California Sues Trump Administration Over Efforts to Deny Gender-Affirming Health Care

Updated 12:31 p.m. Friday

California is leading a coalition of more than a dozen states suing the Trump administration over its restrictions on gender-affirming health care, Attorney General Rob Bonta announced Friday morning.

Bonta said President Trump and U.S. Attorney General Pam Bondi’s orders and directives restricting that care to people under the age of 19 infringe upon states’ laws that protect their residents’ access to gender-affirming care.

The lawsuit is joined by 15 other states and the District of Columbia.

Bonta framed the issue as a life-and-death matter, citing the higher rates of suicide and other forms of self-harm among young people whose assigned gender at birth doesn’t match their identity.

The Trump administration’s “demands that our healthcare providers discriminate against transgender individuals and deny them access to medically-necessary healthcare is cruel and irresponsible,” Bonta said in a statement. “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.”

Oakland-based Kaiser Permanente recently announced it was following Stanford Medicine and other health care providers in pausing gender-affirming surgeries for patients under 19 — something Bonta warned hospitals not to do.

Kaiser, which serves 12 million people across eight states, cited the “significant risks” created by the current legal and regulatory environment surrounding care for transgender minors.

The health care giant pointed to a January executive order from Trump threatening funding for medical centers that provide gender-affirming care to minors. The order directs agencies to “not fund, sponsor, promote, assist, or support the so‑called ‘transition’ of a child from one sex to another.”

Kaiser also cited changes to insurance coverage and ongoing federal investigations. Last month, for example, the Department of Justice subpoenaed more than 20 doctors and clinics that perform gender-affirming procedures on minors.

Equality California, a statewide LGBTQ+ rights organization, said the Trump administration was bullying hospitals and doctors into curtailing gender-affirming treatments, calling the lawsuit announced Friday “a critical step toward protecting access to lifesaving healthcare for transgender youth — and pushing back against a coordinated political assault on our community.”

“These attacks are not about fairness or safety — they are about fearmongering, erasure, and punishing transgender people for simply existing,” Equality California executive director Tony Hoang said in a statement. “The Trump administration’s actions are not just discriminatory — they are dangerous, and fly in the face of both medical standards and basic human decency.”

While several Republican-led states have moved to restrict surgeries and other care for transgender youth, California has doubled down on shielding such medical services. State law bars hospitals from refusing to provide health care to transgender people, and Bonta has warned providers that denying or pausing care for trans youth based on political pressure could be illegal.

State Sen. Scott Wiener (D–San Francisco), who authored a 2022 law to make California a safe refuge for transgender youth seeking medical care, previously told KQED that state politicians should put pressure on Bonta’s office to enforce state law on access to health care.

“I don’t want the state to have to fight with Kaiser or with Stanford or with any of our great health systems, but we have to enforce the law,” he said. “California should be a safe place for trans people and LGBTQ people generally, and this is not what should be happening.”

Groups including the American Medical Association and the American Pediatrics Association maintain that gender-affirming care, including surgeries in some cases, can be medically necessary for both children and adults. A 2022 study by researchers at Stanford University found better mental health outcomes for transgender people who started receiving hormone therapy as teens compared with those who waited until they were adults.

Amy Whelan, a senior staff attorney with the National Center for LGBTQ Rights, told KQED earlier that “there are very few patients under 19 who receive surgery, but for those who do, this is very essential health care.”

A recent study from researchers at Harvard University’s T.H. Chan School of Public Health found that gender-affirming surgeries were rarely performed on transgender or gender-diverse (TGS) youth in the U.S. For 15- to 17-year-olds, the rate of gender-affirming surgeries associated with a TGS-related diagnosis in 2019 was just 2 in 100,000. The rate was 0.1 in 100,000 for 13- and 14-year-olds, and the study found no such surgeries on trans children under 12.

Still, some medical experts have urged greater caution, calling for more scrutiny of the evidence underpinning these gender-affirming treatments. Critics have also questioned the strength of long-term data and raised concerns about the potential irreversibility of certain medical interventions — concerns echoed in a recent report on gender dysphoria commissioned by the Trump administration.