A federal judge appointed by former President Joe Biden in 2023 has ruled that Health and Human Services Secretary Robert F. Kennedy Jr. overreached in his December declaration that “sex-rejecting procedures” for children were “neither safe nor effective.”

U.S. District Judge Mustafa Kasubhai in Oregon ruled that RFK Jr. exceeded his authority and failed to follow required administrative procedures when HHS issued the declaration.

The ruling grants preliminary relief to health professionals who provide the treatments. The judge also denied the government’s motion to dismiss the case, which was brought by 20 blue states and Washington, D.C., that had legalized controversial “sex-rejecting” health services, including “puberty-suppressing hormones, cross-sex hormones, and surgical procedures.”

RFK Jr. used “comprehensive evidence review of “documented risks of significant harm, markedly weak evidence of benefit, unfavorable risk-benefit profiles, inadequate existing clinical guidelines, growing international consensus among countries conducting rigorous evidence reviews, and applicable medical ethics principles” to issue the declaration rejected by Kasubhai as an overreach.

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“Sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and therefore, fail to meet professional recognized standards of health care,” the declaration read. “For the purposes of this declaration, ‘sex-rejecting procedures’ means pharmaceutical or surgical interventions, including puberty blockers, cross-sex hormones, and surgeries such as mastectomies, vaginoplasties, and other procedures, that attempt to align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex.”

The ruling prevents the federal government from immediately enforcing the declaration against hospitals and health professionals.

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The lawsuit argued the declaration was unlawful and an attempt to override established medical standards without public notice or comment. The federal government said the general statement of policy was exempt from legal rule-making requirements.

The declaration was “the Secretary’s non-binding policy position on the safety and efficacy of certain pediatric and adolescent treatment modalities for gender dysphoria, gender incongruence, or other related conditions,” the government argued Feb. 10.

“Secretary Kennedy, just like anyone else, is entitled to articulate his opinion on the safety and efficacy of emerging and controversial medical practices. The Declaration summarizes Secretary Kennedy’s independent evaluation of the cited medical literature and expresses his opinion that certain treatment modalities are not safe and effective and fail to meet professionally recognized standards of health care.”

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Kasubhai’s ruling was at the end of a roughly six-hour hearing and will be followed by a written decision.

“There’s a theme of ‘Break it and see what others will do,’ and that’s not a system or method committed to the rule of law,” Kasubhai said. “That notion that ‘I will go forward, issue a declaration and see if we can get away with it,’ that is not a principle of governance that adheres to the overarching commitment to the democratic public that requires the rule of law to be regarded and respected and honored as sacred.”

New York Attorney General Letitia James, who led the case, said the ruling protects patients, families and providers from federal intimidation.

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“So much of the conversation around transgender health care has lost sight of the real people harmed by the federal government’s attacks,” James wrote in a statement last week, praising the opinion. “Young people are losing access to life-saving treatment, families are being left in the dark, and medical providers are being threatened just for doing their jobs and following standards of care.

“Today’s win breaks through the noise and gives some needed clarity to patients, families, and providers. Health care services for transgender young people remain legal, and the federal government cannot intimidate or punish the providers who offer them.

“It is my duty and my privilege to stand with trans New Yorkers and their families. I will always fight for the LGBTQ+ community.”

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The case was brought by Oregon, New York, California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Rhode Island, Vermont, Wisconsin, Washington and Pennsylvania.

The ruling comes as President Donald Trump has sought to tag a 2024 presidential campaign vow to “protect children from transgender mutilation surgeries” to the 2026 SAVE America Act currently being debated in the Senate.

Sen. Eric Schmitt, R-Mo., formally introduced an amendment to attach the added Trump priorities to the election-integrity bill.

“I’ve worked closely with President Trump and the White House to introduce a substitute amendment that will save our elections, save women’s sports, and save our children from gender mutilation surgeries,” Schmitt wrote in a statement last week. “It’s time to get this done.”