Washington’s State Attorney General Nick Brown announced today that he has filed a multi-state lawsuit against President Donald Trump’s executive order to ban federal support of transgender medical care for people under the age of 19.

Brown, along with three doctors and the Attorneys General from Oregon and Minnesota, seek to block the federal agencies from acting on this “illegal” and “unconstitutional” order.

“But having read this order very, very closely, I need to say something more,” he said. “This president’s order is gross. It is disgusting. It is hateful. We will always take action against the illegal conduct, but this one has special resonance … It promotes harassment and discrimination for people who are already marginalized. It risks their literal health and safety and that of their providers.”

At a press conference Friday, AG Brown said the doctors who’ve joined this suit could not join him at the podium today because they feared being targeted. AG Brown told The Stranger the temporary restraining order was being filed as “we spoke,” and could theoretically come before a judge today.

The complaint, filed in the US District Court of Western Washington this morning, argues that the order’s threat to withhold federal funds and grants from any state Medicaid program, research institution, or hospital that offers gender-affirming care for patients under 19 violates the 5th Amendment’s equal protection guarantee by singling out transgender people, the 10th Amendment for criminalizing medical practices in Washington State, and the separation of powers. Additionally, Congress has already authorized research and education funding for medical institutions in Washington State. The complaint argues Trump can’t unilaterally overrule its intent.

Trump signed the order on January 28th. As we wrote last week, the order equates evidence-based gender health care with “chemical castration” and mutilation. Gender-related surgery is like any other performed by a qualified medical professional, and unlike the order implies, many trans people are capable of having children after transition (remember the pregnant man on Oprah? It’s very possible). Gender-affirming care is supported by all major medical organizations, including the American Medical Association and the American Academy of Pediatrics, and it is not true that hormone replacement therapy guarantees permanent or even temporary sterility.

Luna Crone-Baron, a 19 year old transgender woman and student at University of Washington who spoke at the press conference, said she is living a wonderful life today because of her loving family and the decisions of her healthcare providers. As a child, the feeling she would not be able to grow up into a body or future that felt true. This feeling of hopelessness was a constant weight on her as a child, to the extent that she often felt she would rather die than go through male puberty. It was important that the public understood the magnitude of the order, she said. In short, gender-affirming care saved her life.

“This order will kill trans children,” she said. “That is the gravity of it. That is what I believe is the intent of the order.”

On Monday, Seattle Children’s indefinitely postponed at least one trans teenager’s masculinizing top surgery hours before it was scheduled, and quietly removed references to gender-affirming surgery on its website. It’s unclear what the hospital’s policy is now, or if it will restrict puberty blockers and hormone replacement therapy, too. In a statement to The Stranger, Seattle Children’s said that the hospital is supporting AG Brown's pursuit of a temporary restraining order.

"Given the uncertainty surrounding the orders legal authority, we are seeking clarity to safeguard the best interests of Seattle Children’s patients and families, and our workforce, so we can continue to deliver on our mission. We remain committed to caring for our patients and families who need us and engaging in life changing research, while ensuring we operate within all applicable laws,” the hospital says.

Hospitals in Colorado, Virginia, and Washington DC have paused gender-affirming care for patients under 19. Shortly after NYU Langone in New York City did the same, the state’s Attorney General Letitia James warned hospitals that pausing or restricting care would violate state anti-discrimination laws. It’s unclear if hospitals in states without state restrictions or bans on gender-affirming care need to comply.

Executive orders are not self-enforcing. They direct federal agencies to act. The Department of Health and Human Services has not published a rule, or even discussed rulemaking and public comment. Brown said during the press conference that his office felt this suit will still be necessary to provide hospitals and individual doctors.

If people under 19 do lose access to puberty blockers and hormones at hospitals anxious about federal funding, that order doesn’t prevent them from getting treatment at clinics and telehealth providers that don’t rely on federal funds. But it’s unclear if those providers could scale to meet growing demand if more institutions follow suit.

Washington’s suit isn’t the only challenge against the order. On Tuesday, PFLAG, a group for the family and friends of queer people, the LGBTQ medical advocacy group GMLA, and seven families with trans and nonbinary children sued over the same order in a Baltimore federal court.

The suit in Baltimore also challenged Trump’s order instituting the federal government’s redefinition of sex in starkly binary terms, which doesn’t account for the 5 million intersex people in the US, and other people with medical conditions that contradict its restricted view. The order eliminated the gender-neutral “X” option on US passports and disallowed gender-marker changes on all federal documents. Current applications requesting such changes are apparently frozen until Secretary of State “Little Marco” Rubio issues new guidance.

Brian Bond, CEO of PFLAG, told reporters the organization is receiving a “drumbeat of calls from parents whose kids’ care is being cancelled.” The ACLU and Lambda Legal, who are representing the plaintiffs, wrote in the court filing that this order is trying to illegally or withhold, Congressionally issued funds; and like the suit challenging Tennessee’s ban before the US Supreme Court, the plaintiffs also argue the order discriminates against trans kids because the federal government would still fund same treatments if the child is cisgender or intersex.

This is a developing story. This includes an update statement from Seattle Children's Hospital.