Appeals Court Upholds Indiana Law Banning Gender Transition Procedures for Minors

The law bans hormone treatments and puberty blockers aimed at minors in addition to continuing the prohibition on gender transition surgeries. File photo /Shutterstock

A federal appeals court on Nov. 13, in a split decision, upheld an Indiana law that bans gender surgeries and other transition procedures for minors.

A U.S. district judge incorrectly found previously that plaintiffs who sued over the law would be irreparably harmed by not being able to access puberty blockers and cross-sex hormones if the law were not blocked, the majority of a U.S. Court of Appeals for the Seventh Circuit panel said.

“While it was correct to recognize the record evidence supporting the effectiveness of medical interventions to treat gender dysphoria, the court failed to even discuss other record evidence establishing that psychotherapy and psychosocial support are also effective treatment options,” U.S. Circuit Judge Michael Brennan wrote in the majority opinion. “It might be different if Indiana barred all treatment for gender dysphoria, but [the law] does no such thing.”

U.S. District Court Judge James Patrick Hanlon ruled in 2023 that plaintiffs, youth who say they’re transgender, would be at risk of health issues such as depression and suicidality without puberty blockers and hormone therapy.

The law in question, signed in 2023, bars “any medical or surgical service ... that seeks to alter or remove physical or anatomical characteristics or features that are typical for the individual’s sex; or instill or create physiological or anatomical characteristics that are different from the individual’s sex.” Exceptions are made for the traditional use of the procedures.

The appeals court had lifted Hanlon’s injunction previously but not issued an opinion. The majority said in the new decision that blocking the law, known as SEA 480, would cause significant harm to Indiana and the public interest.

“SEA 480 is a duly enacted law. Indiana’s voters have decided, through their representatives, legislative and executive, that medical interventions are too risky and novel to be safe treatments for children with gender dysphoria. The people of Indiana have a substantial interest in the effectiveness of that decision,” Brennan said. “Because appellees have not shown a likelihood of success, and because their harms are not irreparable, we conclude that the balance of harms favors Indiana.”

The majority also rejected arguments based on the youth’s constitutional rights, including their rights to equal protection. The law “bars gender transition procedures regardless of whether the patient is a boy or a girl: Nobody may receive the treatment the state has chosen to regulate,” Brennan said. “So, sex does not indicate on what basis treatment is prohibited.”

He was joined by U.S. Circuit Judge Kenneth F. Ripple.

U.S. Circuit Judge Candace R. Jackson-Akiwumi said in a dissent that the law violates the First Amendment in part because it prevents doctors from aiding or abetting another doctor in providing gender transition procedures to minors.

“SEA 480’s aiding and abetting provision,” she wrote, “violates the First Amendment because it does not regulate speech integral to unlawful conduct; it does not regulate speech incidental to regulated conduct; and it does not regulate Provider-Plaintiffs’ pure speech in a manner that survives strict scrutiny.”