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The Justice Department said the information was needed to investigate possible fraud or unlawful off-label promotion of drugs, but the information requested — including actual patient records — seemed to be unrelated, the judge said. Phone messages left with the Justice Department’s attorney Ross Goldstein and with a Justice Department public affairs officer were not immediately returned.

“The Administration has been explicit about its disapproval of the transgender community and its aim to end GAC,� Joun wrote, referring to gender-affirming care. The judge later continued, “It is abundantly clear that the true purpose of issuing the subpoena is to interfere with the Commonwealth of Massachusetts' right to protect GAC within its borders, to harass and intimidate BCH to stop providing such care, and to dissuade patients from seeking such care.�

Just eight days after taking office, President Donald Trump issued an executive order aimed at restricting access to medical care for transgender youth. In June, the Justice Department’s Civil Division announced the division would use “all available resources to prioritize investigations of doctors, hospitals, pharmaceutical companies, and other appropriate entities,� in an effort to investigate what it called “radical gender experimentation.�

Attorney General Pam Bondi announced in a statement July 9 that the Justice Department had sent more than 20 subpoenas to doctors and clinics that provide care to transgender patients under 18. Bondi said the requests were part of investigations into “healthcare fraud, false statements, and more.� But the requests did not just seek information on policies or billing practices — they also demanded information about individual patients who had been prescribed puberty blockers or hormone therapy.

Boston Children's Hospital asked the federal court to quash the subpoena on July 8, saying the Justice Department was seeking practically every document related to the provision of gender-affirming care over the past five and a half years, including highly sensitive and personally identifiable information about young patients.

But the Justice Department contended the subpoena was proper and a valid way for the agency to investigate potential violations of off-label prescription drug rules.

includes a range of medical and mental health services to support a person's gender identity, including when it's different from the sex they were assigned at birth. It may include counseling, medications that block puberty, hormone therapy to produce physical changes or surgeries to transform chests and genitals, although those are rare for minors.

Most major medical groups say access to the treatment is important for those with gender dysphoria and see gender as existing along a spectrum.

At least 27 states have adopted laws restricting or banning the care for minors, while several others have adopted laws or policies protecting access to transgender health care.

Massachusetts' state constitution protects the right to gender-affirming care, the judge said, making it difficult to understand exactly what the Justice Department was trying to investigate.

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Associated Press reporter Geoff Mulvihill contributed to this story.