Seattle judge extends order preserving access to gender-affirming care for trans youth

Updated on Saturday, 3/1/25 at 7:48 a.m.

A federal judge in Seattle has extended an earlier order favoring the rights of trans youth to access gender-affirming care.

The order temporarily blocks the Trump administration's ban on federal funding for institutions that provide such care to people under age 19. U.S. District Judge Lauren King granted a preliminary injunction late on Friday intended to prevent funding cutoffs or cancelled treatments while President Trump’s executive order is being challenged in court.

King had initially delayed her decision about whether to extend the original order, which expired Friday night, during a hearing in the case Friday afternoon, but had said she'd make another ruling "soon."

Friday's hearing came in response to a lawsuit filed earlier this month by Washington State Attorney General Nick Brown on behalf of three physician plaintiffs and the states of Washington, Oregon, Minnesota, and Colorado.

RELATED: Seattle Children's halts gender-affirming surgeries after executive order threatens loss of federal funds

Federal judges in Seattle have also been instrumental in recent weeks in temporarily blocking President Trump’s executive orders on birthright citizenship and refugee admissions.

Trump’s Jan. 28 executive order directs federal agencies to withhold funds from medical institutions that offer puberty blockers, hormone therapies, and surgeries to people younger than 19 for the purpose of gender transition.

Washington State's lawsuit notes that Seattle Children’s Hospital was awarded nearly $185 million in federal research grants in 2024 alone. Seattle Children’s cancelled a scheduled gender affirming surgery for a 16-year-old after the order was issued.

Explaining her initial decision to grant a temporary restraining order on Feb. 14, Judge King said Trump’s order is unconstitutional because it “oversteps the president’s authority under the separation of powers” by making congressionally appropriated funding to medical institutions for research on illnesses from cancer to diabetes to asthma suddenly contingent on “whether grant recipients provide certain medical care to individuals 18 and under.”

King said the executive order also violated the Fifth Amendment’s equal protection clause, writing, “Although the executive order’s stated purpose is to protect ‘children’ from regret associated with adults ‘chang[ing] a child’s sex through a series of irreversible medical interventions,’ the order is not limited to children, or to irreversible treatments, nor does it target any similar medical interventions performed on cisgender youth.”

RELATED: Trump's ban on gender-affirming care for young people puts hospitals in a bind

King added that Trump's order discriminates on the basis of transgender status by preventing "transgender youth from obtaining necessary medical treatments that are completely unrelated to their gender identity. For example, a cisgender teen could obtain puberty blockers from a federally funded medical provider as a component of cancer treatment, but a transgender teen with the same cancer care plan could not.”

She also criticized the executive order's broadness, saying it could have unintended consequences.

“For example, the order forbids federal funding to providers who offer surgeries ‘to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions,’" King wrote. "This would prevent such a provider not only from performing gender-affirming surgery on an 18-year-old transgender individual, but also from performing, for example, a vasectomy on a married cisgender 18-year-old man who desires the surgery because he has Huntington’s disease and does not want to pass it to his children.”

King characterized Trump’s order as taking a “‘blunderbuss approach to achieving ostensible goal of protecting children from regret over medical interventions,” noting that the order bans puberty blockers even though they don’t conflict with the order’s stated goal.

Meanwhile, King found the transgender youth affected by the executive order could be subject to irreparable harm if it were allowed to go forward. She cited one of the physician plaintiffs who said discontinuing such gender-affirming care can cause puberty changes within a month, resulting in “higher rates of anxiety, depression, and suicidal ideation” among trans patients.

RELATED: With Trump returning, some trans folks prepare to move to Washington state, or another country

In a declaration, a Minnesota health care executive also said Trump’s ban “could cause transgender minors to avoid other medical screenings and vaccinations because they fear discrimination.”

Attorneys with the U.S. Department of Justice representing the Trump administration argued against the preliminary injunction, saying the president is within his constitutional authority to implement his agenda, and that no federal grants have been withheld, so that part of the lawsuit is not timely.

On the question of attempting to restrict medical treatments for trans youth, federal attorneys argued that Trump’s order relates to “the important governmental interest of safeguarding children from potentially dangerous, ineffective, and unproven treatments.”

They further contended that Trump’s order does not restrict gender affirming care overall because it could still be offered by medical institutions that don’t receive federal grants. They said the order “announces a policy on what sorts of education and research the Executive Branch has chosen to subsidize.”

The attorneys added that “a majority of states have gone further by enacting laws and policies to restrict gender affirming care for minors.”

The day before Washington State's case first came before Judge King, a federal judge in Maryland granted the first temporary restraining order putting Trump's order on hold.

The Maryland case was filed by six transgender individuals between the ages of 12 and 18, along with parents and advocacy groups. A spokesperson for the nonprofit Lambda Legal said that nationwide order has been extended until March 5 while the court "is deciding the motion for" a preliminary injunction.