American Academy of Pediatrics v. James Uthmeier

In the United States Court of Appeals For the Seventh Circuit ____________________ No. 26-2238 AMERICAN ACADEMY OF PEDIATRICS, Plaintiff-Appellee, v. JAMES UTHMEIER, Attorney General of the State of Florida, Defendant-Appellant. ____________________ Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No.1:26-cv-02401— Matthew F. Kennelly, Judge. ____________________ DECIDED JUNE 22, 2026 ____________________ Before HAMILTON, SCUDDER, and JACKSON-AKIWUMI, Cir- cuit Judges. PER CURIAM. In December 2025, James Uthmeier, the At- torney General of the State of Florida, sued the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society in Florida state court. General Uthmeier alleged and announced pub- licly that through their policy statements and legal filings sup- porting access to gender-affirming care, the organizations 2 No. 26-2238 violated the Florida Deceptive and Unfair Trade Practices Act, Florida’s Racketeer Influenced and Corrupt Organizations (RICO) Act, and, later, Florida antitrust law. Three months later, General Uthmeier had not yet even served the organiza- tions with process, but the pending case was hanging over those defendants. The American Academy of Pediatrics (AAP), an Illinois non-profit, then sued General Uthmeier in federal court in Illinois. AAP sued under 42 U.S.C. § 1983. It contends that the Florida enforcement action was brought in bad faith in violation of the First Amendment to retaliate against AAP’s advocacy for gender-affirming care. The district court granted AAP’s motion for a preliminary injunction, enjoining General Uthmeier from pursuing his state court action against AAP. General Uthmeier has ap- pealed and moved for a stay of the preliminary injunction pending our full and expedited consideration of his appeal of the preliminary injunction. See Fed. R. App. P. 8. The issue before us is narrow. We do not decide the merits of the preliminary injunction. We consider only whether we should stay the district court’s injunction pending our expe- dited consideration of the appeal. We deny the requested stay pending appeal. We recognize that an injunction against a pending state enforcement action like this raises serious fed- eralism concerns that are the foundation of Younger absten- tion. See Younger v. Harris, 401 U.S. 37 (1971) (reversing injunc- tion against criminal proceeding brought in good faith). The Younger abstention doctrine, however, has always included an exception for proceedings brought in bad faith. Id. at 46–50, citing Dombrowski v. Pfister, 380 U.S. 479 (1965) (reversing de- nial of injunction against criminal proceedings brought in bad faith). In this case, the district court made detailed findings No. 26-2238 3 indicating the Florida proceeding has been brought in bad faith, so that Younger abstention should not apply. The district court also explained why personal jurisdiction and venue in Illinois are supported by law. The district court’s decision finds strong support from de- cisions by both the Fifth Circuit and the D.C. Circuit, decisions with which neither General Uthmeier nor our dissenting col- league engages. See Defense Distributed v. Grewal, 971 F.3d 485 (5th Cir. 2020) (holding that Texas district court should have enjoined bad-faith enforcement action brought in New Jersey by state a orney general); Media Ma ers for America v. Paxton, 138 F.4th 563 (D.C. Cir. 2025) (affirming D.C. injunction against bad-faith investigation by a orney general in Texas). In light of those cases providing legal support for the injunc- tion here, as well as AAP’s factual showings, General Uth- meier has not made the required “strong showings” that he is likely to succeed on the merits of the appeal or that the injunc- tion will cause him irreparable harm while we consider his appeal on an expedited basis. See Nken v. Holder, 556 U.S. 418, 434 (2009). I A The American Academy of Pediatrics is a non-partisan, non-profit organization incorporated and headquartered in Illinois. Founded in 1930, AAP contributes to the develop- ment of pediatric medicine through conducting research, providing educational materials, hosting events for medical professionals, and publishing Pediatrics, a peer-reviewed sci- entific journal. AAP also files amicus briefs, submits 4 No. 26-2238 comments in response to agency rulemaking, and issues pol- icy statements on issues affecting pediatric health. In 2018, AAP published a policy statement titled “Ensur- ing Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” in the Pediatrics journal. According to its abstract, the policy statement re- views concepts and challenges in the field of gender-affirming care, providing suggestions for pediatric providers that are “focused on promoting the health and positive development” of transgender youth. The policy statement contains an im- portant disclaimer: “The guidance in this statement does not indicate an exclusive course of treatment or serve as a stand- ard of medical care. Variations, taking into account individual circumstances, may be appropriate.” The policy statement provides an overview of various forms of gender-affirming care with an overall supportive tone. It notes that suppression of puberty comes with risks, noting that some research suggests it may have long-term ef- fects on bone metabolism and fertility and observing that the current research is “limited and provides varied results.” The statement favorably summarizes social affirmation, including adapting one’s hairstyle, clothing, and pronouns. The state- ment also describes different types of surgical approaches. It observes that these changes are irreversible and typically are reserved for adults, but that surgery is “occasionally pursued during adolescence on a case-by-case basis.” AAP’s policy statement concludes with several recom- mendations, four of which the district court highlighted as particularly relevant to this case: (1) “that youth who identify as [transgender] have access to comprehensive, gender-af- firming, and developmentally appropriate health care that is No. 26-2238 5 provided in a safe and inclusive space”; (2) “that insurance plans offer coverage for health care that is specific to the needs of youth who identify as [transgender], including coverage for medical, psychological, and, when indicated, surgical gen- der-affirming interventions”; (3) “that pediatricians have a role in advocating for policies and laws that protect youth who identify as [transgender] from discrimination and vio- lence”; and (4) “that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as [transgender].” AAP affirmed this policy statement in 2023. The statement is freely accessible online. In early December 2025, General Uthmeier filed a lawsuit in a state court in Florida against AAP, the World Professional Association for Transgender Health (WPATH), and the Endo- crine Society. His initial complaint alleged that AAP and its co-defendants violated the Florida Deceptive and Unfair Trade Practices Act by making “immoral, unethical, oppres- sive, and unscrupulous” representations, misleading con- sumers about the safety and reversibility of “sex intervention” treatments in order to advertise memberships, goods, and ser- vices. The Florida complaint also alleged that the defendants vi- olated Florida’s RICO Act. The criminal enterprise purport- edly began when defendant WPATH issued a publication in 1998 that did not specify an age minimum for puberty-block- ing hormones, allegedly with no credible supporting evi- dence. Defendant Endocrine Society allegedly joined the criminal enterprise in 2009 by publishing a guideline adopt- ing most of WPATH’s recommendations, stating falsely that puberty blockers were “fully reversible.” 6 No. 26-2238 General Uthmeier alleged that AAP joined the supposed criminal enterprise with its 2018 policy statement, described above, which adopted and cited elements of the WPATH and Endocrine Society reports. General Uthmeier alleged that the three organizations furthered their supposed criminal enter- prise by submi ing comments opposing a rule proposed by the Florida Agency for Health Care Administration that would exclude gender-affirming treatments from Medicaid coverage. Their later amicus briefs challenging the scientific basis for the rule, General Uthmeier alleged, were further ev- idence of their criminal enterprise based on a “formula” of “co-signing amicus briefs that cite each other’s guidelines.” General Uthmeier sought declaratory and injunctive relief, as well as statutory penalties of $1 million against each de- fendant and an additional $10,000 for each allegedly false rep- resentation. Important for our analysis of personal jurisdic- tion and venue, he also asked the Florida state court to grant additional relief including “imposing reasonable restrictions upon Defendants’ future activities,” “[o]rdering the dissolu- tion or reorganization of Defendants’ enterprise,” and “[o]rdering the forfeiture of Defendants’ charters.” The day General Uthmeier filed the state complaint, he an- nounced the enforcement action on X, formerly known as Twi er: “In 2023, @GovRonDeSantis signed legislation to ban so-called 'gender-affirming care' for kids. Now it's time for ac- countability! Today, my office sued @wpath, @AmerAcadPeds, and @TheEndoSociety for mutilating kids and misleading families.” AAP alleges that two days later, General Uthmeier was a guest on a podcast where he dis- cussed the enforcement action and said: “we want to hurt [AAP and its co-defendants] in their wallet,” “we want them No. 26-2238 7 to cough up millions,” and that his lawsuit would “end” gen- der-affirming care “for once and for all.” B Despite the publicity about the filing, General Uthmeier did not serve AAP and its co-defendants in the state enforce- ment action for more than three months after filing the com- plaint. He did so only after AAP filed this lawsuit in the Northern District of Illinois alleging that General Uthmeier had filed the state enforcement action to retaliate against AAP for its advocacy in favor of gender-affirming care and to sup- press its speech in violation of the First Amendment. AAP sought injunctive relief under 42 U.S.C. § 1983 and Ex parte Young, 209 U.S. 123 (1908). See generally Chiles v. Salazar, 607 U.S. —, 146 S. Ct. 1010 (2026) (First Amendment protects speech on issues of gender-affirming care and prevents state from requiring therapists to adopt state’s favored viewpoint). AAP moved for a preliminary injunction. General Uth- meier moved to dismiss the federal lawsuit for lack of per- sonal jurisdiction, improper venue, Younger abstention, and failure to state a claim. On the same day he filed his motion to dismiss, General Uthmeier filed an amended complaint in the Florida court. The amended complaint added an antitrust claim, alleging that the three defendants restrained trade or commerce by “employing biased standards-se ing proce- dures designed to promote their members’ ‘gender-affirming’ model of care.” The amended complaint seeks an additional $1 million penalty for each alleged antitrust violation. After holding a hearing and assessing the record, the dis- trict court denied General Uthmeier’s motion to dismiss, granted AAP’s motion for a preliminary injunction against 8 No. 26-2238 General Uthmeier’s pursuing the Florida enforcement action against AAP pending further proceedings. The court acknowledged General Uthmeier’s argument that his service of process on AAP in Illinois was likely insufficient on its own to establish personal jurisdiction. The district court concluded that the combination of service in Illinois, the chilling effect on AAP in Illinois, and General Uthmeier’s stated intent to halt AAP’s operations in Illinois and nationwide, including dissolving AAP and forfeiting its charter, was likely sufficient to establish personal jurisdiction in Illinois. The district court found that venue, too, was likely proper because the chilling effect of the enforcement action, as well as AAP’s conduct and publications giving rise to the state enforcement action, oc- curred in the Northern District of Illinois. The district court also found at this preliminary stage that AAP’s suit appears likely to meet the Younger exception al- lowing injunctions against bad-faith litigation. Based on the facts before it, the court found that General Uthmeier ap- peared to have filed the enforcement action with no reasona- ble expectation of success. All three state-law claims require General Uthmeier to prove that AAP’s activities are commer- cial. AAP is a nonprofit scientific organization that does not sell or provide gender-affirming care. In addition, the court found, several other factors supported an inference of bad faith: General Uthmeier’s delay in prosecuting the enforce- ment action, the Florida complaint’s inaccurate portrayal of AAP’s stance on age limits and side effects of gender-affirm- ing care, and General Uthmeier’s inflammatory public com- ments. The district court further found that AAP was likely to suc- ceed on the merits of its First Amendment retaliation claim. No. 26-2238 9 General Uthmeier had offered no arguments to rebut AAP’s position that its scientific publications about gender-affirming care were protected by the First Amendment. Also, there was li le doubt that AAP’s protected speech was the impetus for the Florida enforcement action. The monetary and injunctive penalties threatened by the suit also appeared to be severe enough to deter future First Amendment activity. Irreparable harm is presumed in First Amendment violations. The district court also credited AAP’s evidence that the enforcement ac- tion was chilling scientific discourse, undermining security and a endance at AAP’s events, and burdening AAP employ- ees with threats to their safety. Consistent with the reasoning in Younger, the court found that raising a First Amendment defense in state court would likely not provide an adequate remedy for AAP because the right it sought to protect was the right not to be subjected to a bad-faith prosecution in the first place. See Younger, 401 U.S. at 48–49 (injunction would be justified where “defense of the State’s criminal prosecution will not assure adequate vindica- tion of constitutional rights,” and “substantial loss of or im- pairment of freedoms of expression will occur if appellants must await the state court’s disposition and ultimate review in this Court of any adverse determination”), quoting Dom- browski, 380 U.S. at 485–86 (reversing denial of injunction against bad-faith prosecution); Netflix, Inc. v. Babin, 88 F.4th 1080, 1097 n.51 (5th Cir. 2023) (affirming injunction against state-court prosecution for actions protected by First Amend- ment because criminal defendant sought to protect federal right not to be subjected to bad-faith prosecution, and that right could not be vindicated by undergoing prosecution). 10 No. 26-2238 General Uthmeier appealed the injunction. He moved for a stay pending appeal and an immediate administrative stay as to the district court’s order to file a prompt status report detailing his compliance with the preliminary injunction. This court denied the motion for an immediate administrative stay. General Uthmeier then filed his status report in the dis- trict court showing that he had notified the Florida state court of the preliminary injunction. He described the injunction as “lawless” and “illicit” and told the state court that “[t]he in- junction does not bind [it] in any way.” II When considering whether to stay an injunction pending appeal, this court applies a standard parallel to the prelimi- nary injunction standard while keeping in mind “the district court’s exercise of equitable discretion.” Illinois v. Trump, 155 F.4th 929, 936 (7th Cir. 2025), quoting Camelot Banquet Rooms, Inc. v. U.S. Small Bus. Admin., 14 F.4th 624, 628 (7th Cir. 2021). We take a “fresh look at the legal issues but review the district court’s factual findings for clear error.” Id. at 936–37. To justify a stay, the moving party must make a “strong show- ing that he is likely to succeed on the merits,” and that he will be “irreparably injured” absent a stay. Nken v. Holder, 556 U.S. 418, 434 (2009). If he makes such a “strong showing,” then this court considers the balance of harms and the public interest. The party requesting a stay bears the burden of showing it is justified. Id. at 433–34. General Uthmeier argues he is likely to succeed on the merits for three reasons: the district court lacks personal No. 26-2238 11 jurisdiction, venue is improper, and Younger v. Harris de- mands abstention. We address each in turn. A. Personal Jurisdiction First, General Uthmeier argues that he is likely to succeed on the merits because the Illinois district court lacks personal jurisdiction over him. He argues that the effects of the state enforcement action felt by AAP in Illinois are not contacts be- tween himself and Illinois and that the fact that he served pro- cess on AAP in Illinois does not establish sufficient minimum contacts with the state. General Uthmeier has not made the required strong show- ing that the district court lacks personal jurisdiction. Illinois’s long-arm statute permits personal jurisdiction coextensive with the Due Process Clause of the Fourteenth Amendment. Mobile Anesthesiologists Chi., LLC v. Anesthesia Assocs. of Hou. Metroplex, P.A., 623 F.3d 440, 443 (7th Cir. 2010). Thus, General Uthmeier is subject to personal jurisdiction in Illinois if he has “certain minimum contacts” with Illinois such that this law- suit “does not offend ‘traditional notions of fair play and sub- stantial justice.’” Id., quoting International Shoe Co. v. Washing- ton, 326 U.S. 310, 316 (1945). The simple fact of injury in the forum is not enough by itself to establish jurisdiction, but it can be sufficient when a defendant’s intentional conduct in a foreign state is “calcu- lated to cause injury” to the plaintiff in the forum state. Calder v. Jones, 465 U.S. 783, 791 (1984). Under Calder, personal juris- diction based on the location of a plaintiff’s injury is appro- priate when a defendant “expressly aims its actions at the state with the knowledge that they would cause harm to the plaintiff there.” Mobile Anesthesiologists, 623 F.3d at 445. 12 No. 26-2238 “Express aiming” requires some “evidence beyond the plain- tiff’s mere residence in the forum state.” Id. at 447. General Uthmeier maintains that exercising personal juris- diction over an out-of-state a orney general is unprecedented overreach. But the Fifth and D.C. Circuits have each affirmed findings of personal jurisdiction over out-of-state a orneys general in analogous circumstances. General Uthmeier does not engage with those cases and identifies no contrary author- ity. As the district court noted, Defense Distributed v. Grewal, 971 F.3d 485 (5th Cir. 2020), is particularly instructive. De- fense Distributed, a Texas company that promotes popular ac- cess to firearms, produced and made accessible online infor- mation related to the 3D printing of firearms. Id. at 488. New Jersey A orney General Grewal sent a cease-and-desist le er to Defense Distributed in Texas threatening legal action if it published its files online, and he brought a civil lawsuit against Defense Distributed in New Jersey. Defense Distrib- uted filed suit in federal court in Texas alleging the a orney general’s actions violated the First Amendment. Id. at 489. The Fifth Circuit determined that the a orney general had suffi- cient minimum contacts with Texas to subject him to the juris- diction of Texas courts. Notably, the Fifth Circuit reasoned that General Grewal purposefully directed conduct at Texas because, rather than “cabin his request by commanding the plaintiffs to stop pub- lishing materials to New Jersey residents; he instead demands that the plaintiffs cease publication of their materials gener- ally.” Id. at 492. The Fifth Circuit also noted that General Grewal’s conduct beyond sending the cease-and-desist le er confirmed his intent to “crush Defense Distributed’s No. 26-2238 13 operations and not simply limit the dissemination of digital files in New Jersey,” citing his public comments threatening to “come after” “anyone who is contemplating making a printable gun.” Id. Those facts closely track the situation here. General Uthmeier seeks to block AAP’s speech nationwide and to dissolve it and cause its operations to cease. The District of Columbia Circuit found personal jurisdic- tion in another similar action in Media Ma ers for America v. Paxton, 138 F.4th 563 (D.C. Cir. 2025), where a district court in the District of Columbia enjoined the Texas a orney general from pursuing an investigation of a reporter and a nonprofit media watchdog organization. They had published an article asserting that the owner of X.com was endorsing an antise- mitic conspiracy theory on its internet platform. Id. at 571. The D.C. Circuit rejected the Texas a orney general’s a ack on personal jurisdiction: “The point is that the censorship-based effects of the allegedly retaliatory investigation [have] con- nected [Texas A orney General] Paxton to the District [of Co- lumbia], rather than to just Appellees.” Id. at 578, citing De- fense Distributed, 971 F.3d at 495–96. As the circuit courts did in Defense Distributed and Media Ma ers, the district court here reasonably found that General Uthmeier’s actions appear calculated to cause injury to AAP in Illinois. General Uthmeier has asked the Florida state court to impose “restrictions upon [AAP’s] future activities” and even to order “the forfeiture of [AAP’s] charter” in Illinois. Further, his amended state complaint identifies the “relevant market” of AAP’s allegedly misleading advertisements as “the treatment of children and adolescents experiencing gen- der dysphoria in the United States” and notes that AAP and its co-defendants “have thousands of members across the 14 No. 26-2238 country and wield considerable power in the Relevant Mar- ket.” This evidence, beyond AAP’s presence in Illinois, sup- ports the conclusion that General Uthmeier intends to “crush” AAP’s operations in Illinois and to chill its speech there rather than simply to limit the dissemination of AAP policy reports in Florida. See Defense Distributed, 971 F.3d at 493. General Uthmeier has not shown a strong likelihood that these find- ings were clearly erroneous. See Illinois v. Trump, 155 F.4th at 936–37. And he does not otherwise distinguish the authority of the Fifth and D.C. Circuits in Defense Distributed and Media Ma ers, let alone show a strong likelihood of success on his challenge to personal jurisdiction at this preliminary stage. B. Venue General Uthmeier next argues that venue is improper be- cause AAP cannot show a substantial part of the events giving rise to its First Amendment claim occurred in the Northern District of Illinois. He has also failed to show a strong likeli- hood of success on this defense. For venue to be proper, a “substantial” part of the events giving rise to the claim needs to occur in the venue, but not all parts. See 28 U.S.C. § 1391(b)(2). The location of the plaintiff’s harm is not irrelevant in the venue analysis. Other circuits have considered the locus of injury a relevant factor in venue for tort actions. See, e.g., Myers v. Benne Law Offices, 238 F.3d 1068, 1076 (9th Cir. 2001). The fact that the allegedly retaliatory enforcement action is in a Florida state court is not the only event giving rise to the First Amendment claim. General Uthmeier served AAP in the Northern District of Illinois, but even more important, the intended “ensuing adverse effects” occurred there. See Media No. 26-2238 15 Ma ers, 138 F.4th at 583 (venue proper in District of Columbia to enjoin bad-faith investigation in Texas). Further, the en- forcement action is based on allegations concerning the devel- opment and strategy behind AAP’s policy statement and legal filings, including accusing AAP of publishing policy reports to mislead consumers about the efficacy of gender-affirming treatments despite supposedly knowing that its recommen- dations were not backed by medical evidence. These allega- tions address discussions, knowledge, and publications based in the Northern District of Illinois. In sum, then, General Uth- meier has failed to make a strong showing that venue in Illi- nois is improper in this case. C. Younger Abstention It is a well se led principle that federal courts have a “vir- tually unflagging obligation” to hear and decide cases within their jurisdiction. Colorado River Water Conservation Dist. v. United States, 424 U.S. 800, 817 (1976). The Younger abstention doctrine established an important exception to this principle. Younger v. Harris 401 U.S. 37, 43 (1971). Under the Younger doc- trine, federal courts refrain from issuing injunctions that would keep state courts from hearing state criminal cases, as well as civil proceedings akin to criminal cases and other civil cases that implicate a state’s interest in enforcing the orders and judgments of its courts. Sprint Commc’ns, Inc. v. Jacobs, 571 U.S. 69, 72–73 (2013). Younger abstention is grounded in concerns of federalism and comity. In our federal system of dual sovereigns, federal courts must respect the balance between state and federal ju- diciaries. We pay due respect to the legitimate interests that state governments have in enforcing their law in their own 16 No. 26-2238 institutions and in allowing their own courts to apply federal law. Younger, 401 U.S. at 43–45. Younger itself recognized, however, that its limits on fed- eral jurisdiction are not absolute. Younger abstention does not prevent a federal court from honoring its obligation to hear and decide cases when the pending state case involves “bad faith and harassment.” Id. at 49; accord, Huffman v. Pursue, Ltd., 420 U.S. 592, 611 (1975) (“Younger, and its civil counter- part which we apply today, do of course allow intervention in those cases where the District Court properly finds that the state proceeding is motivated by a desire to harass or is con- ducted in bad faith …”). The Supreme Court did not find bad faith in Younger itself, but the Court described the exception in terms of its decision in Dombrowski v. Pfister, 380 U.S. 479 (1965); see generally 17A Moore’s Federal Practice § 122.73[2] (2026) (describing bad- faith exception and Younger’s reliance on Dombrowski). The plaintiffs in Dombrowski were civil rights activists in Louisi- ana. They had been facing prosecution in state court for vio- lating the Louisiana Subversive Activities and Communist Control Law and the Communist Propaganda Control Law. They sued in federal court to challenge the constitutionality of those statutes and to enjoin state officials from continuing to prosecute or threatening to prosecute them. 380 U.S. at 481– 82. A three-judge district court had dismissed the complaint, concluding that it should abstain from intervening in the state criminal proceedings. Id. at 482–83. The Supreme Court No. 26-2238 17 reversed and held that an injunction was appropriate, with its precise terms to be determined on remand. Id. at 497–98. Dombrowski’s logic, as described in Younger, had not devi- ated from “se led doctrines that have always confined very narrowly the availability of injunctive relief against state criminal prosecutions.” Younger, 401 U.S. at 53. Unlike in ear- lier cases, the Dombrowski plaintiffs made “substantial allega- tions” and offered to prove several instances of bad faith and harassment. See id. at 47–48. They had been subject to raids and had their files and records seized pursuant to warrants later vacated for lack of probable cause. Id. at 48. Further, de- spite a state judge “quashing the warrants and suppressing the evidence seized,” the prosecutor threatened to continue prosecution and held “public hearings” where “copies of the illegally seized documents were being used.” Id.1 The bad-faith exception in Younger provides a critical safety valve for protecting federal rights while also respecting states and their courts. We have explained that “[t]he harm posed by bad faith prosecution is both immediate and great.” Collins v. Kendall County, 807 F.2d 95, 98 (7th Cir. 1986). When state officials bring suits in bad faith or to harass, comity con- cerns are at their weakest. A state “does not have any legiti- mate interest in pursuing a bad faith prosecution brought to retaliate for or to deter the exercise of constitutionally pro- tected rights. Perhaps the most important comity rationale 1 Younger was careful to note that Dombrowski did not imply that “the federal courts may give equitable relief, without regard to any showing of bad faith or harassment, whenever a state statute is found … in violation of the First Amendment.” Younger, 401 U.S. at 50. A “chilling effect” on First Amendment–protected speech is not enough on its own to justify en- joining a state proceeding. See id. at 51–52. 18 No. 26-2238 of Younger deference—that of respect for the State’s legitimate pursuit of its substantive interests…—is therefore inapplica- ble.” Id. at 98 n.5, quoting Wilson v. Thompson, 593 F.2d 1375, 1382–83 (5th Cir. 1979) (reversing denial of injunction; plain- tiffs showed bad faith, so Younger abstention did not apply); accord, e.g., Netflix, Inc., 88 F.4th at 1091 (“While states cer- tainly have a legitimate interest in the enforcement of their criminal laws, they have no such interest when the enforce- ment of those laws is carried out in bad faith. … Comity … gives way once good faith does.”). Federal courts do not apply the bad-faith exception to Younger lightly, or often. A plaintiff must allege and ulti- mately prove specific facts to support an inference of bad faith. See Collins, 807 F.2d at 98. But the exception is a critical feature of the federalism balance struck in Younger doctrine. The Supreme Court has framed the exception in both sub- jective and objective terms. In Perez v. Ledesma, the Court noted that the bad-faith exception is implicated when harass- ment or prosecution is undertaken “without hope of obtain- ing a valid conviction.” 401 U.S. 82, 85 (1971). Several years later, in Kugler v. Helfant, the Court defined the exception in more objective terms, explaining that bad faith requires that state officials undertook a prosecution “without a reasonable expectation of obtaining a valid conviction.” 421 U.S. 117, 126 n.6 (1975), citing Perez, 401 U.S. at 85. This court has described bad faith as the use of prosecutions “as instrumentalities for the suppression of speech” or prosecutions brought “with no expectation of convictions.” Collins, 807 F.2d at 101, quoting No. 26-2238 19 first Sheridan v. Garrison, 415 F.2d 699, 706 (5th Cir. 1969), then Cameron v. Johnson, 390 U.S. 611, 621 (1968). The district court in this case discussed factors relevant to both subjective and objective bad faith on the part of General Uthmeier. Based on extensive factual findings, the court con- cluded that together the facts at this preliminary injunction stage of the case support an inference of bad faith. See Collins, 807 F.2d at 98. General Uthmeier argues in his motion to stay, as he did in the district court, that the bad-faith exception applies only in circumstances of repeated prosecutions. He has not identi- fied any substantial authority imposing such a multiple-pros- ecution requirement. Younger itself did not impose such a re- quirement. The Court wrote that the exception did not apply in Younger because the plaintiff did not suggest the prosecu- tion was “brought in bad faith or [was] only one of a series of repeated prosecutions.” 401 U.S. at 49 (emphasis added); see also Fi gerald v. Peek, 636 F.2d 943, 944 (5th Cir. 1981) (“[T]he threat of multiple or repeated prosecutions is not necessary to establish bad faith prosecution.”); Wilson, 593 F.2d at 1381 (“Nearly every Supreme Court case addressing the bad faith exception has described it in terms which indicate that it is not limited to situations of repeated or multiple prosecutions.”). General Uthmeier also argues that the district court was wrong to consider the merits of the Florida enforcement ac- tion’s claims in its bad-faith analysis. He asserts that, regard- less, he has a reasonable expectation of obtaining a judgment on his claims under the FDUTPA, Florida RICO Act, and Flor- ida antitrust laws. We disagree. 20 No. 26-2238 The objective framing of the bad-faith inquiry in Kugler at least invites and probably requires some consideration of the likelihood of success on the underlying state claims. See 421 U.S. at 126 n.6. Even a purely subjective test would invite con- sideration of the merits as circumstantial evidence of the state actor’s good or bad faith. Consideration of the merits features prominently in many cases addressing the exception. E.g., Netflix, Inc., 88 F.4th at 1094–95 (affirming preliminary injunc- tion against state prosecution, and concluding that bad-faith exception applied in part because “presumably,” as to the merits, “there are none”); Nobby Lobby, Inc. v. City of Dallas, 970 F.2d 82, 83–84, 88 (5th Cir. 1992) (affirming preliminary injunction; bad-faith exception applied, in part because city seized video and computer equipment even though all offi- cials “were fully aware” of recent court decision narrowing relevant statute’s construction); see also Collins, 807 F.2d at 101 (holding that district court did not err in applying Younger abstention when defendants had “successfully prosecuted the plaintiffs on three obscenity charges”). But see Fi gerald, 636 F.2d at 945 (a prosecution “brought for the purposes of har- assment and retaliation … will justify an injunction regardless of whether valid convictions conceivably could be obtained”). At this preliminary stage, the merits of the Florida claims against AAP appear weak. The district court found that Gen- eral Uthmeier’s theory—that AAP’s policy statements were commercial in nature, a prerequisite for all three state claims—lacked any merit because AAP is a nonprofit that does not sell or provide any gender-affirming care, and be- cause its policy statement resembled “scientific and medical advocacy, not a money-making scheme.” No. 26-2238 21 General Uthmeier now counters that the state claims are meritorious because, despite its nonprofit status, AAP is a “standards-se ing” association that derives benefits from its standards, including influence and memberships. In doing so, he relies on Wilk v. American Medical Ass’n, 895 F.2d 352, 357– 58 (7th Cir. 1990), where this court explained that the AMA’s “standards-se ing” speech implicated antitrust laws based on its labeling of chiropractors as an “unscientific cult” and instruction to its members that it was unethical for medical practitioners to associate with chiropractors. Id. at 356. This speech prevented physicians from referring patients to chiro- practors and therefore imposed higher costs on chiropractors by forcing them to pay for their own x-ray equipment and preventing medical physicians from teaching chiropractors. Id. at 360. AAP’s policy statement in Pediatrics, surveying the field of gender-affirming care, and its comments and amicus briefs opposing regulation of gender-affirming care, do not appear to have a similar boyco ing effect that implicates an- titrust principles. At the very least, General Uthmeier has not made a strong showing that the district court erred in its as- sessment, which is what would be required to obtain a stay pending appeal. General Uthmeier asserts that AAP’s statements are “false.” He argues they were published in the conduct of “trade or commerce” because AAP intends to induce pur- chase of puberty blockers, surgeries, and “social transition- ing” services from its members. This argument does not re- fute the district court’s findings that the AAP does not sell gender-affirming care and that its policy statements appear to discuss scientific research and advocacy debate, “not a money-making scheme.” Accord, Endocrine Soc’y v. Federal Trade Comm’n, No. 26-512, 2026 WL 1257289 (D.D.C. May 7, 22 No. 26-2238 2026) (granting preliminary injunction against FTC’s civil in- vestigative demands on First Amendment grounds; “clinical guidance, education, and policy advocacy clearly fall on the ‘ideas’ rather than ‘products’ side of the line”); accord, Chiles v. Salazar, 607 U.S. —, 146 S. Ct. 1010, 1029 (2026) (state may not censor speech on gender-affirming care based on view- point). Moreover, the alleged intended commercial induce- ment of gender-affirming care would not even materialize in the state of Florida. Since May 2023, it has been a crime to pro- vide gender-affirming care to minors in Florida. The district court found that other facts also contributed to the finding of bad faith at this preliminary stage. The court observed that General Uthmeier’s complaint in state court made misleading allegations, including that AAP knew scien- tific evidence did not support lowering age minimums for gender-affirming surgery yet deliberately provided no age minimum in its policy statement. On the contrary, the district court found, the evidence instead showed that AAP had not omi ed a specific age minimum to encourage surgery for mi- nors. AAP had instead tried to avoid broadly approving of sur- geries for minors. AAP had noted that surgery is generally ac- ceptable only for adults and should be available to minors only on a case-by-case basis. The district court found that General Uthmeier’s three- month delay in pursuing the state enforcement action, despite his public statements about the lawsuit in the interim, also contributed to a finding of bad faith. So, too, did General Uth- meier’s public comments opposing gender-affirming care and vowing to hold AAP accountable for “mutilating children.” The district court acted within its discretion in drawing “un- favor