Publication
U.S. Attorney General Issues Memorandum to DOJ Regarding Enforcement of Prohibitions on Healthcare for Transgender Children
On April 22, 2025, U.S. Attorney General Pam Bondi released a memorandum outlining new Department of Justice (DOJ) enforcement measures aimed at limiting gender-affirming care for transgender youth (the Memorandum).1 The AG Memorandum arises as part of a series of federal efforts to regulate medical and surgical gender-affirming treatments for children.
The Memorandum follows an earlier Executive Order from President Trump declaring a national policy against federally supporting gender transition procedures for individuals under 19 (the Executive Order).2 Federal district courts in Maryland3 and Washington4 issued preliminary injunctions against parts of the Executive Order, citing constitutional and legal concerns. The Maryland ruling had a nationwide effect, while the Washington injunction covered four western states.
The Memorandum echoes and expands upon Section 8 of the Executive Order, calling for enforcement of 18 U.S.C. § 116, a law originally aimed at banning female genital mutilation. The Attorney General is now using it to potentially criminalize gender-affirming medical care. Additional directives in the memorandum include investigations into potential violations of federal drug and fraud laws related to puberty blockers and hormone treatments, rejecting established medical guidelines such as those from the World Professional Association for Transgender Health (WPATH), and proposing new legislation to allow lawsuits against providers of gender-affirming care.
The Memorandum serves as a prosecutorial directive. DOJ employees have been instructed to investigate and pursue criminal and civil cases tied to gender-affirming care, including working with whistleblowers and state officials to uncover potential violations. This directive increases the legal exposure of healthcare providers, potentially subjecting them to federal investigations or lawsuits, even if their actions are permissible under state law. The Memorandum has already triggered renewed attention to the ongoing federal cases, with plaintiffs likely to request expansion of existing injunctions to include the Memorandum.
For healthcare professionals and institutions, the Memorandum is consistent with an active enforcement environment under the Trump administration. Providers must now navigate conflicting federal and state policies — some of which protect access to gender-affirming care — while facing targeted scrutiny from federal authorities. As enforcement ramps up, Snell & Wilmer will continue to monitor developments in this area, including the potential expansion of the existing injunctions.
*Any opinions expressed are those of the authors, and not necessarily the firm or their colleagues.
Footnotes
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Preventing the Mutilation of American Children, U.S. Attorney General Memorandum (2025) (available at https://s3.documentcloud.org/documents/25912589/bondi-memo-42225.pdf).
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Protecting Children from Chemical and Surgical Mutilation, Exec. Order 14,187 (Jan. 28, 2025) (available at https://www.whitehouse.gov/presidential-actions/2025/01/protecting-children-from-chemical-and-surgical-mutilation/).
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Mem. Op., PFLAG, Inc. et al. v. Trump et al., Civ. No. 25-337-BAH (D. Md. Mar. 4, 2025).
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Order Granting in Part and Denying in Part Motion for Preliminary Injunction, Washington et al. v. Trump et al., No. 2:25 cv 244-LK (W.D. Wash.) (Feb. 28, 2025).
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