Developments in Transgender Rights:
This week’s Transgender Rights Digest examines escalations in federal targeting of healthcare institutions, significant state and federal court rulings on civil rights protections, key administrative policy shifts in education, and an international crackdown on LGBTQ+ civil society.
Federal pressure on medical institutions intensified as NYU Langone Health and the University of Pittsburgh Medical Center (UPMC) became the fifth and sixth major health systems to enter into settlement agreements with the Department of Justice (DOJ), agreeing to maintain prohibitions on gender-affirming care for youth while paying significant financial penalties. In Colorado, a Denver judge found Children’s Hospital Colorado compliant with non-discrimination orders despite affiliated physicians individually refusing to provide care, while Alliance Defending Freedom filed a separate federal lawsuit challenging Colorado’s civil rights statute. Court decisions elsewhere yielded further setbacks, as the Ninth Circuit Court of Appeals dissolved housing protections for incarcerated transgender women in Oregon, the Seventh Circuit permitted the American Academy of Pediatrics to drop its federal suit against Florida, the North Dakota Supreme Court unanimously upheld a criminal ban on healthcare for transgender youth, and an Indiana-based federal court formally dismissed the ACLU’s challenge to Indiana’s gender-affirming care ban for youth.
In public education and administrative policy, school districts in Idaho and Michigan faced legal and regulatory fallout over facility access and student privacy policies, while a federal judge enjoined the University of California from enforcing its policies prohibiting intentional misgendering against members of a conservative group. Conversely, Virginia Governor Abigail Spanberger provided a notable victory for student rights by formally withdrawing a proposed Youngkin-era administrative rule that sought to restrict transgender students’ access to facilities and sports.
Finally, looking internationally, Turkish authorities launched a sweeping national crackdown, executing overnight raids on LGBTQ+ and HIV support groups and detaining over 200 activists and protestors.
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Top Line News Stories
NYU Langone and UPMC Surrender Pediatric Gender-Affirming Programs in Federal Settlements
NYU Langone Health and UPMC reached settlement agreements with DOJ, agreeing to keep gender-affirming care closed to minor patients and pay $8.5 million and $950,000 respectively, following federal probes alleging billing irregularities under federal healthcare programs.
Spokespersons for both health systems stated that resolving the matter was necessary to avoid prolonged litigation and shield sensitive patient records from government subpoenas, with NYU Langone spokesperson Steve Ritea denying any wrongdoing and noting that the agreement protects patients, families, providers, and the institution.
These concessions follow similar financial settlements by Texas Children’s Hospital, Cleveland Clinic, Connecticut Children’s Medical Center, and Mount Sinai Health System, bringing the total number of capitulating institutions to six.
Legal analysts highlight that four of these settlements occurred in states without youth gender-affirming care bans, such as New York and Connecticut, which maintain statutory shield laws specifically enacted to protect access to gender-affirming care.
Legislation & Litigation Developments
Overview
A Denver judge found Children’s Hospital Colorado compliant with non-discrimination orders despite physician refusals to prescribe puberty blockers and hormone treatments under federal pressure, while Alliance Defending Freedom filed a separate federal lawsuit challenging Colorado’s anti-discrimination law.
The Ninth Circuit overturned an injunction requiring the Oregon Department of Corrections to house transgender women in women’s facilities.
The Seventh Circuit permitted the American Academy of Pediatrics to drop its federal lawsuit against Florida, dissolving an injunction and allowing state litigation over clinical care guidelines to proceed.
The Boise School District agreed to pay $34,000 to resolve the first private lawsuit filed under Idaho’s school bathroom ban.
A federal district court formally dismissed with prejudice a lawsuit challenging Indiana’s ban on gender-affirming care for youth.
A federal judge blocked the University of California from enforcing misgendering harassment policies against a conservative group, while a state court upheld Chino Valley’s parental disclosure rule.
The North Dakota Supreme Court unanimously upheld the state’s criminal ban on gender-affirming care for youth.
Children’s Hospital Colorado Avoids Contempt as Federal Threats Halt Youth Care Amid Conservative Lawsuit Against State Civil Rights Law
A Denver District Court Judge ruled that Children’s Hospital Colorado is not in contempt of court for failing to provide gender-affirming prescriptions for youth following a state Supreme Court order prohibiting anti-transgender discrimination. Although the hospital officially reinstated gender-affirming care within its offered scope of services to comply with state anti-discrimination law, affiliated physicians from the University of Colorado School of Medicine individually refused to write prescriptions for puberty blockers and hormone therapy, citing fear of federal retaliation and potential exclusion from Medicaid.
Because the doctors are independent contractors rather than hospital employees, the court held that the state law prohibits the hospital from overriding their independent medical judgment or forcing them to prescribe certain treatments. This ruling comes after disclosures that federal officials launched another administrative investigation into the hospital, targeting diagnostic and billing codes.
Additionally, access to gender-affirming care for transgender youth in Colorado faces renewed challenges as Alliance Defending Freedom filed a federal lawsuit on behalf of a Christian medical group challenging the Colorado Anti-Discrimination Act, seeking to exempt healthcare providers with religious and ethical obligations from non-discrimination mandates that require equal access to medical procedures regardless of gender identity.
Ninth Circuit Overturns Injunction Requiring Oregon to Presumptively House Transgender Women in Facilities Aligned With Their Gender Identity
A three-judge panel of the U.S. Court of Appeals for the Ninth Circuit vacated a class-wide preliminary injunction requiring the Oregon Department of Corrections to evaluate transgender incarcerated women with a presumption of placement in women’s facilities. Reversing the magistrate judge’s finding that default placement in men’s prisons exposed trans women to severe risks of physical and sexual assault, the appellate panel held that the lower court relied on flawed statistical assumptions and failed to defer to state administrative assessments.
Writing for the panel, Trump-appointee Judge Eric Tung scolded the district court for displacing state administrative authority while utilizing hostile terminology, referring to transgender women as "male inmates who claim to be female.” The panel also vacated class certification, holding that allegations of harm reflected individual circumstances rather than systemic grounds for class-wide relief.
Seventh Circuit Permits Pediatric Group to Withdraw Suit, Restoring Florida Action Over Transgender Youth Care Standards
The en banc U.S. Court of Appeals for the Seventh Circuit granted a request by the American Academy of Pediatrics (AAP) to withdraw its federal lawsuit against Florida Attorney General James Uthmeier.
In December 2025, Florida officials initiated state court enforcement actions against the AAP, the Endocrine Society, and the WPATH, alleging that published clinical guidelines supporting gender-affirming care for youth violate state consumer protection and racketeering laws.
Although a federal district court initially enjoined Florida’s enforcement action on First Amendment grounds, the full Seventh Circuit vacated that injunction, prompting the AAP to seek voluntary dismissal and clearing the way for Florida’s state court litigation to proceed.
Boise School District Settles First Private Lawsuit Under Idaho Transgender Bathroom Ban
The Boise School District entered into a $34,000 settlement with a former student represented by the conservative Idaho Family Policy Center, resolving the first lawsuit filed under Senate Bill 1100. Enacted in 2023, the Idaho statute mandates that public school students use facilities matching their sex assigned at birth and creates a statutory private right of action enabling students to claim civil damages for facility encounters.
District officials allowed transgender students to use facilities aligning with their gender identity during a period when enforcement of Senate Bill 1100 was paused under a Ninth Circuit Court of Appeals stay, but an Ada County District Judge ruled that the federal stay did not preclude private civil litigation under state law. School representatives maintain that the district acted appropriately and denied all liability.
Federal Court Formally Dismisses Challenge to Indiana Ban on Gender-Affirming Care for Transgender Youth
The U.S. District Court for the Southern District of Indiana formally dismissed with prejudice the ACLU’s lawsuit challenging the state’s ban on gender-affirming medical care for minors.
Originally filed in 2023, the lawsuit alleged that the statute violated the Equal Protection Clause and federal provisions under the Medicaid Act and Affordable Care Act by barring necessary healthcare and referral services.
Following Seventh Circuit and higher court rulings establishing binding precedent allowing state youth healthcare restrictions, plaintiffs conceded that viable legal paths forward were eliminated and moved to terminate the case, leaving Indiana’s ban fully operational.
Federal Court Enjoins UC Pronoun Policy for Conservative Group Members as State Judge Upholds Revised Chino Valley Parent Disclosure Rule
U.S. District Court Judge Fred W. Slaughter issued a preliminary injunction barring University of California administrators from enforcing campus anti-harassment guidelines against members of Defending Education, a conservative advocacy organization that opposes campus diversity initiatives and gender identity protections. The suit challenges policy provisions prohibiting deliberate deadnaming and misgendering of transgender individuals with the court concluding that defining intentional misgendering as prohibited harassment likely constitutes unconstitutional viewpoint regulation under the First Amendment.
This decision coincides with a parallel setback in K-12 privacy rights, as a California Superior Court judge ruled that the Chino Valley Unified School District’s policies do not violate state law by disclosing a student’s transgender identity to parents upon request. The board adopted the “upon request” standard after courts enjoined its initial mandatory policy requiring staff to automatically notify parents whenever a student asserted trans identity.
North Dakota Supreme Court Unanimously Upholds Criminal Ban on Gender-Affirming Care for Youth
On September 17, the North Dakota Supreme Court unanimously affirmed a lower court ruling upholding the state’s 2023 criminal ban on pediatric gender-affirming care. Rejecting claims brought by pediatric endocrinologist Luis Casas, the justices held that the state legislature acted within its authority to regulate medicine and determined that the restriction does not violate sex-based discrimination protections.
In response to the ruling, Dr. Casas stated that the decision forces families into impossible choices between leaving North Dakota or foregoing recommended medical care.
Trend and Policy Watch
Overview
The DOJ threatened a Michigan public school system with federal enforcement and possible litigation unless it rescinds student gender privacy protections within fourteen days.
Virginia Governor Abigail Spanberger withdrew a Youngkin-era rulemaking petition that sought to restrict transgender students from accessing school facilities and participating in sports.
DOJ Demands Michigan School District Rescind Transgender Students Privacy Protections
The DOJ notified Ann Arbor Public Schools that the school district’s updated guidelines protecting transgender and gender-nonconforming student privacy remain noncompliant with federal requirements. The federal probe focuses on district provisions that mandate the use of students’ chosen names and pronouns while restricting school staff from disclosing a student’s transgender status to parents without explicit consent.
Rejecting recent policy adjustments passed by the school board as insubstantial, the DOJ ordered the district to formally rescind the policy within fourteen days and instruct all employees that privacy guidelines cannot restrict parental access to records. DOJ further warned that noncompliance may trigger judicial proceedings and the revocation of federal financial assistance.
Virginia Governor Spanberger Rescinds Proposed Administrative Restrictions on Transgender Students
Virginia Governor Abigail Spanberger announced the withdrawal of a proposed administrative rule initiated under former Governor Glenn Youngkin that sought to restrict transgender students from accessing school bathrooms, locker rooms, and athletic teams aligning with their gender identity.
The rulemaking process, originally triggered in October 2025 when Youngkin directed the Virginia Board of Health to restrict facility access and sports participation, was formally pulled from the regulatory docket in late July. Following a legal review with Attorney General Jay Jones, the administration determined that the Board of Health possessed no statutory authority to regulate public school facilities or interscholastic sports.
International Impacts
While this newsletter typically focuses on domestic policy and legal trends, we would be remiss if we did not at times zoom out even further and look at how these policies and trends fit into the greater context of the international struggle for bodily autonomy, liberation, and democracy.
Turkish Authorities Arrest Dozens of LGBTQ+ Activists and Protestors in Sweeping National Crackdown
Turkish police executed coordinated overnight raids against LGBTQ+ and HIV awareness organizations across multiple provinces, detaining at least 50 activists and blocking advocacy websites. The government termed the initiative “My Family is Safe.” Justice Minister Akin Gurlek stated that investigations across major cities like Istanbul and Ankara targeted suspects and organizations to protect family institutions, citing international funding received by civil society groups.
Following the raids, police intervened at a demonstration outside an Istanbul courthouse, detaining at least 150 additional protestors.
European Parliament Turkey rapporteur Nacho Sanchez Amor characterized the wave of arrests as a “shocking escalation” of repression that blatantly violates fundamental rights, while Council of Europe Commissioner for Human Rights Michael O’Flaherty emphasized that invocations of family values cannot justify human rights restrictions and called for the immediate release of detained civil society workers.