transgender

WASHINGTON  — The Supreme Court has cleared the way for President Trump to remove transgender markers from new passports and to require applicants to designate they were male or female at birth.

By a 6-3 vote, the justices granted another emergency appeal from Trump’s lawyers and put on hold a Boston judge’s order that prevented the president’s new passport policy from taking effect.

“Displaying passport holders’ sex at birth no more offends equal protection principles than displaying their country of birth,” the court said in an unsigned order. “In both cases, the Government is merely attesting to a historical fact without subjecting anyone to differential treatment.”

Justice Ketanji Brown Jackson filed a dissent, joined by Justices Sonia Sotomayor and Elena Kagan.

She said there was no emergency, and the change in the passport policy would pose a danger for transgender travelers.

“The current record demonstrates that transgender people who use gender-incongruent passports are exposed to increased violence, harassment, and discrimination,” she wrote. “Airport checkpoints are stressful and invasive for travelers under typical circumstances—even without the added friction of being forced to present government-issued identification documents that do not reflect one’s identity.

“Thus, by preventing transgender Americans from obtaining gender-congruent passports, the Government is doing more than just making a statement about its belief that transgender identity is ‘false.’ The Passport Policy also invites the probing, and at times humiliating, additional scrutiny these plaintiffs have experienced.”

Upon taking office in January, Trump ordered the military to remove transgender troops from its ranks and told agencies to remove references to “gender identity” or transgender persons from government documents, including passports.

The Supreme Court has put both policies into effect by setting aside orders from judges who temporarily blocked the changes as discriminatory and unconstitutional.

U.S. passports did not have sex markers until the 1970s. For most of time since then, passport holders have had two choices: “M” for male and “F” for female. Beginning in 1992, the State Department allowed applicants to designate a sex marker that differed from their sex at birth.

In 2021, the Biden administration added an “X” marker as an option for transgender and non-binary persons.

Trump sought a return to the earlier era. He issued an executive order on “gender ideology extremism” and said his administration would “recognize two sexes, male and female.” He required “government-issued identification documents, including passports” to “accurately reflect the holder’s sex” assigned at birth.

The ACLU sued on behalf of transgender individuals who would be affected by the new policy. They won a ruling in June from U.S. District Judge Julia Kobick who blocked the new policy from taking effect.

The transgender plaintiffs “seek the same thing millions of Americans take for granted: passports that allow them to travel without fear of misidentification, harassment, or violence,” the ACLU attorneys said in an appeal to Supreme Court last month.

They said the administration’s new policy would undercut the usefulness of passports for identification.

“By classifying people based on sex assigned at birth and exclusively issuing sex markers on passports based on that sex classification, the State Department deprives plaintiffs of a usable identification document and the ability to travel safely…{It} undermines the very purpose of passports as identity documents that officials check against the bearer’s appearance,” they wrote.

But Solicitor Gen. D. John Sauer argued the plaintiffs had no authority over official documents. He said the justices should set aside the judge’s order and allow the new policy to take effect.

“Private citizens cannot force the government to use inaccurate sex designations on identification documents that fail to reflect the person’s biological sex — especially not on identification documents that are government property and an exercise of the President’s constitutional and statutory power to communicate with foreign governments,” he wrote.

California Gov. Gavin Newsom this week signed a suite of privacy protection bills for transgender patients amid continuing threats by the Trump administration.

But there was one glaring omission that LGBTQ+ advocates and political strategists say is part of an increasingly complex dance the Democrat faces as he curates a more centrist profile for a potential presidential bid.

Newsom vetoed a bill that would have required insurers to cover, and pharmacists to dispense, 12 months of hormone therapy at one time to transgender patients and others. The proposal was a top priority for trans rights leaders, who said it was crucial to preserve care as clinics close or limit gender-affirming services under White House pressure.

Political experts say Newsom’s veto highlights how charged trans care has become for Democrats nationally and, in particular, for Newsom, who as San Francisco mayor engaged in civil disobedience by allowing gay couples to marry at City Hall. The veto, along with his lukewarm response to anti-trans rhetoric, they argue, is part of an alarming pattern that could damage his credibility with key voters in his base.

“Even if there were no political motivations whatsoever under Newsom’s decision, there are certainly political ramifications of which he is very aware,” said Dan Schnur, a former GOP political strategist who is now a politics lecturer at the University of California-Berkeley. “He is smart enough to know that this is an issue that’s going to anger his base, but in return, may make him more acceptable to large numbers of swing voters.”

Earlier this year on Newsom’s podcast, the governor told the late conservative activist Charlie Kirk that trans athletes competing in women’s sports was “deeply unfair,” triggering a backlash among his party’s base and LGBTQ+ leaders. And he has described trans issues as a “major problem for the Democratic Party,” saying Donald Trump’s trans-focused campaign ads were “devastating” for his party in 2024.

Still, in a conversation with YouTube streamer ConnorEatsPants this month, Newsom defended himself “as a guy who’s literally put my political life on the line for the community for decades, has been a champion and a leader.”

“He doesn’t want to face the criticism as someone who, I’m sure, is trying to line himself up for the presidency, when the current anti-trans rhetoric is so loud,” said Ariela Cuellar, a spokesperson for the California LGBTQ Health and Human Services Network.

Caroline Menjivar, the state senator who introduced the measure, described her bill as “the most tangible and effective” measure this year to help trans people at a time when they are being singled out for what she described as “targeted discrimination.”

In a legislature in which Democrats hold supermajorities in both houses, lawmakers sent the bill to Newsom on a party-line vote. Earlier this year, Washington became the first to enact a state law extending hormone therapy coverage to a 12-month supply.

In a veto message on the California bill, Newsom cited its potential to drive up health care costs, impacts that an independent analysis found would be negligible.

“At a time when individuals are facing double-digit rate increases in their health care premiums across the nation, we must take great care to not enact policies that further drive up the cost of health care, no matter how well-intended,” Newsom wrote.

Under the Trump administration, federal agencies have been directed to limit access to gender-affirming care for children, which Trump has referred to as “chemical and surgical mutilation,” and demanded documents from or threatened investigations of institutions that provide it.

In recent months, Stanford Medicine, Children’s Hospital Los Angeles, and Kaiser Permanente have reduced or eliminated gender-affirming care for patients under 19, a sign of the chilling effect Trump’s executive orders have had on health care, even in one of the nation’s most progressive states.

California already mandates wide coverage of gender-affirming health care, including hormone therapy, but pharmacists can currently dispense only a 90-day supply. Menjivar’s bill would have allowed 12-month supplies, modeled after a 2016 law that allowed women to receive an annual supply of birth control.

Luke Healy, who told legislators at an April hearing that he was “a 24-year-old detransitioner” and no longer believed he was a woman, criticized the attempt to increase coverage of services he thought were “irreversibly harmful” to him.

“I believe that bills like this are forcing doctors to turn healthy bodies into perpetual medical problems in the name of an ideology,” Healy testified.

The California Association of Health Plans opposed the bill over provisions that would limit the use of certain practices such as prior authorization and step therapy, which require insurer approval before care is provided and force patients and doctors to try other therapies first.

“These safeguards are essential for applying evidence-based prescribing standards and responsibly managing costs — ensuring patients receive appropriate care while keeping premiums in check,” said spokesperson Mary Ellen Grant.

An analysis by the California Health Benefits Review Program, which independently reviews bills relating to health insurance, concluded that annual premium increases resulting from the bill’s implementation would be negligible and that “no long-term impacts on utilization or cost” were expected.

Shannon Minter, legal director for the National Center for LGBTQ Rights, said Newsom’s economic argument was “not plausible.” Although he said he considers Newsom a strong ally of the transgender community, Minter noted he was “deeply disappointed” to see the governor’s veto.

“I understand he’s trying to respond to this political moment, and I wish he would respond to it by modeling language and policies that can genuinely bring people along.”

Newsom’s press office declined to comment further.

Following the podcast interview with Kirk, Cuellar said, advocacy groups backing SB 418 grew concerned about a potential veto and made a point to highlight voices of other patients who would benefit, including menopausal women and cancer patients. It was a starkly different strategy than what they might have done before Trump took office.

“Had we run this bill in 2022-2023, the messaging would have been totally different,” said another proponent who requested anonymity because they were not authorized to speak publicly on the issue.

“We could have been very loud and proud. In 2023, we might have gotten a signing ceremony.”

Advocates for trans rights were so wary of the current political climate that some also felt the need to steer clear of promoting a separate bill that would have expanded coverage of hormone therapy and other treatments for menopause and perimenopause. That bill, authored by Assembly member Rebecca Bauer-Kahan, who has spoken movingly about her struggles with health care for perimenopause, was also vetoed.

In the meantime, said Jovan Wolf, a trans man and military veteran, patients like him will be left to suffer. Wolf, who had taken testosterone for more than 15 years, tried to restart hormone therapy in March, following a two-year hiatus in which he contemplated having children.

Doctors at the Department of Veterans Affairs told him it was too late. Days earlier, the Trump administration had announced it would phase out hormone therapy and other treatments for gender dysphoria.

“Having estrogen pumping through my body, it’s just not a good feeling for me, physically, mentally. And when I’m on testosterone, I feel balanced,” said Wolf, who eventually received care elsewhere. “It should be my decision and my decision only.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

SACRAMENTO — Gov. Gavin Newsom on Monday signed legislation to study inequalities in youth sports, a move likely to draw ire from Republicans who believe the measure is intended to support transgender athletes.

The legislation, Assembly Bill 749, creates a commission to examine whether a new state board or department is needed to improve access to sports regardless of race, sex, sexual orientation, gender identity, disability, income or geographic location.

In an open letter last month to the governor, Senate Minority Leader Brian Jones (R-Santee) zeroed in on the term “gender identity.”

“The author and supporters of [this legislation] know if they were upfront and put forth a straightforward bill allowing biological males to compete against young women and girls, it would be easily defeated,” Jones wrote on Sept. 26. “So instead they are trying to establish a stacked commission to indirectly rig the issue in their favor.”

Jones urged Newsom to veto the bill and referenced the governor’s previous remarks about transgender athletes. During the first episode of his podcast “This Is Gavin Newsom,” the governor — a longtime ally of the LGBTQ+ community — acknowledged the struggle faced by transgender people but called transgender women’s participation in women’s sports “deeply unfair” and warned it was hurting Democrats at the polls.

Assemblymember Tina S. McKinnor, who introduced the bill, said Jones should keep his focus on Washington.

“Senator Brian Jones’ time would be better spent writing to the Republican controlled Congress to end the Trump Shutdown and reopen the federal government, rather than attacking trans students,” McKinnor (D-Hawthorne) wrote in an email to The Times.

Legislation referencing gender identity tends to be a lightning rod for controversy nationwide, with opinion polls suggesting Americans hold complex views on transgender issues.

A survey conducted this year by the nonpartisan Pew Research Center found 66% of U.S. adults favor laws requiring transgender athletes to compete on teams that match their sex assigned at birth. At the same time, 56% of adults supported policies protecting transgender people from discrimination in jobs and public spaces.

During legislative committee hearings on the bill, McKinnor focused on the legislation’s potential racial impact. She said last year’s Play Equity Report found 59% of white youth participated in structured sports programs, compared with 47% of Black youth and 45% of Latino youth.

“Participation in youth sports remains unequal despite the well-documented physical, mental and academic benefits,” McKinnor told the Senate Health Committee in July. “These disparities stem from systemic barriers such as financial limitations, uneven program quality, outdated physical education standards and the lack of a coordinated statewide strategy.”

More than two dozen organizations endorsed the bill, including the Los Angeles Rams, city of San Diego, USC Schwarzenegger Institute, YMCA of Metropolitan Los Angeles and the Boys and Girls Clubs of West San Gabriel Valley and Eastside.

The legislation directs the state public health officer to convene the commission, which will be composed of 10 members appointed by the governor and three appointed by each the speaker of the Assembly and the Senate Committee on Rules. The health officer will also sit on the panel, or appoint their own designee.

Newsom did not issue a statement when his office announced a slate of bills he signed on Monday.

In March, Newsom infuriated the progressive wing of his party when, while hosting conservatives commentator Charlie Kirk on the governor’s podcast, he broke away from many Democrats on the issue of transgender athletes. Newsom, an outspoken champion of LGBTQ+ rights since he was mayor of San Francisco, publicly criticized the “unfairness” of transgender athletes participating in women’s sports.

Sept. 23 (UPI) — Texas Gov. Greg Abbott has signed legislation banning transgender people from accessing restrooms and other facilities, including domestic violence shelters and prisons, that align with their gender identity.

Abbott, a Republican, signed the legislation Monday, sharing a video of it on X.

“This is just common sense,” he said, while holding up the signed document, showing it to the camera.

Abbott signed Senate Bill 8 after the Texas House passed it 86-45 on Aug. 28.

The bill, which takes effect Dec. 4, requires people to use facilities, such as bathrooms and restrooms, in government-owned buildings, including schools and universities, that align with their gender assigned at birth.

Other facilities affected include family violence shelters, prisons and jails.

Organizations that violate the law can face a $25,000 fine for a first offense and $125,000 for a second.

“Let’s hope more states follow suit,” state Rep. Angelia Orr, a sponsor of SB 8, said in a statement after Abbott announced her bill had been signed. “This is common sense policy to protect the women and girls of Texas!”

Texas passed the bill amid a larger conservative push to pass legislation affecting the rights and healthcare of LGBTQ Americans, though specifically targeting transgender Americans.

The Lone Star State GOP lawmakers have been trying to pass a so-called bathroom ban since 2017, but were unable to get it through the House until this summer.

The American Civil Liberties Union of Texas was swift in rebuking Abbott fpr signing S.B. 8 into law, saying it will encourage gender policing by those who seek to attack transgender people, or simply those who don’t adhere to stereotypical gender roles.

“This law puts anyone at risk who doesn’t seem masculine or feminine enough to a random stranger, including the cisgender girls and women this bill purports to protect,” Ash Hall, policy and advocacy strategist on LGBTQIA+ rights at the ACLU of Texas, said in a statement.

“This bill is bad for trans and intersex people, bad for cisgender people, bad for business, bad for public health and safety and bad for Texas,” they added. “Transgender people have always been here and always will be.”

According to Every Texan, a nonprofit that researches equitable policy solutions, there are an estimated 122,700 transgender people in Texas, including nearly 30,000 youth.

The Movement Advancement Project states there are 19 states with some form of bathroom ban, including two states that make it a criminal offense.

WASHINGTON — President Trump’s administration asked the Supreme Court on Friday to let it enforce a passport policy for transgender and nonbinary people that requires male or female sex designations based on birth certificates.

The Justice Department appealed a lower-court order allowing people use the gender or “X” identification marker that lines up with their gender identity.

It’s the latest in a series of emergency appeals from the Trump administration, many of which have resulted in victories amid litigation, including on banning transgender people from the military.

The government argues it can’t be required to use sex designations it considers inaccurate on official documents. The plaintiffs, meanwhile, say the policy violates the rights of transgender and nonbinary Americans.

The State Department changed its passport rules after Trump handed down an executive order in January declaring the United States would “recognize two sexes, male and female,” based on what it called “an individual’s immutable biological classification.”

Transgender actor Hunter Schafer, for example, said in February that her new passport had been issued with a male gender marker, even though she submitted the application with the female gender marker she has used for years on her driver’s license and passport.

A judge blocked the Trump administration policy in June after a lawsuit from nonbinary and transgender people, some of whom said they were afraid to submit applications. An appeals court left the judge’s order in place.

The Trump administration on Friday asked the Supreme Court to put the order on hold while the lawsuit plays out.

“The Constitution does not prohibit the government from defining sex in terms of an individual’s biological classification,” Solicitor Gen. D. John Sauer wrote.

He pointed to the high court’s recent ruling upholding a ban on transition-related health care for transgender minors. The courts conservative majority found that law doesn’t discriminate on the basis of sex, and Sauer argued that finding also supports the Trump administration’s decision to change passport rules issued in 2021.

An attorney for the plaintiffs, on the other hand, said the passport rules are discriminatory.

“This administration has taken escalating steps to limit transgender people’s health care, speech, and other rights under the Constitution, and we are committed to defending those rights,” said Jon Davidson, senior counsel for the LGBTQ & HIV Project at the American Civil Liberties Union.

Whitehurst writes for the Associated Press.

Marc Seawright took pride in his job at the U.S. Equal Employment Opportunity Commission, where he worked for more than eight years and most recently oversaw technology policy to support the agency’s mission of combating workplace harassment and discrimination.

But then President Trump began targeting transgender and nonbinary people within hours of returning to the White House by issuing a series of executive orders — including one declaring the existence of two unchangeable sexes. Seawright was ordered to develop technology to scrub any mention of LGBTQ+ identities from all EEOC outreach materials, which had been created to help employers understand their obligations under civil rights law.

Suddenly, his tech expertise “was being leveraged to perpetuate discrimination against people like me,” said Seawright, 41, who served as the EEOC’s director of information governance and strategy before he quit in June, citing a hostile work environment. “It became overwhelming. It felt insurmountable.”

A San Francisco-based Army veteran, Seawright is one of 10 transgender and gender nonconforming government employees across federal agencies who spoke with the Associated Press about their workplace experiences since Trump regained office, describing their fear, grief, frustration and distress working for an employer that rejects their identity — often with no clear path for recourse or support. Several requested anonymity for fear of retaliation; some, including Seawright, have filed formal discrimination complaints.

Since January, the Trump administration has reversed years of legal and policy gains for transgender Americans, including stripping government websites of “gender ideology” and reinstituting a ban on transgender service members in the military.

The White House and the EEOC declined to respond to allegations that the president’s policies created a hostile workplace for transgender federal employees. But his executive order, which defines sex as strictly male or female, states that its goal is to protect spaces designated for women and girls.

“Efforts to eradicate the biological reality of sex fundamentally attack women by depriving them of their dignity, safety, and well-being,” the order says.

Independent Women, a nonprofit that advocates for legislation defining sex as male and female, supports Trump’s executive order.

“Women’s rights can get erased if men can just self-identify to women’s spaces,” said the organization’s senior legal advisor Beth Parlato.

Brad Sears, senior scholar at UCLA School of Law’s Williams Institute, which researches policy impacting LGBTQ+ people, points to “a sweeping, government-wide initiative to really erase transgender people from public life,” including adults in the workplace.

“The federal workplace is increasingly an inhospitable place for the transgender employees who remain,” Sears said.

Compared with private sector workers, transgender federal employees are especially vulnerable because many ultimately answer to the president, said Olivia Hunt, director of federal policy at Advocates for Trans Equality, which seeks legal and political rights for transgender people in the United States.

“In the absence of an ability to impose their will directly on employers throughout the country, this administration is going to use the tools that they have to attack the trans people who are in close proximity to them, and that includes federal workers,” Hunt said.

After serving as the first openly transgender soldier in the Illinois National Guard, LeAnne Withrow retired from the military due to injury, and now works in a federal civilian role helping military families access resources.

Withrow visits armories across Illinois for her job, sometimes in remote areas. But Trump’s executive order directing agencies to take “appropriate action” to ensure that intimate spaces “are designated by sex and not identity” created a major hurdle for Withrow when her supervisors informed her that she was no longer allowed to use the women’s restroom at work.

“I don’t use men’s spaces because I don’t feel comfortable doing that,” the 34-year-old said.

At locations without single-occupancy options, a simple bathroom break can mean a 45-minute round trip to a nearby gas station or McDonald’s.

Represented by the ACLU, Withrow filed a class action complaint in May challenging the Trump administration’s policy on the basis of sex discrimination.

A spokesperson for the Illinois National Guard declined to comment on the pending lawsuit but said the agency is “committed to treating all of our employees with dignity and respect.” The Department of Defense also declined to comment, citing policy, but affirmed its commitment to enforcing relevant laws and implementing the gender executive order.

For Seawright at the EEOC, he feels like his skill set was being wielded against the agency’s mission, not to support it. Following Trump’s signing of his executive order, Acting EEOC Chair Andrea Lucas, a Republican, quickly began reshaping policy and, among other things, removed the agency’s “pronoun app,” which allowed employees to display their pronouns in their profiles. It was a tool that was created — then dismantled — by Seawright.

He had spent two years developing the app to support a nonbinary employee at the agency.

“For it to be just kind of yanked away summarily with none of the thoughtfulness and planning that went into implementing the tool … that became really frustrating,” Seawright said.

His mental health suffered, and he requested extended personal leave shortly after he completed the project scrubbing references to gender identity. When he returned in late February, the situation continued to deteriorate.

He hired lawyers at Katz Banks Kumin and filed a formal discrimination complaint. In June, Seawright resigned, citing “significant distress, anxiety, depression, sleeplessness, anger, and sadness” caused daily by Lucas’ “anti-transgender actions.”

Withrow, meanwhile, still works in her role while navigating similar challenges.

“I do feel as though there is at least an implied threat for trans folks in federal service,” she said. “We’ll just continue to meet the objectives and focus on the mission, and hope that that is enough proof that we belong.”

Savage writes for the Associated Press.

California and a coalition of other liberal-led states sued the Trump administration Friday over efforts to end gender-affirming care for transgender, intersex and nonbinary children and young adults nationwide — calling them an unconstitutional attack on LGBTQ+ patients, healthcare providers and states’ rights.

The lawsuit was brought by California Atty. Gen. Rob Bonta and officials from 15 other states and the District of Columbia. It challenges a Jan. 28 executive order by President Trump that denounced gender-affirming care as “mutilation” and called on U.S. Justice Department officials to effectively enforce a ban, including by launching investigations into healthcare providers.

The lawsuit notes the Justice Department last month sent more than 20 subpoenas to doctors and clinics that have provided such care nationwide, with justice officials suggesting they may face criminal prosecution.

Bonta’s office, in a statement, said such efforts “have no legal basis and are intended to discourage providers from offering lifesaving healthcare that is lawful under state law.” The lawsuit asks a federal court in Massachusetts to vacate Trump’s order in its entirety for exceeding federal authority and undermining state laws that guarantee equal access to healthcare.

The White House did not immediately respond to a request for comment Friday.

Trump made reining in transgender rights a key promise of his presidential campaign. Upon taking office, he moved swiftly to do so through executive orders, funding cuts and litigation. And in many ways, it has worked — particularly when it comes gender-affirming care for minors.

Clinics across the country that had provided such care have closed their doors in response to the threats and funding cuts. That includes the renowned Center for Transyouth Health and Development at Children’s Hospital Los Angeles, one of the largest and oldest pediatric gender clinics in the U.S.

The clinic told thousands of its patients and their families that it was shuttering last month. Other clinics have similarly closed nationwide, radically reducing the availability of such care in the U.S.

Republicans and other Trump supporters have cheered the closures as a major win, and they praised the president for protecting impressionable and confused children from so-called woke medical professionals pushing what they allege to be dangerous and irreversible treatments.

Bonta said in the Friday statement that Trump and his administration’s “relentless attacks” on such care were “cruel and irresponsible” and endangered “already vulnerable adolescents whose health and well-being are at risk.”

“These actions have created a chilling effect in which providers are pressured to scale back on their care for fear of prosecution, leaving countless individuals without the critical care they need and are entitled to under law,” Bonta said.

Mainstream U.S. medical associations have supported gender-affirming care for minors experiencing gender dysphoria for years. They and LGBTQ+ rights organizations have accused Trump and his supporters of mischaracterizing that care, which includes therapy, counseling and support for social transitioning, and can include puberty blockers, hormone treatment and, in rarer circumstances, mastectomies.

Queer advocates, many patients and their families say such care is life-saving, alleviating intense distress — and suicidal thoughts — in transgender and other gender-nonconforming youth. They and many mainstream medical experts acknowledge that gender-affirming care for young people is still a developing field, but say it is also based on decades of solid research by medical professionals who are far better equipped than politicians to help families make difficult medical decisions.

However, as the number of children who identify as transgender or nonbinary has rapidly increased in recent years, that argument has failed to take hold in many parts of the country. Conservatives and Republican leaders have grown increasingly alarmed by such care, pointing to young people who changed their minds about transitioning and now regret the care they received.

“Countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding,” Trump’s executive order stated.

Trump and others have escalated tensions further by spreading misinformation about kids being whisked away from school to have their gentials mutilated without their parents’ knowledge — which is not happening.

The battle has played out in the courts, in part as a state’s rights issue. In June, the Supreme Court ruled that conservative states may ban puberty blockers and hormone treatments for transgender teens, with the court’s conservative majority finding that states are generally free to set their own standards of medical care.

The Trump administration, however, has not taken the same view. Instead, it has aggressively tried to eradicate gender-affirming care nationwide, regardless of state laws — like those in California — that protect it.

Trump’s Jan. 28 executive order, titled “Protecting Children from Chemical and Surgical Mutilation,” claimed that “medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions.”

It defined children as anyone under the age of 19, and said that moving forward, the U.S. wouldn’t “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” but would “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”

The states’ lawsuit focuses on one particular section of that order, which directed Atty. Gen. Pam Bondi to convene state attorneys general and other law enforcement officials nationwide to begin investigating gender-affirming care providers and other groups that “may be misleading the public about long-term side effects of chemical and surgical mutilation.”

The section suggested those investigations could be based on laws against “female genital mutilation,” or even around a 1938 law known as the Food, Drug, and Cosmetic Act, which authorizes the Food and Drug Administration to regulate food, drugs, medical devices and cosmetics.

On July 9, Bondi announced the Justice Department’s subpoenas to healthcare providers, saying doctors and hospitals “that mutilated children in the service of a warped ideology will be held accountable.”

On July 25, The Times reported that Bill Essayli, the Trump administration’s controversial pick for U.S. attorney in L.A., had floated the idea of criminally charging doctors and hospitals for providing gender-affirming care, according to two federal law enforcement sources who spoke on the condition of anonymity for fear of reprisal.

The targeting of gender-affirming care is part of a wider effort by the administration to eliminate transgender rights more broadly, in part on the premise that transgender people do not exist. On his first day in office, Trump issued another executive order declaring there are only two sexes and denouncing what he called the “gender ideology” of the left.

His administration has sought to limit the options transgender people have to get passports that reflect their identities, and the Justice Department has sued California over its policies allowing transgender girls to compete against other girls in youth sports. Many transgender Americans are looking for ways to flee the country.

Still, many in the LGBTQ+ community fear the attacks are only going to get worse. Among those who are most scared are the parents and families of transgender kids — including those who believe their health records may have been collected under the Justice Department’s subpoenas.

One mother of a Children’s Hospital patient told The Times last month that she is terrified the Justice Department is “going to come after parents and use the female genital mutilation law … to prosecute parents and separate me from my child.”

Bonta is leading the lawsuit along with the attorneys general of Connecticut, Illinois, Massachusetts and New York. Joining them are Pennsylvania Gov. Josh Shapiro and the attorneys general of Delaware, the District of Columbia, Hawaii, Maine, Maryland, Michigan, Nevada, New Jersey, New Mexico, Rhode Island and Wisconsin.

When Children’s Hospital Los Angeles first told thousands of patients it was shuttering its pediatric gender clinic last month, Jesse Thorn was distraught but confident he could quickly find a new local care team for his kids.

But by the time the Center for Transyouth Health and Development officially closed its doors on Tuesday, the father of three was making plans to flee the country.

“They’re targeting whoever they can,” Thorn said. “[I’m afraid] the police will show up at my door because I took my child to see their doctor.”

Until this week, Children’s was among the largest and oldest pediatric gender clinics in the United States — and one of few providing puberty blockers, hormones and surgical procedures for trans youth on public insurance.

The closure of the renowned program signals a wider unraveling in the availability of care across the country, experts said. That includes in former safe havens such as California, New York and Illinois, where state laws protecting trans-specific healthcare are crumbling under mounting legal pressure and bureaucratic arm-twisting by the Trump administration.

In the last week, University of Chicago Medicine and Children’s National in D.C. announced they will end or dramatically scale back services for trans youth, following similar moves by Stanford Medicine, University of Pittsburgh Medical Center and Children’s Hospital of Orange County.

“There’s a rapid collapse of the provision of this care in blue states,” said Alejandra Caraballo, a civil rights attorney and legal instructor at Harvard. “By end of 2025, most care will effectively be banned.”

Some parents in L.A. say they fear the Department of Justice will use private medical data subpoenaed from California’s largest pediatric safety-net hospital to take their children away from them.

“It’s absolutely terrifying,” said Maxine, the mother of a Children’s Hospital patient, who declined to give her last name for fear of attacks on her son.

“I’m very afraid that the DOJ and this acting Attorney General are going to come after parents and use the female genital mutilation law … to prosecute parents and separate me from my child,” she said.

On July 9, Atty. Gen. Pam Bondi announced the Department of Justice was subpoenaing patient medical records from more than 20 doctors and clinics, the latest in a cavalcade of legal and technical maneuvers against providers who care for trans youth.

“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,” Bondi said in a news release announcing the move.

Children’s would not say whether it had been subpoenaed or if it had turned over records responsive to the government’s demand.

The Justice Department was already investigating pediatric specialists for a litany of alleged crimes, from deceptive trade practices to billing fraud. Federal health agencies have vowed to withhold funding from institutions that continue to provide affirming care.

“These threats are no longer theoretical,” Children’s Hospital executives wrote to staff in an internal email announcing the closure June 12. “[They are] threatening our ability to serve the hundreds of thousands of patients who depend on CHLA for lifesaving care.”

Advocates say gender-affirming care is also lifesaving. They point to statistics — contested by the federal government and some experts — showing high rates of suicide among trans youth.

In June, the decision to shutter the clinic was widely condemned. Advocates said Children’s Hospital L.A. had “thrown trans kids under the bus” in disregard of state law.

Few are saying that now.

“You could see kids with leukemia being cut off their chemo therapy unless these hospitals stop provide care to trans people,” Caraballo said. “If one of the biggest children’s hospitals in the country couldn’t shoulder that burden, I don’t see many others being able to do so.”

Others agreed.

“No matter what California or any other state has done to say, ‘We want to protect these kids,’ unless they can write checks that equal the amount of money that’s being lost, [programs close],” said Dara E. Purvis, a law professor at Temple University.

So far, the Trump administration has painted parents as victims of “radical gender ideology.”

Some experts warned that as the government tightens the screws on doctors and hospitals, trans teens and their families are likely to seek hormones outside the medical system, including through gray market channels.

“We’ve seen this with abortion,” Caraballo said. “People are going to go about getting it whichever way they can.”

There are fears that families could face prosecution for continuing to seek medications, similar to charges being filed against mothers who have secured abortion pills for their teenagers.

“We’re working with Congress on existing criminal laws related to female genital mutilation to more robustly protect children,” Justice Department Chief of Staff Chad Mizelle said during a Federal Trade Commission workshop entitled “The Dangers of ‘Gender-Affirming Care’ for Minors.”

“We are using all of the tools at the Department of Justice to address this issue,” Mizelle said.

For now, dozens of hospitals across California still provide gender-affirming care, including hormone therapy and surgical procedures.

But the list changes almost day to day.

“Even programs that may have been operating a month ago are not operating now,” said Terra Russell-Slavin, chief impact officer at the Los Angeles LGBT Center. “There’s a lot of concern about even being public about offering care because those agencies become targets.”

With the medical care their children rely on under threat and few promised protections from the state, some families are unsure what the coming months will bring.

For one Orange County father, who asked not to be named for fear of retaliation against his trans son, plans for future travel are suddenly in jeopardy.

He said only about half of his son’s identity documents match his gender, and they’ve been warned not to try to change others.

“He won’t be able to leave the country because he can’t get a matching passport,” the father said.

For Maxine, the L.A. mom, balancing the banal with the existential is a daily strain.

“My kid is just living their life. They want to go to concerts, they want to go shopping for back to school — they don’t know any of this is happening,” the mother said. “You have to experience this intense fear while maintaining a normal household for everybody else.”