Federal judge partially blocks Indiana's ban on gender-affirming care for minors

A federal judge Friday blocked parts of Indiana’s gender-affirming care ban for transgender youth from taking effect July 1. The ACLU of Indiana is challenging the ban in court on behalf of four transgender minors receiving gender-affirming care and their parents.

SEA 480 bans medicinal and surgical gender-affirming care for transgender youth in Indiana and also bans providers from “aiding and abetting” parents seeking that treatment outside of the state. Gender-affirming care is health care that encompasses mental, social, medicinal and surgical care designed to treat gender dysphoria. And gender dysphoria is a clinically significant distress experienced by people whose gender assigned at birth and gender identity don’t match — though not all transgender people experience gender dysphoria.

Federal Judge James Patrick Hanlon halted the law’s ban on medicinal care and limitations on provider referrals. He wrote in his opinion, preliminary evidence showed the law would “violate [the] constitutional rights” of the plaintiffs and risk “irreparable harm.”

However, he stopped short of halting the state’s ban on gender-affirming surgeries for minors from taking effect. Transgender youth in Indiana already do not have access to gender-affirming surgeries because it goes against national guidance for those under 18.

During testimony on the measure and in court documents, gender-affirming care providers said minors are not offered gender-affirming surgeries, as it would go against national and international guidance.

“Here, the stipulated facts show that no minor could receive gender transition surgery from a physician or other practitioner in Indiana, regardless of SEA 480,” Hanlon wrote. “Plaintiffs therefore cannot show that SEA 480's prohibition on gender-transition surgery would cause any minor in Indiana an injury that is likely to be redressed by a favorable judicial decision.”

Hanlon did, however, block the rest of the law from taking effect — including the limitations on providers and the medicinal care.

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If SEA 480 were to have taken effect on July 1, transgender youth on puberty blockers would have immediately lost access to them and those on hormone replacement therapies — known as HRT — would have lost access by the end of the year.

“Medical harms, including to mental health, can constitute irreparable harm, and Defendants do not contest that gender dysphoria is a psychiatric diagnosis that requires 'clinically significant distress' to diagnose,” Hanlon wrote. “And — again — there's evidence that puberty blockers and cross-sex hormone therapy reduces distress for some minors diagnosed with gender dysphoria.”

In court documents and during a hearing on Wednesday, the state argued SEA 480 did not discriminate based on sex, but instead was focused on medical procedures and conditions. Hanlon disagreed with that claim.

“At bottom, sex-based classifications are not just present in SEA 480's prohibitions; they're determinative,” Hanlon wrote.

For example, under SEA 480, puberty blockers would be banned as gender-affirming care, but would still be available to children experiencing precocious puberty. A cisgender teenage girl in Indiana may receive a gender-affirming surgery like a breast augmentation, but the same procedure — which would go against national guidance on age-appropriate care — is banned for a transgender teenage girl.

That holds the law to greater scrutiny, which is also what the Eighth Circuit Court of Appeals held a similar gender-affirming care ban to. The greater scrutiny requires “exceedingly persuasive justification” and a “close means-end fit.”

“In other words, the state's specific ‘means’ (SEA 480's broad ban) must fit its ‘ends’ (protecting minors and regulating the medical profession),” Hanlon wrote.

Hanlon said “most detrimental” to the state’s argument that SEA 480 did not require greater scrutiny were the actions highlighted in European countries — several of which have imposed limitations on access to gender-affirming care for adolescents, but none have imposed outright bans.

“In short, these European countries all chose less-restrictive means of regulation. In defendants' view, however, the data from the systematic reviews gives the state unfettered discretion to choose how to regulate gender transition procedures for minors — up to and including a broad prohibition,” Hanlon wrote.

The vast majority of medical organizations support gender-affirming care, and there is national and international guidance on age-appropriate interventions for transgender youth.

Hanlon was appointed to the federal district court in 2018 by former President Donald Trump.

Lauren is our digital editor. Contact her at lchapman@wfyi.org or follow her on Twitter at @laurenechapman_.