Appeals Court Upholds Subpoena in Gender-Affirming Care Probe

A divided federal appeals court has ruled that President Donald Trump's stated goal of ending gender-affirming care is not improper, and cannot be used as a basis to block a Justice Department subpoena issued to a provider of such treatments for transgender youth.

The ruling, handed down Friday by a 2-1 panel of the 9th U.S. Circuit Court of Appeals, reverses a lower court decision that had quashed the subpoena against QueerDoc, a telemedicine provider based in Washington state. The case now returns to the district court to consider other arguments raised by the company.

Judge Carlos Bea, writing for the majority, said the efficacy and long-term risks of gender-affirming treatments remain "uncertain," and that presidents have the authority to align law enforcement priorities with their broader policy objectives. "Every President has law enforcement priorities, just as every President has signature policies," Bea wrote. He was joined by Judge Daniel Bress, a Trump appointee.

The Justice Department announced last year that it had issued more than 20 subpoenas to doctors and clinics providing gender-affirming care, as part of an investigation into potential healthcare fraud. Several federal judges had previously quashed similar subpoenas, viewing them as illegitimate attempts to intimidate providers.

The subpoena at issue seeks QueerDoc's personnel files, billing records, communications with drug manufacturers, and patient records related to prescriptions for puberty blockers or hormone therapy.

The American Civil Liberties Union, representing QueerDoc, said it would continue fighting the subpoena in district court, arguing it is overbroad and burdensome. "We're ready to continue defending one of the most fundamental principles of healthcare: every patient's right to confidential medical care," said ACLU attorney Adrien Leavitt.

The Justice Department has said it has reason to believe the company may be misleading people about the effects of puberty blockers and hormones.

Trump has signed executive orders defining sex as unchangeable and seeking to end federal funding for gender-affirming care for patients under 19. Those orders also direct the Justice Department to prioritize investigations into entities that may be misleading the public about long-term side effects of such treatments.

Gender-affirming care includes counseling, puberty-blocking medications, hormone therapy, and, rarely for minors, surgical procedures. Most major medical groups support access to these treatments for individuals with gender dysphoria, viewing gender as existing along a spectrum. The 9th Circuit majority, however, characterized the discussion as "an unsettled scientific debate."