The plaintiffs alleged that three laws interfered with their ability to exercise their parental rights. Some argued the laws made them hesitant to discipline their children or discuss gender in fear that the kids may run away to a homeless shelter to seek the care without their consent, as allowed by the statutes. 

The ruling says that the parents lacked Article III standing, which requires “actual or imminent” injury. 

“A plaintiff ‘cannot manufacture standing merely by inflicting harm on themselves based on their fears of hypothetical future harm that is not certainly impending,’” the 9th Circuit ruled, citing a U.S. Supreme Court decision that says Article III standing fails without concrete evidence of harm. 

The lawsuit challenged three laws: one permits minors who are at least 13 years old to receive “outpatient treatment” without parental consent; the second requires overnight shelters to reach out to the state instead of the parents if a child runs away to seek “protected” health care, which includes gender-affirming care; and the third allows children to stay in shelters for up to 90-days.

“Children are too young to understand and consent to the harmful effects of medically altering their sex,” one of the plaintiffs, Advocates Protecting Children, wrote in a statement to The Center Square.  “We must implement a non-medical treatment that targets the root cause of this social contagion.”

The 9th Circuit ruling called the plaintiffs’ decisions to avoid certain topics or discipline their children voluntary reactions based on hypothetical fears. While all the parents argued their child’s school had socially transitioned them without their consent, the court argued these laws don’t regulate schools.

The statutes in question primarily focus on shelters and medical providers, not public education.

“The Court’s dismissal of legitimate parental concerns is almost contemptuous of parents,” one of the plaintiffs, Partners for Ethical Care, or PEC, wrote in a statement to The Center Square, “and is willfully naïve about the dangers of unrelated parties having physical control and influence over children.”

President Donald Trump issued an executive order in January to ban the use of federal funding for gender reassignment procedures. The U.S. Department of Health and Human Services also recently published a report advocating for behavioral therapy in place of irreversible medical interventions. 

While a federal judge temporarily blocked Trump’s executive order after Washington and other states sued, the Trump administration will likely continue to appeal to the U.S. Supreme Court. The nation’s high court recently upheld Tennessee’s ban on gender-affirming care for minors, and may rule similarly over Trump’s order and other cases. 

PEC cofounder Martha Shoultz told The Center Square that children are referred to counseling of the state’s choice when in a shelter’s custody. She said it opens the door for “dangerous and permanent psychological and medical interventions,” initiated by strangers with no vested interest in the child’s future. 

“We’ve also seen instances of trafficking that occur when children are kept from their parents and ‘cared for’ by unrelated parties,” Shoultz told The Center Square,  “including state institutions, using the excuse that the parents disagree with medical transition to keep the child from his or her parents.”

Some children cited in the 9th Circuit ruling were allegedly encouraged to run away after expressing body dysmorphia, and at least one underwent “hospitalizations” with limited information provided to the parents as to why. They fear their children may run away — again — to seek gender-affirming care.

“[The] plaintiffs’ claims rely on an enormity of ‘ifs’ and ‘shoulds,’ without any detail or explanation as to when or why these contingencies might occur,” according to the 9th Circuit ruling.

Reporting by The Center Square found that medical providers performed 1,082 gender reassignment procedures on minors under 18 years old in Washington state between 2019 and 2023. That put it in third place for the most procedures performed on children, just behind California and New York. 

The youngest child nationwide to undergo the gender-affirming care was only 7 years old, according to Do No Harm. The organization defines these “procedures” as the use of puberty or hormone blockers and gender reassignment surgeries, such as mastectomies and penile reconstruction. 

“Medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex,” according to Trump’s directive. “The blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity.”

Kaiser Permanente says it will no longer perform the surgeries on minors starting next month. 

While some are suing the provider for performing the procedures on them as minors, National Nurses United, the largest nursing union in the country, disagreed with Kaiser Permanente’s decision.

“Gender-affirming care is safe and effective,” Lady Rainsard, a registered nurse with Kaiser San Francisco, argued in a news release. “Right now, we deem it a much greater risk to cave to this kind of government overreach than it is to provide this care to our patients, no matter their age.”

CHILDREN’S NATIONAL HOSPITAL ENDS ITS GENDER TRANSITION PROGRAMS

Do No Harm, which represents physicians, nurses and medical students across the country, disagrees.

“It is dangerous and destructive to let children, whose minds are still developing, make such life-altering decisions at such young ages – especially since 90% of children who believe they are a different sex no longer hold that view as adults if left to develop on their own without medical interventions,” the group says.