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Oregon hit back in the battle over transgender health care Tuesday, leading a coalition of states suing to block a proposed Trump administration policy that would cut off federal funding to institutions that provide gender affirming care to minors.

The U.S. Department of Health and Human Services announced that rule change Dec. 18, with a declaration that condemned “sex-rejecting procedures” for minors as “neither safe nor effective”—putting the force the the U.S. federal government on the side of a mounting global movement that sees medical interventions, ranging from puberty blockers to hormone therapy to surgery, as plainly inappropriate treatments for youth diagnosed with gender dysphoria.

In the new suit, filed in U.S. District Court in Eugene, Oregon and 18 other plaintiffs states say the declaration is not only wrong—”research and clinical data support gender-affirming care as a safe and effective treatment for gender dysphoria in adolescents”—but in violation of multiple federal laws.

The declaration violates laws banning the federal government from intervening in certain ways in the practice of medicine, the plaintiffs say. They also argue it violates laws governing how new federal rules are established. And though the declaration says it is issued “pursuant to the authority vested in” HHS secretary Robert F. Kennedy Jr., the plaintiffs say he does not in fact have the authority to declare the standard of medical care in the United States.

The suit also notes the way federal guidance conflict with the laws of certain plaintiff states. For example, Oregon law guarantees that the Oregon Health Plan cover gender-affirming care. If systems like Oregon Health & Science University and Legacy Health cease to provide this care, the plaintiffs say, patients under the Oregon health plan will lose access to gender-affirming care for which they are statutorily guaranteed coverage.

The legal battle comes as different countries, and U.S. states, issue divergent policies governing medical treatment for transgender youth.

Compounding the confusion is the fact that gender affirming care is a rather capacious term. It can refer to social affirmation of someone’s chosen gender identity, or legal affirmation, where government documents reflect that identity (the Trump administration has moved to restrict this too).

The term can also refer to medical treatments, such as puberty blockers, which are generally reversible, according to the American Academy of Pediatrics. It says other treatments like hormone therapy are partially reversible, while surgery is not reversible. The AAP endorses carefully-administered gender-affirming care in minors with gender dysphoria as a way to promote their physical and social well being.

The stakes in this debate are high for Oregon because OHSU has in recent years become a major provider of such care. The university’s press office hasn’t offered details on the scope of its patient base but, in a 2023 report, OHSU described its Transgender Health Program as one of the “largest and most comprehensive” in the United States.