Federal Judge Extends Block on Executive Orders Limiting Gender-Affirming Care

By Paul J. Giancola, Claudia E. Stedman, and Savannah Wix

On January 28, 2025, President Trump issued an executive order restricting access to gender affirming care for individuals under the age of nineteen (the Executive Order).¹ Within two weeks of its issuance, two federal courts (in Washington and Maryland) issued nationwide temporary restraining orders (TROs) temporarily halting enforcement of certain provisions of the Executive Order.² On February 28, 2025, the Washington TRO was converted into a preliminary injunction, which is a longer-term order that can be appealed. Now, the Washington preliminary injunction affects only four states: Colorado, Minnesota, Oregon, and Washington.³ The Maryland TRO was extended until March 5, 2025. For states other than Colorado, Minnesota, Oregon, and Washington, enforcement of the Executive Order will be determined by whether the Maryland judge either extends the TRO again or issues a preliminary injunction. However, as discussed further below, even a preliminary injunction may not resolve the uncertainty in light of the variations in state laws that impact gender affirming care.

President Trump’s Executive Order affects various aspects of gender affirming care, including the use of prescription puberty blockers and surgical procedures that modify physical characteristics to align with an individual’s gender identity. The Executive Order directs the Secretary of Health and Human Services (the HHS Secretary) to publish a review of existing literature on “best practices for promoting the health of children who assert gender dysphoria” within 90 days of the order and “take all appropriate actions” to cease gender affirming care of individuals under nineteen years old. The HHS Secretary is also required to withdraw the 2022 Health and Human Services guidance “HHS Notice and Guidance on Gender Affirming Care, Civil Rights and Patient Privacy,” and issue new guidance aimed at protecting whistleblowers who “take action related to ensuring compliance with” the Executive Order.

The Executive Order also instructs each department and agency that provides funding to medical institutions to ensure that those recipients do not provide gender affirming care. Additionally, the Secretary of Defense (the Defense Secretary) is instructed to develop regulations that would phase out all gender affirming care from TRICARE coverage. Meanwhile, the Attorney General is instructed to prioritize the investigation and enforcement of these mandates and collaborate with Congress to create a private right of action with “a lengthy statute of limitations” for individuals to pursue legal action against medical professionals providing gender affirming care.

On the eve of the expiration of the first TRO, the Maryland District Court extended the nationwide TRO, but only until March 5, 2025. Meanwhile, the Washington District Court weighing the other TRO issued a preliminary injunction applying to Colorado, Oregon, Minnesota, and Washington. With the nationwide TRO’s impending expiration, medical institutions receiving federal funding may want to be prepared to comply with the rules and guidance ultimately developed by the HHS and Defense Secretaries. However, providers, payers, and institutions should also be aware that some states’ laws may be inconsistent with federal regulations. For instance, California and New York have anti-discrimination laws related to access to gender affirming care. On the other hand, states like Arizona have laws stating that “[a] physician may not provide irreversible gender reassignment surgery to any individual who is under eighteen years of age” unless the surgery falls under one of the listed exceptions. See A.R.S. § 32 3230.

Due to the variations in state laws and uncertainty of future rules that may be promulgated by HHS and the Department of Defense, providers, payers, and healthcare entities and institutions may want to consider engaging legal counsel to discuss strategies for compliance with forthcoming federal law prior to any enforcement actions to mitigate risk of penalties, investigations, or legal liability.

Snell & Wilmer will continue to monitor developments in this area, including the status of the nationwide TRO extension and the issuance of any rules or guidance related to gender affirming care.

**Any opinions expressed are the authors’ and not the firm’s or the authors’ colleagues’.