On September 10, 2025, a federal judge in Boston handed down a decision that has sent ripples through the nation’s ongoing debate over transgender rights and health care. The ruling blocked a Justice Department subpoena seeking the medical records of transgender minors who received gender-affirming care at Boston Children’s Hospital, a move hailed by advocates as a crucial safeguard for patient privacy and a rebuke to the Trump administration’s aggressive posture on transgender issues.
This legal drama unfolds against a turbulent backdrop of executive orders, federal lawsuits, and shifting agency policies. Beginning in 1992, the US State Department’s passport office permitted transgender people to obtain passports that identified their sex consistent with their gender identity. The policy expanded under the Biden administration, allowing non-binary people to select an X marker for sex on their passports, further easing the process for those seeking recognition of their gender identity. Congress, notably, never codified or overturned these changes.
But the landscape shifted dramatically on January 20, 2025. On the day of his second inauguration, President Trump issued Executive Order 14168, stating, “it is the policy of the United States to recognize two sexes, male and female,” defining these strictly by reproductive biology at conception. The order further declared, “it was a false claim that males can identify as and thus become women and vice versa.” The State Department, acting swiftly and without following the procedures required by the Administrative Procedure Act (APA), changed its passport rules to require all passports to reflect only the sex assigned at birth, eliminating the X option for non-binary individuals.
The immediate consequences were deeply felt by transgender and non-binary Americans. Existing passports that reflected a person’s gender identity would remain valid until expiration, but new or renewed passports reverted to listing sex assigned at birth. Applicants quickly discovered the change, sparking outrage and legal action. The American Civil Liberties Union (ACLU), along with other advocacy groups, filed federal lawsuits on behalf of affected individuals. On April 18, District Judge Julie E. Kobick in Boston issued a preliminary injunction barring Secretary of State Rubio and State Department officials from applying the new policy to the named plaintiffs. The injunction, however, did not name President Trump personally.
As the case unfolded, Judge Kobick expanded the lawsuit on June 17 to include non-binary people and certified two classes—transgender and non-binary—opening the door for broader relief. The government’s motion to stay the preliminary injunction was denied on July 11, and on September 4, a three-judge panel of the First Circuit Court of Appeals unanimously denied the government’s appeal to halt the injunction. According to the panel, the government “had not sufficiently demonstrated that the balance of harms and equities favors upending the status quo and subjecting the plaintiffs to the immediate harms identified by the district court.” The court considered the “status quo” to be the policy in effect for more than 30 years before Trump’s executive order.
Meanwhile, just days after the First Circuit’s refusal to stay the injunction, Chief US District Judge George L. Russell, III in Baltimore granted a preliminary injunction in a related case. Like Judge Kobick, Judge Russell found that plaintiffs were likely to succeed on their constitutional equal protection claim, entitling them to preliminary relief. Both judges pointed to “unconstitutional animus toward transgender Americans” as a key factor in finding the new passport policy likely violated the Fifth Amendment’s equal protection requirements. Judge Kobick also concluded the State Department acted in an “arbitrary and capricious” manner, violating the APA.
The government, for its part, argued that the policy was unreviewable because it was ordered by the president, a claim the courts rejected. Judge Kobick reasoned that the State Department retained discretion in how to implement the directive, making its actions subject to judicial review. The First Circuit agreed, noting the government failed to cite any Supreme Court or appellate opinions supporting its position, leaving the matter as one of “first impression.”
Underlying these legal battles is a broader federal campaign targeting gender-affirming care for transgender youth. In January 2025, President Trump signed an executive order prohibiting federal funding or support for gender transition of individuals aged 19 or younger. Shortly after, the Department of Justice (DOJ) issued more than 20 subpoenas to doctors and clinics, including Boston Children’s Hospital, demanding home addresses, Social Security numbers, and medical records of transgender minors. The DOJ’s actions followed an April memorandum from Attorney General Bondi directing the Civil Division to “act decisively to protect our children and hold accountable those who mutilate them under the guise of care.”
U.S. District Judge Myong Joun, in blocking the DOJ’s subpoena, found it was “motivated only by bad faith.” He wrote, “It is abundantly clear that the true purpose of issuing the subpoena is to interfere with the Commonwealth of Massachusetts’ right to protect GAC within its borders, to harass and intimidate [Boston Children’s Hospital] to stop providing such care, and to dissuade patients from seeking such care.” Boston Children’s Hospital, the nation’s first pediatric and adolescent transgender health program, praised the ruling, stating it “safeguards the privacy of our patients, their families, and the healthcare professionals who provide their care,” according to TIME. The hospital reaffirmed its commitment to “safe, evidence-based, and compassionate care for every patient and their family.”
The Trump administration’s stance has already had tangible effects. Several clinics providing gender-affirming care have closed in recent months, even in Democratic strongholds, due to threats of federal funding cuts. The Department of Health and Human Services (HHS) released a report in May 2025 seeking to discredit gender-affirming care, instead promoting “exploratory therapy”—a practice condemned by the American Psychological Association and the American Academy of Child and Adolescent Psychiatry as harmful and ineffective.
Medical consensus remains firmly in favor of gender-affirming care for transgender people, including minors. Every major US medical association supports such care, and research shows that surgeries are rarely performed on minors with gender dysphoria. Instead, the care provided is considered safe and often life-saving. Advocacy organizations, including GLAAD, have celebrated the court’s decision to block the DOJ’s subpoena. “The federal government’s unhinged campaign against best practice care should alarm every family who knows that health care decisions belong with them and that their private data should be protected,” a GLAAD spokesperson told TIME.
As the legal battles continue, the government’s appeal of the preliminary injunctions is still pending at the First Circuit. The State Department has resumed processing passport applications under the previous, more inclusive policy, at least for now. With the First Circuit composed entirely of Democratic appointees and the possibility of an emergency motion to the Supreme Court looming, the future of federal policy on transgender recognition and care remains uncertain. Plaintiffs are represented by the ACLU, Lambda Legal, and pro bono attorneys from major law firms, underscoring the high stakes and national attention these cases command.
For transgender and non-binary Americans, these courtroom victories offer a measure of relief and hope, but the struggle for recognition and access to care is far from over. The next chapters will play out not only in the courts, but in the lives of those whose identities and well-being hang in the balance.
