A federal judge in Oregon ruled on Thursday that Health Secretary Robert F. Kennedy Jr. overstepped his legal authority when he declared last December that providers of gender-transition medical treatments for minors “do not meet professionally recognized standards.”
The decision, a setback for the Trump administration, gives temporary relief to hospitals, clinics and health professionals who provide such treatments. In the weeks after Mr. Kennedy issued his written declaration, the Department of Health and Human Services indicated that it would investigate institutions that continued to prescribe medication to minors for gender transitions and would potentially bar them from receiving federal Medicare and Medicaid funds.
Twenty-one states, all led by Democrats, had filed a lawsuit over Mr. Kennedy’s issuing of the 12-page declaration, claiming that the statement interfered with the power of states to regulate the practice of medicine within their borders. The declaration states that it “supersedes” statewide or national standards of care and that “sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors.”
The states asserted that the federal government had attempted to unilaterally establish a national medical standard, violating the Administrative Procedure Act, which requires federal agencies to act within the bounds of authority delegated to them by Congress.
The federal government countered that the states had failed to show they were harmed by Mr. Kennedy’s declaration, because no individual providers of gender-transition care have been barred from receiving Medicare and Medicaid at this point. In court documents, the federal government’s lawyers characterized Mr. Kennedy’s declaration as a “non-binding policy position” and likened it to an opinion piece in a publication: “Secretary Kennedy, just like anyone else, is entitled to articulate his opinion on the safety and efficacy of emerging and controversial medical practices,” the lawyers wrote.
Gender transition treatments have been banned in 27 Republican-led states, but they are legal in the states bringing the lawsuit, which include Oregon, California, Michigan, Pennsylvania and New York. In some of those states, health care institutions that fail to offer the treatments may run afoul of state anti-discrimination laws.
The Trump administration also argued that it has the authority to bar providers of medical care that fail to meet professionally recognized standards from participating in Medicare and Medicaid. That power, the government argued, exists simultaneously with the traditional power of states to regulate medicine.
After a six-hour hearing in the case in Eugene, Ore., on Thursday, Judge Mustafa Kasubhai of U.S. District Court said that Mr. Kennedy had not followed normal procedures before publishing his declaration on the issue.
The judge, who was appointed to the bench by former President Joseph R. Biden Jr., said that the case spoke to broader tactics that threatened to undermine democracy.
“The notion that ‘I will go forward and issue a declaration and see if we can get away with it’ is not a principle of governance that adheres to the overarching commitment to a democratic republic that requires the rule of law to be regarded and respected and honored as a sacred,” the judge said.
Legal experts said the decision was likely to be appealed. The Department of Health and Human Services did not immediately respond to a request for comment.
Gender-transition treatments for minors include medications that delay puberty by suppressing the production of estrogen or testosterone, and hormone therapies that can help align an adolescent’s appearance — breast development, fat distribution, voice range, facial and body hair — with their gender identity. Treatment can also include surgery for breast removal, although genital surgery is almost never performed on minors.
For more than a year, the Trump administration has sought to prevent hospitals from helping adolescents transition, asserting that many of the children are impressionable and confused and may later regret the medical interventions. In response, many clinics and hospitals in the United States have scaled back or stopped providing gender-related treatments to minors.
The treatments remain a topic of fraught debate among medical authorities. Most major American medical societies endorse providing hormone therapy as effective in treating the distress experienced by some minors whose gender identity diverges from their birth sex. But a 2024 report commissioned by the British government found that the risks and benefits of such therapy have not been studied well enough to make that determination.
In Britain, Finland, Sweden and New Zealand, health officials have restricted gender-transition treatments for youths, while groups drafting guidelines in Germany, Austria and Switzerland have endorsed them. In the United States, the American Society of Plastic Surgeons recently recommended that its members refrain from performing gender transition procedures on young patients until they reach age 19, but some members of the group criticized its leadership for failing to allow a task force devoted to the question to complete its work.
Last year, the Supreme Court ruled that states should be able to decide whether and how to provide the treatments to minors. Writing for the majority in upholding Tennessee’s ban on the treatments, Chief Justice John G. Roberts Jr. cited the “fierce scientific and policy debates about the safety, efficacy and propriety of medical treatments in an evolving field” and said the questions should be resolved by “the people, their elected representatives and the democratic process.”
In the Oregon case, the statement at issue, widely referred to as “the Kennedy declaration,” was released in late December in conjunction with an announcement by the federal health department that it would seek to bar hospitals that provide transition treatments from participating in Medicaid and Medicare programs. That plan, which could face challenges, required a period of consideration: a period of public comments and review before new rules can be released.
The declaration, by contrast, could have allowed the government to act sooner and to reach beyond major hospitals to clinicians in private practices and community health centers that rely on the federal programs to cover a large part of the cost of patient care.
According to court documents, officials of the Health and Human Services Department have referred 13 academic medical institutions, including Seattle Children’s Hospital, Children’s Hospital Colorado, Lurie Children’s Hospital of Chicago and Boston Children’s Hospital, to the department’s inspector general’s office for investigation since Mr. Kennedy released his declaration.
Amy Harmon is a Times reporter who covers how shifting conceptions of gender affect everyday life in the United States.
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