DOJ’s Inquiries into Gender-Affirming Care Face Mounting Legal Challenges

The Department of Justice’s investigations into providers of gender-affirming medical care are putting the department on a collision course with both providers seeking to quash the subpoenas as unlawful, and the federal courts. In July 2025, DOJ publicly announced that it had sent more than 20 subpoenas to providers of gender-affirming care.

Over the past year, some providers have succeeded in blocking the efforts through motions to quash and applications for emergency relief. These challenges highlight multiple legal obstacles to the subpoenas, including constitutional privacy interests, potential breaches of physician-patient privilege, overbreadth concerns, and questions about the underlying federal violations being investigated.   

Following successful legal challenges to the initial subpoenas, DOJ has strategically moved to enforce certain subpoenas out-of-district, resulting in dueling legal proceedings over the same subpoenas and putting federal prosecutors defending those actions in the court's crosshairs. Those DOJ lawyers are contending with the loss of the presumption of regularity, a legal doctrine in which courts presume that government officials are acting in good faith and that until recently, made challenging a DOJ subpoena in court an uphill battle. But now that presumption has been eroded by mounting judicial findings of lack of candor and even misrepresentations by department lawyers.

The situation came to a head last week during a hearing in the U.S. District Court for the District of Rhode Island regarding the DOJ's attempts to enforce a subpoena to a Rhode Island hospital in the Northern District of Texas. The Rhode Island judge referred the DOJ attorneys to a court disciplinary committee for misleading the court about negotiations over the subpoena and the DOJ's efforts to enforce it out of district.  At the same time, DOJ’s strategy of moving to enforce the subpoena in another district kept the inquiry alive. Even though the Rhode Island judge quashed the subpoena in May, DOJ prevailed in Texas federal court. The Texas court ordered the hospital to provide all responsive records to the court in camera for safekeeping until the legal challenges in both the First and Fifth Circuit Courts of Appeal concluded. Days later, the First Circuit declined to halt the order while appeals in both circuits continued.

Even while individual DOJ attorneys are facing potential discipline and multiple courts are questioning the legal basis for the subpoenas, the department continues to push forward its inquiries into gender-affirming care. Recently, DOJ issued grand jury subpoenas, signaling that a criminal investigation is under way. As the stakes get higher, legal challenges can be expected to ramp up as well. On June 1, 2026, a putative class action was filed in the Southern District of New York challenging a grand jury subpoena to NYU Langone Hospital. A similar case was filed at the end of May 2026 in the Northern District of California, challenging a grand jury subpoena to the Lucile Salter Packard Children’s Hospital at Stanford. On June 8, 2026, the presiding judge issued an emergency order directing the hospital not to comply with the subpoena and ordering the DOJ not to take further enforcement action as to the patient records at issue without further order from the court.

What’s the upshot? Multiple federal circuit courts are grappling in real time with the legal issues presented by the subpoenas but until the law is more settled, the requests will continue to be heavily litigated on both sides. Recipients of these subpoenas should consider court intervention early, considering DOJ's multijurisdictional strategy and state-specific privacy and privilege concerns, as well as the evolving landscape of legal challenges.