A divided federal appeals court ruled that the Trump administration's opposition to gender-affirming care for minors is a legitimate policy goal, and reinstated a DOJ subpoena against a telemedicine company the government suspects of misleading patients.
The 9th U.S. Circuit Court of Appeals, based in San Francisco, reversed a lower court that had thrown out the subpoena against QueerDoc, a Washington state telemedicine provider that prescribes puberty blockers and hormones to transgender youth. The 2-1 panel decision sent the case back to district court for further proceedings, handing the Justice Department its first appellate win in a broader campaign to investigate gender-care providers for potential healthcare fraud.
The ruling marks a significant turn. Federal judges around the country had quashed many of the more than 20 subpoenas the DOJ issued to doctors and clinics providing gender-affirming care, calling them illegitimate efforts to intimidate providers into stopping treatment. The 9th Circuit, long considered one of the most left-leaning appellate courts in the country, broke that pattern. As ACLU attorney Adrien Leavitt acknowledged, this was the first federal appeals court to weigh in on the subpoenas.
Judge Carlos Bea, a George W. Bush appointee, wrote the majority opinion. Judge Daniel Bress, a Trump nominee, joined him. The core of their reasoning was straightforward: a president's policy goals do not make a DOJ investigation improper. QueerDoc and the ACLU had argued that because President Trump openly opposes gender-affirming care, any subpoena tied to that opposition amounts to political harassment rather than legitimate law enforcement.
Bea rejected that argument. As the Associated Press reported, the majority opinion stated plainly:
"Every President has law enforcement priorities, just as every President has signature policies (often, the former are components of the latter)."
The panel went further. The majority called the efficacy and long-term risks of puberty blockers and hormone therapy "uncertain" and described the broader discussion around gender-affirming care as "an unsettled scientific debate." That language matters. Lower courts that blocked the subpoenas had largely treated the medical consensus as settled. The 9th Circuit majority did not.
The panel also held that the Trump administration could justify its opposition to these treatments on ethical or philosophical grounds, not just medical ones. That opens a wider lane for the DOJ to pursue its investigation without having to prove that every medical claim about gender-affirming care is wrong.
The subpoena at issue seeks a broad set of records from QueerDoc: personnel files, billing documents, communications with drug manufacturers, and records of patients prescribed puberty blockers or hormone therapy. The Justice Department has said it has reason to believe the company may be misleading people about the drugs it prescribes.
QueerDoc and the ACLU have called the subpoena overbroad and burdensome. The district court agreed and quashed it. But the 9th Circuit majority found that the lower court's main reason for blocking the subpoena, that Trump's stated goal of ending gender-affirming care made the investigation improper, did not hold up. The case now returns to the district court, which must consider QueerDoc's remaining arguments, including the overbreadth claim.
One judge on the three-member panel dissented. The source did not name the dissenting judge or detail the grounds for the dissent.
The QueerDoc case is one piece of a broader enforcement push. The DOJ announced last year that it had issued more than 20 subpoenas to doctors and clinics providing gender-affirming care, framing the effort as a healthcare fraud investigation. Federal judges blocked many of those subpoenas, calling them tools of intimidation rather than legitimate investigative instruments.
President Trump has backed the campaign with executive action. One executive order defines sex as only male or female and as unchangeable. A second seeks to end federal funding of gender-affirming care for patients under 19 and directs the DOJ to "prioritize investigations" into violations of a drug safety law by "any entity that may be misleading the public about long-term side effects of chemical and surgical mutilation."
Major medical groups, not specifically named in reporting on the case, have maintained that access to gender-affirming care is important for people with gender dysphoria and that gender exists along a spectrum. The 9th Circuit majority did not dismiss those views outright but characterized the science as unsettled, a framing that undercuts the argument that the DOJ has no legitimate basis for investigating providers.
Leavitt, the ACLU attorney representing QueerDoc, said the organization is not backing down. In a statement, Leavitt said:
"We're ready to continue defending one of the most fundamental principles of healthcare: every patient's right to confidential medical care."
The case is far from over. The district court still has to rule on QueerDoc's other objections, including whether the subpoena sweeps too broadly. But the 9th Circuit's decision removes the biggest shield providers had: the claim that a president's stated policy opposition to a medical practice automatically taints any DOJ investigation into that practice.
That distinction matters well beyond this one case. If the ruling stands, it clears the path for the Justice Department to press forward with the remaining subpoenas, and puts providers on notice that political sympathy from lower courts is not a permanent defense against federal oversight.
When even the 9th Circuit says the government can investigate what doctors are telling patients about experimental drugs given to children, the providers who have nothing to hide should welcome the scrutiny, and the ones fighting hardest to block it ought to explain why.
