SEATTLE (AP) — President Donald Trump’s plan to pull federal funding from institutions that provide gender-affirming care for transgender youth will remain blocked on a long-term basis under a federal judge’s ruling in Seattle late Friday.

U.S. District Court Judge Lauren King previously granted a two-week restraining order after the Democratic attorneys general of Washington, Oregon and Minnesota sued the Trump administration — Colorado has since joined the case.

King’s temporary order expired Friday, and she held arguments that day before issuing a preliminary injunction blocking most of Trump’s plan pending a final decision on the merits of the case.

The judge found the states lacked standing on one point: the order’s protections against female genital mutilation. Female genital mutilation is already illegal in the four states that are part of the lawsuit, and the judge said the record “is bereft of any evidence” that the plaintiffs plan to perform such procedures.

Washington Attorney General Nick Brown praised the ruling.

“The president’s disregard for the Constitution is obvious and intentional,” he said in a statement. “But once again, states and the courts have stepped up to affirm the rule of law and the values that hold us together as a nation.”

An email message was sent to the White House seeking comment.

Two of Trump’s executive orders are at issue in the case.

One, “Defending Women from Gender Ideology Extremism,” calls for stripping federal money from programs that “promote gender ideology.”

The other, “Protecting Children from Chemical and Surgical Mutilation,” calls for the federal government to cut off research and educational grants for institutions, including medical schools and hospitals, that provide gender-affirming care to people under age 19. Several hospitals around the country ceased providing care, including puberty blockers and hormone treatments, following the order.

Medicaid programs in some states cover gender-affirming care, and Trump’s “Protecting Children” order suggests that practice could end. It also raises the prospect that medical professionals could be criminally charged for providing gender-affirming care under a law that bans medically unnecessary genital mutilation of underage females — a notion that the states suing Trump call repugnant and legally unsupportable.

Young people who persistently identify as a gender that differs from their sex assigned at birth — a condition called gender dysphoria — are far more likely to suffer from severe depression and to kill themselves if they do not receive treatment, which can include evaluation by a team of medical professionals; a social transition, such as changing a hairstyle or pronouns; and eventually puberty blockers or hormones. Surgery is extremely rare for minors.

In her ruling Friday, the judge said the order was not limited to children or to irreversible treatments and that it doesn’t target medical interventions performed on cisgender children.

“In fact, its inadequate ‘means-end fit’ would prevent federally funded medical providers from providing necessary medical treatments to transgender youth that are completely unrelated to gender identity,” she wrote. “For example, a cisgender teen could obtain puberty blockers from such a provider as a component of cancer treatment, but a transgender teen with the same cancer care plan could not.”

In his arguments Friday, Washington Assistant Attorney General William McGinty stressed the urgency of the issue.

“There are going to be young people who are going to take their lives if they can no longer receive this care,” he said.

The executive order uses derisive terminology — words such as “maiming,” “sterilizing” and “mutilation” — that contradicts what is typical for gender-affirming care in the United States. Such care is widely endorsed by the medical community, including the American Academy of Pediatrics, the American Medical Association and the American Academy of Family Physicians.

King, the judge in Seattle, grilled Justice Department attorney Vinita Andrapalliyal in court about the meaning and effect of Trump’s executive orders.

“What is gender dysphoria?” she asked.

“Your honor, I am not a medical provider,” Andrapalliyal responded.

“It’s a thing, correct?” King asked. “It’s a medically recognizable diagnosis?”

“I don’t have an official position on that,” Andrapalliyal said.

The judge continued to press, saying she was “looking for a legitimate government interest” that would justify Trump’s orders.

The four Democratic attorneys general suing in Seattle argued that the orders violate equal rights protections, the separation of powers and the states’ right to regulate issues not delegated to the federal government.

The Trump administration disputed those claims in court filings. “The President’s authority to direct subordinate agencies to implement his agenda, subject to those agencies’ own statutory authorities, is well established,” Justice Department attorneys wrote.

In addition to the orders on health care access and defining the sexes as unchangeable, Trump has also signed orders that open the door to banning transgender people from military service; set up new rules about how schools can teach about gender; and would ban transgender athletes from participating in girls’ and women’s sports.

Many legal challenges have been filed.