Just
a few weeks into Trump’s return to the White House, thousands of people made their way to a Manhattan park
close to NYU Langone Hospital. The rally, one of the earlier mass protests against the president’s second
administration, was in defense of transgender rights. NYU Langone had begun
quietly canceling appointments for gender-affirming
care for minors, seemingly in response to a cruel executive order decreeing that the new
administration would “rigorously enforce all laws that prohibit or limit these
destructive and life-altering procedures.” (The executive order had not, to be
clear, made it illegal to prescribe puberty blockers or hormones, Chase Strangio, the co-director
of the ACLU’s LGBT & HIV Project, told me at the time; it was mostly a
threat to withhold funding.) Speakers at the rally urged everyone to contact the hospital’s management and
trustees and demand they stand up to the administration. The hospital’s complying
with Trump, the protesters warned, would not protect it.
They
were more than correct. The hospital ended care when it was under no legal
obligation to do so, and the Trump administration still did not let up. Earlier
this month, a federal court in the Northern District of Texas issued a subpoena
to NYU Langone, ordering it “to provide information pertaining to patients
under the age of 18 who received gender affirming care,” as well as the names
of those who provided that care as far back as January 2020, according to an announcement the hospital posted to its website.
Among the records the Department of Justice wants handed over are “documents sufficient to
identify each patient who underwent Sex-Rejecting Procedures” (the
administration’s term for gender-affirming care), as well as related billing
records, insurance claims, and clinical evaluations, along with “complete
personnel files” on hospital staff involved.
In the administration’s ongoing attacks on
trans kids, legal experts have said, the subpoena is a marked escalation, in
which the federal government is using the secretive grand jury process to
extract private health care information from an institution providing
gender-affirming care to minors. The Justice Department purposefully pursued
this order in a district with no relationship to the underlying
issues, but where it would get a judge, Reed
O’Connor, who was almost certain to give it what it wanted. As
GLAD legal director Joshua Rovenger put it at a press briefing on Wednesday, “It’s
not law enforcement—it’s harassment dressed up in a subpoena.”
In
essence, a federal court in Texas—where you can count on getting a judge who’s
repeatedly ruled in favor of the Trump administration’s mission—has now reached
across the country and into the intimate lives of countless young New Yorkers
and others who sought care in the state—where Texas arguably had no basis to
intervene. If this sounds familiar—if a federal court in Texas with a history
of taking cases involving other states’ business seems to ring a bell—you may
be recalling a recent abortion story. In 2023, in the same district court, the Northern District of
Texas, a group of anti-abortion doctors formed an organization and brought a
legal challenge aimed at taking the drug mifepristone, commonly and safely used
for medication abortion, off the market. The doctors didn’t provide care in the
jurisdiction, nor had they cared for patients anywhere who had used the drug. They
chose their location, Amarillo, because it guaranteed they would be assigned a judge
who was most
likely to bless their lawsuit—another
MAGA favorite, Matthew Kacsmaryk. That
legal challenge to mifepristone was one
in a series of attempts to block medication abortion access in states where
abortion is banned, but where patients can still receive pills by mail.
After
Dobbs, one might imagine that such efforts were unnecessary: Since that
ruling, any state that wants to ban abortion can. But apparently this power is
not enough. Some states with bans have begun trying to extend the reach of the
laws outside their borders. They’re bringing legal challenges meant to prevent their residents
from accessing abortion; they’re launching investigations into providers who may serve their
residents; they’re getting arrest warrants for out-of-state providers; and
they’re seeking federal
intervention
in order to block care they find objectionable.
A
similar cross-state strategy is being applied now to intimidate health care
providers into complying with bans on gender-affirming care for minors in other
states. The strategy also targets patients, compelling states to turn over
private medical information or engage in other forms of surveillance. It is
becoming clear that simply living in a state with protective laws does not mean
you can access care without fear of intimidation, if you can access care at
all.
By
the time the criminal subpoena made it to NYU Langone, the hospital had already
officially ceased providing
gender-affirming care
to minors. In fact, it had failed to restore care even after the New York
attorney general demanded it do so. It is far from alone in this
decision. Since Trump returned to office, more than 40 hospitals have stopped providing gender-affirming care,
according to STAT News.
Meanwhile,
the Trump administration has repeatedly lost when its anti-trans demands were
challenged in court. A few weeks before the NYU Langone subpoena, a district
court judge permanently blocked a decree from Health and Human
Services head Robert F. Kennedy Jr., in which the administration (again) threatened
to withhold funding from hospitals that provided gender-affirming care to
minors. This week, a federal court order allowed a Colorado hospital to
restore gender-affirming
care for minors, while a legal challenge to the ban proceeds. Another federal
judge recently blocked an administrative subpoena that
would have forced a Rhode Island hospital to turn over the medical records of
youth who received gender-affirming care—following a wave of similar decisions thwarting the Justice Department’s efforts
to seek such information after it issued at least 20 administrative
subpoenas since
last summer. These mounting losses may be why the Department of Justice has turned to grand jury subpoenas, such as
the one NYU Langone has now received, and a friendlier court.
The
current administration did not invent these intimidation tactics. Before Texas
lawmakers outright banned gender-affirming care for minors in 2023, Texas Attorney General Ken Paxton was experimenting with a variety of legal threats
against providers and parents meant to accomplish what a ban would, or worse. He
unilaterally deemed gender-affirming care for minors
to be “abuse” (five years ahead of Robert F. Kennedy’s similar decree, in December 2025, broadly defining such care as unsafe)
and directed state agencies to investigate parents of trans kids, should they
help their own children access care. He opened investigations into two Texas hospitals, claiming
they were violating unspecified state laws, and demanding that they turn over
the same kinds of records now being demanded of NYU Langone. By the time gender-affirming
care was banned in Texas, it was already nearly impossible to access. In 2021,
some Texas families I met as they were lobbying against the ban and other anti-trans laws had
already arranged care out of state, or had moved out of the state entirely.
But
for officials seeking to end gender-affirming care in Texas, the state’s ban was
not enough. Paxton began bringing lawsuits against individual providers who allegedly continued offering
gender-affirming care to minors, referring in court filings to one provider as
“a scofflaw who is putting the
health and safety of minors at risk,”
and another as “a Radical Gender Activist.” This week, Paxton, now a Trump-approved candidate for John Cornyn’s Senate seat, and
the DOJ announced their latest victory in such
efforts: They have forced the largest children’s hospital in Texas into
creating a so-called “detransition” clinic that, as Paxton put it, “will help
provide free care to those who have been victimized by twisted, morally
bankrupt transgender ideology.” The hospital must also pay $10 million in fines
and damages and revoke the medical privileges of five physicians.
In
the case of NYU Langone, we are seeing a number of extreme, lawless trends
collide: Providers and patients are being intimidated with the malicious
collection of private health care information; and states are attempting to
apply their bans on stigmatized health care to states that have no such bans—that
have, in fact, protective laws meant to ensure patients’ rights and patients’
access.
Since November 2024, nearly one in 10 transgender
people reported having moved to a different state, in a survey conducted by NORC and the Movement
Advancement Project—an estimated 400,000 people. They are seeking
refuge in what appear to be blue sanctuaries like New York, where shield laws protect providers of both
gender-affirming care and abortion care. If, despite such laws, federal law
enforcement and a grand jury in Texas are allowed to reach into New York state,
what does that mean? Is anywhere safe? Is anyone? These are the questions these
legal threats are forcing us to live with. The attacks, said Cynthia Weaver,
litigation director at Human Rights Campaign, “create instability that can have
detrimental, cascading impact on trans people’s health and well-being.” Whether
or not the attacks succeed in court, the fear is already real. It cannot be
rolled back with a court order.
