Colorado Orders Children’s Hospital to Resume Puberty Blockers 

The Colorado Supreme Court on May 18 ordered Children’s Hospital Colorado to resume prescribing puberty blockers and hormone therapy to transgender patients under 18, placing the Rocky Mountain region’s largest pediatric hospital between a state court injunction and an unresolved federal funding threat. The hospital receives $182.6 million in federal funding annually, nearly half of it through Medicaid. Denver District Court Judge Ericka F.H. Englert, who refused the same order in February specifically to protect that funding, has been directed by the Supreme Court to issue it. As of publication she had not done so. Children’s Hospital Colorado stated it was “evaluating this decision in the broader context of the many federal, state, and legal matters currently before us” and had not announced compliance. Denver Health, which also suspended treatments for minors in January, had not responded to the ruling.

The case, Boe v. Children’s Hospital Colorado, 2026 CO 32, was filed January 20 by four minor patients — identified in court records as Bella Boe, Chloe Coe, Danielle Doe, and Gabriella Goe — after the hospital suspended all medical gender-affirming care to patients under 18. The suspension followed a December 18, 2025 declaration by HHS Secretary Robert F. Kennedy Jr. that puberty blockers and hormone therapy for gender dysphoria in minors are neither safe nor effective, and that providers faced exclusion from Medicare and Medicaid. Children’s Hospital Colorado halted the treatments rather than risk losing the federal programs its patient base depends on.

The five-justice majority, written by Justice William Hood, found that the hospital violated the Colorado Anti-Discrimination Act. The reasoning turned on a single factual point: Children’s Hospital Colorado continued prescribing puberty blockers and hormone therapy to cisgender patients during the same period it stopped prescribing them to transgender patients. The majority held that applying different access rules to the same drugs based on a patient’s gender identity constitutes discrimination under state law. The court reversed Judge Englert’s denial and remanded with instructions to issue a preliminary injunction.

Justice Brian Boatright, joined by Justice Carlos Samour, dissented. Boatright identified the clinical distinction the majority did not resolve: puberty blockers for central precocious puberty — an endocrine disorder — are not the same treatment as puberty blockers for gender dysphoria, which the American Psychiatric Association’s DSM-5-TR classifies as a psychiatric diagnosis. Withholding a drug from one patient population while providing it to another is not discrimination when the underlying diagnoses are medically distinct. Boatright also argued the majority placed the entire hospital system at risk. “It completely minimizes the reality of the situation,” he wrote.

The FDA has never approved GnRH agonists — the drug class that includes Lupron Depot-Ped and Supprelin LA — for gender dysphoria in minors. The drugs carry FDA approval for central precocious puberty, certain cancers, and endometriosis; their use for gender dysphoria is off-label. In July 2022, the FDA added an intracranial hypertension warning to GnRH agonist labeling after a safety review; one of the six cases involved a transgender patient. The majority opinion in Boe does not address the off-label status or Boatright’s clinical distinction. It addresses only the statutory question under CADA.

The federal threat that drove the hospital’s suspension has itself been struck down. On April 18, 2026, U.S. District Court Judge Mustafa Kasubhai of the District of Oregon vacated the Kennedy Declaration in its entirety in Oregon v. Kennedy, No. 6:25-cv-02409-MTK, ruling Kennedy exceeded his statutory authority and bypassed required notice-and-comment rulemaking under the Administrative Procedure Act. The court permanently enjoined HHS and its Office of Inspector General from implementing the declaration or any materially similar policy. No HHS appeal appeared in the federal docket as of publication, and the Trump administration had not issued a public response to the Colorado ruling.

The vacatur of the Kennedy Declaration does not eliminate Children’s Hospital Colorado’s exposure. CHC attorney Patrick O’Rourke told the Colorado Supreme Court during oral argument: “I think it would be very dangerous to put any actions past this administration in terms of whether or not it believes that something would be politically unfeasible.” The Kennedy Declaration was one enforcement mechanism. The federal regulatory authority over Medicare and Medicaid participation remains intact.

Judge Englert reached the same conclusion in February for the same reason. “Plaintiffs essentially ask the Court to call the bluff of the federal government and order CHC to take action in violation of federal law,” she wrote. The Colorado Supreme Court overruled her on both factors, holding that harm to the four plaintiffs was actual and immediate while harm to the hospital from federal enforcement remained speculative.

The Colorado Supreme Court answered one question: a hospital subject to CADA cannot restrict access to a drug based on a patient’s gender identity when it provides that same drug to other patients. It did not answer whether administering an off-label drug to alter a minor’s hormonal development for a psychiatric diagnosis carries the same medical justification as administering it for an endocrine disorder. Judge Englert must now issue an order she already decided once was too dangerous to give, with the federal exposure that drove her original ruling still unresolved.