In Pennsylvania, two federal judges appointed by President Barack Obama are now at the center of a fight over whether the U.S. government can seize the private medical records of transgender youth. The battle, two legal cases unfolding in both Philadelphia and Pittsburgh, pits families and hospitals against the Department of Justice and raises fundamental questions about constitutional privacy, federal power, and the future of gender-affirming health care in the United States.

The cases stem from a series of administrative subpoenas issued by the Justice Department this summer as part of the Trump administration’s escalating campaign against gender-affirming care. Families and their attorneys argue that the government is not attempting to root out fraud, as the DOJ claims, but to intimidate providers and chill access to care that remains legal in Pennsylvania and endorsed by every major medical association.

Two courts, two judges, one question

On September 22, six families filed a motion to quash in the United States District Court for the Eastern District of Pennsylvania. The case is before Judge Mark A. Kearney, who joined the bench in 2014. On September 24, four families brought a parallel challenge in the Western District. That case is before Judge Cathy Bissoon, who has served since 2011. Both judges, appointed by Obama, will now decide whether the Department of Justice may compel hospitals to disclose years of individual patients’ private medical records to the government.

The subpoenas demand extraordinary categories of information, including patient names, dates of birth, Social Security numbers, home addresses, details of parents and guardians, and clinical notes documenting treatment decisions. They also require intake forms, consent paperwork, and parental authorizations for puberty blockers and hormone therapy. In effect, they cover every minor treated for gender dysphoria at the hospitals in the last five years.

A July crackdown

The subpoenas in Pennsylvania are part of a much larger national dragnet. On July 9, the Justice Department announced that it had issued more than 20 subpoenas to doctors and clinics involved in what it called “transgender medical procedures on children.” At the time, Attorney General Pamela Bondi said, “Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice.” All major medical associations, including the American Medical Association and the American Academy of Pediatrics, support gender-affirming care as evidence-based, safe, and effective medical treatment that is necessary and often lifesaving.

The DOJ said the investigations focused on potential health care fraud and false statements, but advocates saw the announcement as proof that the federal government was targeting providers not for legitimate misconduct, but because of the type of care they provide.

“If our Constitution means anything”

Mimi McKenzie, legal director at the Public Interest Law Center, which represents families in both Pennsylvania cases, told The Advocate that the subpoenas must be understood as part of this larger strategy. “If our Constitution means anything, it means that the federal government can’t rifle through your child’s medical records in order to intimidate you,” she said.

McKenzie warned that even if prosecutions never follow, the chilling effect is already profound. The Children’s Hospital of Philadelphia continues to treat patients while challenging its subpoena in court. However, UPMC announced on June 30 that it would no longer provide gender-affirming care to patients under the age of 19, citing liability concerns. “Families are scared because the government has equated this care to child abuse,” McKenzie explained. “Even if they don’t follow through, the intimidation alone disrupts care.”

In Washington, D.C., the Federal Trade Commission quietly held a workshop on July 9 titled “The Dangers of ‘Gender-Affirming Care’ for Minors.” The event, widely criticized by public health experts and LGBTQ+ advocates, assembled anti-trans attorneys, so-called detransitioned activists, and conservative medical voices to argue that care for transgender youth may constitute unfair or deceptive practices. FTC Chair Andrew Ferguson opened the workshop by accusing parts of the medical establishment of removing age minimums from treatment guidelines under political pressure. The event repositioned gender care not as health care but as potential consumer fraud. Health care policy experts called the FTC event a “government-sponsored disinformation campaign.”

The July DOJ press release announcing the subpoenas echoed earlier executive orders from President Donald Trump, including one called Protecting Children From Chemical and Surgical Mutilation, which instructed the attorney general to investigate gender-affirming care. DOJ guidance soon directed prosecutors to treat the care as a form of child abuse, and to collaborate with state attorneys general in pursuing cases.

After the U.S. Supreme Court ruled against trans people in Skrmetti this summer, allowing state legislatures to ban gender-affirming care for minors, states like Tennessee implemented a complete prohibition on this care.

In April, the White House called “the sinister threat of gender ideology” one of the most prevalent forms of child abuse in America.

Courts elsewhere have begun pushing back. Earlier this month, a federal judge in Massachusetts quashed a subpoena to Boston Children’s Hospital, calling it a “fishing expedition” and a product of bad faith. The Pennsylvania families cite that ruling to argue that the DOJ’s campaign is legally indefensible.

Beyond trans youth

The implications extend far beyond Pennsylvania. Courts in the Third Circuit have long recognized heightened constitutional protections for medical, reproductive, and mental health records. If the government can demand disclosure here, advocates warn, then no medical relationship is safe from political targeting.

“There is nothing other than the courts and public pressure to stop the weaponization of the Department of Justice,” McKenzie said. “What is really to stop them from seeking other types of records — reproductive health, mental health — of groups of people they don’t like?”

Kearney has ordered the DOJ to respond to the Philadelphia families’ motion by October 6. Bissoon’s case in Pittsburgh is just beginning. Both courts are expected to move quickly, as administrative subpoena challenges typically do, McKenzie said.

For now, the families pressing their cases under pseudonyms emphasize that their fight is not just about their own children; it is also about the children of others.

“It’s important that transgender youth and their parents know that there are people out there fighting for their constitutional right to privacy,” McKenzie said.