal and policy moves are already having a chilling effect. Several major providers have reportedly pulled back on offering this care to young patients since the Trump administration returned to office, even in states where it remains legal. Nationally, Medicaid programmes in slightly less than half of states currently cover gender-affirming care, while at least 27 states have adopted laws restricting or banning it.
The states joining New York in the lawsuit are California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Wisconsin, Washington, and the District of Columbia. Pennsylvania's Democratic governor also joined the legal action. An HHS spokesperson declined to comment on the pending litigation.
