A divided federal appeals court ruled late last week that the Justice Department may pursue invasive subpoenas targeting a telemedicine provider of gender-affirming care, marking the first appeals court decision on the administration’s nationwide subpoena campaign.
The two-to-one decision by the U.S. Court of Appeals for the Ninth Circuit reversed a lower court ruling that had blocked subpoenas issued to Queer Doc, a Washington State-based organization. The DOJ had sought personnel files, billing documents, communications with drug manufacturers and patient records related to puberty blocker and hormone therapy prescriptions.
Judge Carlos Bea, 92 years old, nominated by President George W. Bush, was joined by Judge Daniel Bress, a Trump appointee, in holding that the president possesses authority to align enforcement priorities with broader policy goals. The ruling established that gender-affirming care treatment risks remain “uncertain.”
The majority cited a Finnish study released in March 2026 claiming gender-affirming care lacks effectiveness. However, researchers including Dr. Meredith McNamara from Yale University School of Medicine later criticized the study as fundamentally flawed. Critics noted that “gender dysphoria” as a diagnostic category did not appear in the DSM until 2013. Therefore studying treatments for gender dysphoria prior to 2013 is methodologically unsound — because the diagnosis in and of itself didn’t even exist.
In dissent, Judge Consuelo Paez argued that Judge Bea was “desperately looking for evidence” to support his position, having introduced the Finnish study without either party raising it during oral arguments.
Judge Paez went even further and said the Trump administration’s claims of investigating wrong-doing are disingenuous.
“We need not assume that DOJ is acting in good faith to investigate crimes when it has told us that it is acting with the intent to end an industry,” wrote Judge Carlos Paez.
Adrian Levitt, ACLU attorney representing Queer Doc, said the organization would continue defending “the fundamental principle that every patient has a right to confidential medical care.”
Federal judges have quashed more than 20 similar subpoenas issued by the Justice Department to doctors and clinics providing gender-affirming care nationwide.
According to Chris Geidner at Law Dork, plaintiffs could ask the entire court to review the case. If so, that may lead to a different outcome as the majority of judges were appointed by Democratic Presidents.
Parallel Victory: Trump ACA Rule Struck Down
In a separate development, Senior U.S. District Judge Nathaniel Gorton, appointed by President George H.W. Bush, invalidated a 2025 Affordable Care Act regulation that would have barred insurers from classifying certain gender-affirming procedures as essential health benefits.
A coalition of 20 states, led by Pennsylvania Democratic Gov. Josh Shapiro, challenged the Marketplace Integrity and Affordability Final Rule, arguing it exceeded the Department of Health and Human Services’ statutory authority and would increase premiums and out-of-pocket costs.
“This victory blocks the Trump administration’s attempt to make gender-affirming care more expensive and less accessible,” said Massachusetts Attorney General Andrea Joy Campbell, one of the participating states. “Gender-affirming care is critical to the emotional and physical wellbeing of transgender individuals.”
