A coalition of states is suing the Trump administration over policies aimed at banning federal support for gender-affirming medical care.

On Jan. 20, President Donald Trump signed Executive Order 14187, entitled, “Protecting Children from Chemical and Surgical Mutilation.”

As per the conditions of that order and two accompanying directives, the 45th and 47th president aims to halt all federal funding to institutions that provide pediatric gender transition services or any form of gender-affirming care to individuals under 19.

On Friday, presented in a 79-page lawsuit, 15 states along with the District of Columbia petitioned a federal judge in Massachusetts to rule the order as “unconstitutional and unlawful” and halt its enforcement.

Leading the plaintiffs are Massachusetts and New York Attorney General Letitia James, aiming to challenge federal threats against state laws safeguarding the provision of gender-affirming care.

“Numerous Plaintiff States have established laws, policies, and protections for transgender residents, including transgender and intersex individuals under 19, within a rightful and lawful use of their traditional police powers to oversee medical practices within their territories,” states the lawsuit. “These safeguards ensure the right to access essential healthcare, irrespective of gender identity.”

The plaintiffs assert that the federal government is determined to establish an effective nationwide prohibition on such care through actions involving “unfounded civil and criminal prosecution, along with burdensome investigations and data requests,” as outlined in the lawsuit.

From the filing, at length:

Plaintiff States have the authority and exercise the authority to regulate the practice of medicine within their States. Moreover, the regulation of healthcare and of the practice of medicine is a core function of state authority under our system of federalism.

The States— not the federal government—are empowered to regulate the practice of medicine and the medical profession, including by licensing medical professionals ensuring that evidence-based medical care is available to their residents. Defendants’ efforts to leverage unrelated and inapplicable statutes to institute a de facto national regime barring the provision of this care to adolescents flatly disregards this long-established state authority and seeks to impose a federal standard of medical care on every medical provider in the country, effectively usurping a core state police power…

“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” James said in a press release announcing the litigation. “This administration is ruthlessly targeting young people who already face immense barriers just to be seen and heard, and are putting countless lives at risk in the process. In New York and nationwide, we will never stop fighting for the dignity, safety, and basic rights of the transgender community.”

The heart of the Trump administration’s campaign against transgenderism is the weaponization of several federal statutes that have nothing do with gender-affirming care, the plaintiffs argue.

In one section of the president’s order – and a concomitant enforcement directive issued by U.S. Attorney General Pam Bondi – the federal government purports to use a federal law against female genital mutilation (FGM) — a practice almost exclusively occurring outside of the Americas — to secure compliance. On its own terms, this section anticipates using “law enforcement officers to coordinate” the enforcement of the 1996 federal ban on FGM.

To hear the plaintiffs tell it, however, the U.S. Department of Justice is abusing this law – as well as two other statutes that are not intended for such uses – to go after legitimate medical providers.

“DOJ has issued these directives notwithstanding the fact that there is no lawful basis for it to do so,” the lawsuit continues. “On the contrary, these directives reverse and conflict with the law, as well as years of practice. In other words, DOJ has improperly weaponized its authority by issuing a novel and atextual legal interpretation that has intimidated providers, pressuring them to stop offering lawful, necessary, and often lifesaving medical care to transgender adolescents.”

The litigation alleges numerous violations of the Administrative Procedure Act, the federal statute governing the behavior of federal departments and agencies, as well as a 10th Amendment challenge – a formerly-rare avenue of relief that has become increasingly common in lawsuits against the second Trump administration.

“In the complaint, the attorneys general emphasize that medical experts overwhelmingly agree that gender-affirming care is safe, necessary, and in many cases, lifesaving care,” the press release continues. “Every major medical association in the United States, including the American Academy of Pediatrics, the American Medical Association, and the American Psychiatric Association, recognizes gender-affirming care as the appropriate treatment for gender dysphoria. Denying access to such care has been shown to significantly increase rates of depression, anxiety, and suicidality in transgender youth.”