Chicago judge sides against Florida attorney general on kids transgender medicine

By Scott Holland | Legal Newsline
The Center Square

A federal judge in Chicago has refused to dismiss a lawsuit the American Academy of Pediatrics lodged against Florida Attorney General James Uthmeier, seeking to block Utheimer from suing the AAP over its endorsement of gender transition medicine for children.

In an opinion filed June 2, U.S. District Judge Matthew Kennelly granted AAP’s request for a preliminary injunction and ruled against Uthmeier’s motion to dismiss the complaint. The AAP had alleged Utheimer had sued the group in a Florida state court in an attempt to violate its First Amendment speech rights.

The dispute dates to a 2018 AAP policy statement titled “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.” The group reaffirmed the statement in 2023, which Kennelly said remains freely accessible online.

Uthmeier sued AAP, along with the World Professional Association for Transgender Health and the Endocrine Society, in 2025, alleging violations of the Florida Deceptive and Unfair Trade Practices Act and its Racketeer Influence and Corrupt Organizations Act.

Uthmeier’s complaint traced the beginning of the alleged criminal enterprise to a 1998 Standard of Care publication from the WPATH, claiming the group “had no credible evidence” for recommendations that became more widely adopted, first by the Society in 2009 and then the AAP in 2018. He also noted all three bodies challenged a rule the Florida Agency for Health Care Administration proposed to “exclude puberty blockers, cross-sex hormones and surgical interventions from Medicaid coverage,” Kennelly wrote.

The Chicago-based AAP filed its lawsuit in March 2026. Uthmeier responded with his dismissal motion, and on the same day amended his Florida complaint to add a state antitrust claim and seeking $1 million for each alleged violation on top of the statutory penalties in the initial litigation.

Kennelly first rejected Uthmeier’s jurisdictional challenge, saying that although Illinois wasn’t the “focal point” of Uthmeier’s actions and statements targeting the AAP, “the effect on the Illinois audience is a key part of the First Amendment harm that AAP alleges. Besides the general harm to its reputation among Illinois residents, AAP has submitted an uncontroverted affidavit attesting that it has faced security issues at its events and that its members have been harassed. Though it does not specify the location of these incidents, it is implausible that these issues are happening everywhere but the state in which AAP is headquartered.”

He further examined the relevance of Uthmeier entering Illinois to serve a summons on the agency, finding established precedent to be of mixed value. But Kennelly said the convincing argument is that the relief Uthmeier seeks — specifically an injunction to prevent the group from publishing anything supporting its position or collaborating with the other defendants — isn’t limited to what the group does in Florida.

“In case there were any ambiguity in the original state complaint, the amended state complaint adds an antitrust claim based on the same challenged conduct and defines the relevant geographic market as the entire United States,” Kennelly wrote.

After concluding the venue for hearing the lawsuit is proper, Kennelly examined Uthmeier’s invocation of the “Younger abstention,” a doctrine drawn from a 1971 U.S. Supreme Court opinion, Younger v. Harris, which he said established a framework for when “federal courts should abstain from interfering with certain ongoing state proceedings.”

That opinion, he continued “contemplated that some situations would nonetheless justify federal intervention. As relevant here, the Court recognized that a federal court may enjoin a state proceeding that is brought in bad faith or to harass.” He further said Uthmeier’s Florida litigation meets the criteria of “quasi-criminal civil enforcement proceedings,” one of the applicable exceptions.

“In this case, there is no dispute that AAP’s support of gender-affirming care is the but-for cause of Uthmeier’s decision to bring the state court lawsuit,” Kennelly wrote. “Indeed, as AAP emphasizes, Uthmeier has been open that the goal of the lawsuit is to punish AAP for its speech. The parties’ dispute instead centers on whether AAP’s advocacy was protected by the First Amendment.”

Kennelly said although AAP essentially argued Uthmeier’s lawsuit was filed in bad faith, it must “show more than a mistake” on the attorney general’s part with the actual legal question being “whether Uthmeier initiated the enforcement action in subjective bad faith or without an objectively reasonable expectation of success.”

There is “a significant weakness” on Uthmeier’s lawsuit, Kennely said, because all his state law claims “require AAP’s support of gender-affirming care to be somehow commercial in nature,” but the agency has nonprofit status and doesn’t sell any such forms of care.

Uthmeier alleged the commercial aspect is the sale of AAP memberships and services, like patient referral and training seminars. But Kennelly said the “2018 policy statement does not mention, let alone promote, AAP’s membership or services.”

He framed Uthmeier’s legal theory as AAP deciding “to intentionally publish misleading information to legitimize gender-affirming care specifically — evidently because it was a particularly profitable industry to promote, for whatever reason — with the hope that the medical providers benefited by such legitimacy would pay AAP back in the form of memberships. This quid-pro-quo theory can be fairly characterized as highly speculative at best.”

While allowing it’s possible such care is now profitable, he said it’s unclear how any of the defendants would have predicted that outcome when first publishing support, “Nor is it clear why they would choose to back gender-affirming care specifically — a form of care that only a relatively tiny proportion of the population would pay for — if their true motivation was to make money. Add the fact that AAP’s supposed economic scheme was to prop up this industry not to directly participate in it, but to profit indirectly by enticing practitioners to pay for AAP memberships, and the theory starts to strain credulity. And, unsurprisingly, there are no facts suggesting that AAP had such an unlikely plan.”

The theory that AAP’s publications enabled profit for its members who provide this type of care “is perhaps more economically plausible from a theoretical standpoint, but it similarly lacks factual support,” Kennelly wrote. “Viewing the AAP’s policy statement as a whole, it is difficult to see how it reflects a commercial interest. It looks and reads like an informational document, not an advertisement. Some portions do seem to approve of and promote gender-affirming care, but they do so in a way that resembles standard scientific and medical advocacy, not a money-making scheme. Indeed, the statement’s explanations are often accompanied by open disclosure of potential health risks that a financially motivated actor would likely omit.”

Finding Uthmeier’s theory about the statement being commercial “as weak as they come,” Kennelly said he would have “no objectively reasonable expectation of success” and further said it suggested the document was “noncommercial speech entitled to a greater level of First Amendment protection.”

He also said Uthmeier’s lawsuit “distorts what AAP’s policy statement actually says” regarding general age ranges for possible treatment, calling some aspects of the original filing “egregious misrepresentation.” Kennelly said review of the larger context shows the AAP actually opposed WPATH’s suggestion of “relaxed age minimums because it did not want them to be construed as broad approval of surgery for minors.”

Kennelly added that the “clear misrepresentations” invite questions regarding “more subtle discrepancies” such as omitting from the complaint any acknowledgement that AAP policy identified potential long-term effects, but relied on concerns about effects in other studies to frame the agency’s policy as “methodologically bankrupt.” He further said “it is hard to see how AAP’s statement goes beyond good-faith medical disagreement and into the realm of false and deceptive conduct. That is another objective weakness in the state complaint, and the misrepresentations used to disguise it suggest subjective bad faith as well.”

AAP also pointed to Uthmeier’s public statements to suggest his personal convictions affected professional enforcement decisions and specifically to file the lawsuit it seeks to defeat. Kennelly agreed, and also took note of Uthmeier waiting three months to effectuate service of his claim, only acting after AAP filed the federal complaint and failing to correspond with the group at all.

While he said Uthmeier’s conduct was “consistent with standard litigation practices,” he also said there was no apparent change in circumstances that prompted the addition of antitrust claims after AAP filed its federal suit and said the objective weakness of Uthmeier’s lawsuit might contextualize his actions.

“Each individual item of AAP’s evidence might arguably be too ambiguous to infer bad faith when viewed in isolation,” Kennelly wrote. “When viewed together, the evidence — the weaknesses and misrepresentations on the face of the state complaint; Uthmeier’s inflammatory public commentary; and his delay in prosecuting the case, followed by the addition of an antitrust claim seeking significant additional penalties (and seemingly without merit) when AAP asserted its First Amendment rights — all points in the same direction and is indicative that the state lawsuit is one undertaken in bad faith and without a reasonable expectation of success.”

Finding dismissal improper, Kennelly then said AAP showed it was likely to succeed on its retaliation claim as well as the potential for irreparable harm absent a court order freezing the Florida suit, then directed the group to submit a draft of such an injunction.

A status hearing is set for June 8.

Florida Attorney General James Utheimer’s office did not respond to a request for comment from The Record.

However, in a post on social media platform X, Uthmeier referred to the ruling as a “frivolous order based on a frivolous lawsuit.”

Jonathan Bilyk contributed to this report.