New York State Attorney General Letitia James has advised health care providers in the state that failing to provide gender-affirming care to transgender minors violates New York antidiscrimination law.

Donald Trump issued an executive order last week titled “Protecting Children from Chemical and Surgical Mutilation,” targets the use of puberty blockers, hormone therapies, and surgeries for anyone under 19, referring to them as “chemical and surgical mutilation.” It directs federal agencies to rescind policies supporting such treatments, withdraw funding from institutions that provide them, and enforce existing laws limiting access to these procedures. This comes even though these procedures are endorsed by every major medical organization.

The order requires the Department of Health and Human Services to review and revise medical guidelines related to gender-affirming care. It specifically singles out the World Professional Association for Transgender Health and its Standards of Care, calling it lacking in “scientific integrity.” HHS is instructed to publish a review of the existing literature on gender dysphoria and develop alternative guidelines, while agencies like the Department of Justice are tasked with investigating providers and enforcing stricter legal measures against what the order terms “deceptive practices.”

In the wake of the order, NYU Langone, a New York City hospital, canceled appointments for some young trans people seeking care, The New York Timesreports. Two families told the Times their children’s appointments to receive puberty blockers had been canceled. The Times sought comment from NYU Langone, but a spokesperson declined.

In an open letter posted online Monday, James referred to a temporary restraining order stopping the Trump administration from freezing all federal funding. The Department of Justice issued the required notice of compliance with the order, which James quoted.

“The notice states that ‘federal agencies cannot pause, freeze, impede, block, cancel, or terminate any awards or obligations on the basis of the OMB memo, or on the basis of the President’s recently issued Executive Orders,’ such as those targeting DEI programs and gender affirming care for minors. The DOJ Notice further states that this prohibition ‘applies to all awards or obligations,’ including those made to grant recipients such as hospitals, non-profits, or other organizations or entities, and also applies to future grants of federal assistance.”

“Regardless of the availability of federal funding, we write to further remind you of your obligations to comply with New York State laws, including those that prohibit discrimination against individuals based on their membership in a protected class, such as sex, gender identity or expression, sexual orientation, race, creed, color, national origin, citizenship or immigration status, military status, disability, or marital status,” she continued. “Electing to refuse services to a class of individuals based on their protected status, such as withholding the availability of services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria, while offering such services to cisgender individuals, is discrimination under New York law.”

Puberty blockers are often given to cisgender people for treatment of early-onset puberty, endometriosis, and other conditions.

New York State Sen. Brad Hoylman-Sigal denounced the Trump administration’s move to restrict gender-affirming care for trans youth. “Simply put, this decision could put lives at risk,” Hoylman-Sigal, a gay man, said in a statement to the Times. “It is imperative that all New Yorkers, including those under the age of 19, are able to receive necessary and life-preserving gender-affirming care to which they are legally entitled to in the State of New York.”

Hospitals in some states have stopped providing gender-affirming care to trans youth because of the executive order, but others are standing up to Trump. In Oregon, for instance, officials with Oregon Health & Science University and Legacy Health, both based in Portland and major providers of this care, have said nothing has changed,The Oregonian reports. And the state’s attorney general, Dan Rayfield, said he is considering legal action.

He issued a statement calling the order “a clear example of the administration imposing its political agenda at the expense of some of the most vulnerable people,” according to The Oregonian. “How the order is implemented will impact how we approach our work to protect access to care,” he added. “All legal options are on the table at this point.”