Health Law Daily Wrap Up, GENERAL HEALTH CARE NEWS—D. Mass.: States challenge gender-affirming care EO, DOJ actions, (Aug 4, 2025)

By Sheila Lynch-Afryl, J.D., M.A.

The Bondi memo encourages investigations of violations of the Food, Drug, and Cosmetic Act, False Claims Act, and law prohibiting female genital mutilation.

More than a dozen states filed a lawsuit challenging President Donald Trump’s January 28 Executive Order (EO) targeting youth gender-affirming care and actions that the Department of Justice (DOJ) has since taken pursuant to the EO. The complaint, filed in the District of Massachusetts by 16 states and the District of Columbia, alleges that the Trump administration’s actions of “relentlessly, cruelly, and unlawfully target[ing] transgender individuals” have chilled the provision of health care for adolescents, even in states where such care is legal and protected. California Attorney General (AG) Rob Bonta said, “The Trump Administration’s unlawful threats have not only undermined State rights but have directly contributed to diminishing access to gender-affirming care” (Commonwealth of Massachusetts v. Trump, No. 25-cv-12162 (D. Mass. Aug. 1, 2025)).

EO 14187. EO 14187 said that “it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.” The EO requires HHS to “take all appropriate actions to end the chemical and surgical mutilation of children,” defined as individuals under age 19. Section 8(a) of the EO requires the DOJ to review enforcement of 18 U.S.C. § 116, which makes it a felony to perform or attempt to perform “female genital mutilation” (FGM) on a person under 18, and “prioritize enforcement of protections against female genital mutilation.” Section 8(c) requires the DOJ to prioritize investigations and take appropriate action to end deception of consumers, fraud, and violations of the Food, Drug, and Cosmetic Act (FDC Act) by any entity that misleads the public about “long-term side effects of chemical and surgical mutilation.”

DOJ memos. On April 22, AG Pam Bondi issued a memo ordering: (1) U.S. Attorneys to investigate “all suspected cases of FGM”; (2) the Civil Division's Consumer Protection Branch to investigate violations of the FDC Act by manufacturers and distributors engaged in “misbranding by making false claims about the on- or off-label use” of puberty blockers and hormones; and (3) the Civil Division's Fraud Section to investigate under the False Claims Act claims submitted to federal health care programs for “any noncovered services related to radical gender experimentation.”

A June 11 memo by Assistant AG Brett Shumate outlined Civil Division enforcement priorities, including using “all available resources to prioritize investigations of doctors, hospitals, pharmaceutical companies, and other appropriate entities consistent with” Bondi’s and the EO’s directives. In July the DOJ announced that it has sent more than 20 subpoenas to doctors and clinics involved in performing “transgender medical procedures on children” and the Federal Trade Commission hosted a workshop on unfair or deceptive trade practices in gender-affirming care for minors.

Complaint. The complaint alleges that the EO and DOJ’s actions “are causing chaos, confusion, and fear among medical care providers and stoking anxiety and dread” among affected adolescents, and some providers have scaled back or stopped providing gender-affirming care. The states allege that the EO and DOJ actions threaten their sovereign interests and also affect them as providers and payers of health care.

The complaint alleges:

• the DOJ memos are arbitrary and capricious, in violation of the Administrative Procedure Act (APA);

• the DOJ memos are contrary to law, in violation of the APA; and

• the EO and agency actions violate the Tenth Amendment.

Injunctions blocking section 4. Two courts have blocked section 4 of EO 14187, which requires agencies and departments that provide research or education grants to medical institutions, including medical schools and hospitals, to “immediately take appropriate steps” to ensure that they “end the chemical and surgical mutilation of children.” In PFLAG v. Trump, the District of Maryland granted a nationwide preliminary injunction as to section 4, and in Washington v. Trump, the Western District of Washington blocked enforcement of section 4 in Colorado, Minnesota, Oregon, and Washington. Both preliminary injunction orders are being appealed.

The case is No. 25-cv-12162.

Attorneys: Adam M. Cambier, Massachusetts Attorney General's Office, for Commonwealth of Massachusetts, State of California and State of New York.

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