A group of state attorneys general, led by New York, has filed a lawsuit accusing the Trump administration of mounting an unconstitutional pressure campaign against gender-affirming care for transgender youth. The lawsuit, filed Friday in the U.S. District Court in Massachusetts, challenges actions taken by the Justice Department to investigate and halt gender-affirming care across the country. 

The lawsuit argues that the Trump administration is pursuing a backdoor strategy to restrict gender-affirming care at the federal level through threats of criminal and civil penalties, while skirting state laws that protect transgender patients’ health care. 

As federal investigations and funding threats roll out, hospitals across the country are shutting down their gender-affirming care programs for minors — including in areas where access to this care is protected by state law. Clinics and medical programs have shuttered in California, Connecticut, Colorado, Illinois and Washington, D.C., among others — despite state laws that protect the care’s legality. Multiple hospitals have attributed shuttering or pausing their gender-affirming care programs to President Donald Trump’s executive orders and federal administrative actions, including the Yale health system and Denver Health in Colorado. 

The White House recently celebrated these closures as a direct result of Trump’s executive orders. 

“The administration’s actions put providers in an impossible position: either comply with unlawful federal threats or violate state laws that require nondiscriminatory access to medical care,” New York Attorney General Letitia James’ office said in a statement. 

James and other attorneys general suing the Trump administration argue that these actions are not based in law, since no federal statute prohibits gender-affirming care in the United States. Instead, these actions are an intimidation tactic to suppress the health care, the lawsuit alleges. Through the courts, they are attempting to halt the Justice Department’s actions.

Plaintiffs in the lawsuit include the attorneys general of states where gender clinics have recently shuttered, as well as Pennsylvania Gov. Josh Shapiro. They assert that gender-affirming care is legally protected in all of their states and that federal efforts to block that care violate states’ rights provided by the 10th Amendment. 

Over the past few months, federal agencies have begun to follow through on Trump’s executive orders regarding gender-affirming care. 

In early July, Chad Mizelle, chief of staff at the Justice Department, announced that the agency had launched at least 20 subpoenas into clinics involved in gender transition care, alongside subpoenas to drug manufacturers and investigations into hospitals providing the care. Doctors are being subpoenaed for patients’ private information, the New York Times reports. The agency is following the White House directive it received in January, via executive order, to broadly investigate gender-affirming care. In these directives, the Trump administration has incorrectly conflated the care with female genital mutilation. 

The New York lawsuit challenges these actions, as well as FBI criminal investigations into three children’s hospitals that currently provide gender-affirming care or have done so in the past. Although the lawsuit is being brought against Trump, Attorney General Pam Bondi and the Justice Department, it also references other actions taken by federal agencies targeting gender-affirming care — including an all-day event hosted by the Federal Trade Commission. That event, titled “the dangers of ‘gender-affirming care’ for minors,” is where the Justice Department first announced its subpoenas for confidential patient information. 

Major medical groups including the American Medical Association, American Psychological Association and the American Academy of Pediatrics have endorsed gender-affirming care for transgender youth. The new president of the World Professional Association for Transgender Health, which sets global standards for doctors and nurses providing health care to trans patients, has expressed concerns that banning gender-affirming care will simply drive the care underground and endanger patients.

Transgender people, as well as the families and parents of transgender youth, are feeling increasingly worried and scared as the Trump administration targets their identities and their health care. For years, states have banned gender-affirming care for minors in red states and through Republican-controlled legislatures; but now, with the crackdown taking place on a national level, trans people living in blue states and liberal cities face the same threat.