On December 24, 2025, a sweeping legal and political battle erupted over the future of gender-affirming care for young people in the United States, as a coalition of 19 states and the District of Columbia filed a lawsuit against the U.S. Department of Health and Human Services (HHS), its Secretary Robert F. Kennedy Jr., and the department’s inspector general. The lawsuit, lodged in the U.S. District Court in Eugene, Oregon, challenges a recent declaration from HHS that could fundamentally restrict access to gender-affirming medical treatments for minors—an issue that has become a lightning rod in the nation’s ongoing culture wars.
The controversy centers on a declaration issued by HHS on December 19, 2025. In this document, the department labeled treatments such as puberty blockers, hormone therapy, and surgeries for children and adolescents experiencing gender dysphoria as "unsafe and ineffective." The declaration further warned that health care providers who offer such care could face exclusion from critical federal health programs like Medicare and Medicaid. According to the Associated Press, the declaration was based on a peer-reviewed report produced by HHS earlier in the year, which urged a shift toward behavioral therapy over medical interventions for youth experiencing gender dysphoria. The report also raised alarms about the ability of adolescents to give informed consent for treatments that, in some cases, could result in permanent infertility.
HHS’s new stance comes amid a broader push by the federal government to curtail access to gender-affirming care for minors. According to PhillyVoice, the declaration followed an executive order from January 2025 directing HHS "to take all appropriate actions to end" such treatments for youth. On the same day as the declaration, HHS also unveiled two proposed federal rules: one that would cut off Medicaid and Medicare funding to hospitals providing gender-affirming care to children, and another that would prohibit federal Medicaid dollars from being used for such procedures. While these rules are not yet final—they must still undergo a lengthy rulemaking process and public comment period—their announcement has already sent shockwaves through the health care community.
"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," New York Attorney General Letitia James, who spearheaded the lawsuit, said in a statement Tuesday. The lawsuit argues that HHS’s declaration is both inaccurate and unlawful, alleging that it seeks to coerce providers into halting gender-affirming care and circumvents basic legal requirements for changing federal health policy—namely, public notice and an opportunity for comment.
Joining James in the legal action are Democratic attorneys general from 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 signed on. The lawsuit does not address the proposed rules, as they are not yet finalized, but it seeks to block enforcement of the declaration itself.
According to HuffPost, major U.S. medical organizations, including the American Medical Association and the American Academy of Pediatrics, have sharply criticized the HHS report and declaration, maintaining that gender-affirming care can be medically necessary and that restrictions on such care are not supported by the best available evidence. These groups continue to oppose limits on transgender care for young people, arguing that such decisions should remain between patients, their families, and their doctors.
The stakes are high for hospitals and health systems across the country. As PhillyVoice reported, several major providers have already pulled back on gender-affirming care for young patients since President Trump’s return to office—even in states where the care remains legal and is protected by state law. Penn Medicine, for example, stopped offering gender-affirming care to individuals under 19 earlier this year. The Children’s Hospital of Philadelphia, which operates one of the nation’s leading programs for transgender youth, has found itself embroiled in a court battle with the Trump administration over access to medical records of its patients. Other prominent health systems, such as Jefferson Health and Main Line Health, have declined to comment on the new HHS declaration, reflecting the intense pressure and uncertainty facing providers.
Meanwhile, the legal landscape continues to shift. At least 27 states have adopted laws restricting or outright banning gender-affirming care for minors, and the Supreme Court’s recent decision upholding Tennessee’s ban signals that most state-level restrictions are likely to remain in place. Medicaid programs in slightly less than half of states currently cover gender-affirming care, but the threat of losing federal funding could prompt even more providers to scale back or eliminate these services.
Supporters of the new HHS approach, including some in the current administration, argue that the federal government has a responsibility to protect children from what they view as experimental or irreversible medical procedures. They point to the department’s peer-reviewed report, which questioned the standards set by the World Professional Association for Transgender Health and highlighted the potential long-term consequences of early medical intervention. They also emphasize the need for greater reliance on behavioral therapy and caution that adolescents may not be mature enough to consent to treatments with lifelong implications.
Opponents, however, see the declaration and proposed rules as a dangerous overreach that threatens to undermine access to essential health care for a vulnerable population. They argue that the government is inserting itself into deeply personal medical decisions and disregarding the consensus of major medical organizations. As Letitia James put it, "At the core of this so-called declaration are real people: young people who need care, parents trying to support their children, and doctors who are simply following the best medical evidence available."
For families and patients caught in the crossfire, the uncertainty is palpable. The prospect of losing access to gender-affirming care—whether due to legal restrictions, loss of insurance coverage, or providers’ fear of federal penalties—has left many scrambling for answers and support. As the legal battle plays out in federal court, the future of transgender health care for minors in the United States remains precarious, with the outcome likely to reverberate far beyond the courtroom.
As the year draws to a close, the clash between federal policy, state law, and medical consensus is intensifying, and the lives of countless young people and their families hang in the balance.
