Florida Can Enforce Ban on Puberty Blockers, Gender Surgeries for Children: Appeals Court

Stock photo of children in a classroom. Taylor Wilcox/Unsplash

A federal appeals court has allowed Florida to enforce a ban on hormone replacement therapy for children while the legal challenge against the ban proceeds.

In the Aug. 26 decision, a three-judge panel of the 11th U.S. Circuit Court of Appeals sided with Florida, reversing a district judge’s order that put the ban on hold while the matter is appealed. The court also approved expedited proceedings in the appeal.

“The district court itself recognized that there were ‘legitimate concerns’ about some of the treatments’ effects, as well as a ’risk of misdiagnosis,‘ ’risks attendant to treatment,‘ and the potential for ’additional medical risks,'” the panel’s 2–1 majority, Judges Britt Grant and Robert Luck, wrote in the unsigned opinion.

The defendants, including Florida Surgeon General Joseph Ladapo and the Florida Board of Medicine, have made “a strong showing that they are likely to succeed on the merits,” the judges concluded.

At the center of the legal battle is a 2023 law that prohibits doctors and nurses from performing sex-reassignment surgeries or prescribing medication such as cross-sex hormones and puberty blockers to anyone under the age of 18, regardless of parental consent. Children who were already taking those medications when the law was passed may continue, but surgeries are no longer permitted.

The law also places restrictions on adults seeking gender transition treatment, requiring that adult patients receive such treatment exclusively from a physician and sign the consent form in person, effectively preventing them from seeking the treatment from nurses or telehealth services.

In June, Judge Robert Hinkle of the Northern District of Florida ruled in favor of those challenging the restrictions, including the parents of a 10-year-old boy diagnosed with gender dysphoria. The judge stated that while Florida may regulate treatments, it should not deny “safe and effective medical treatment” to people identifying as transgender.

The state appealed Hinkle’s ruling and asked the judge to allow it to enforce the law while waiting for the appellate hearing. Without a stay, the state argued, it would not be able to ensure those treatments meet appropriate medical standards.

“That is simply not true. The state has in place abundant means of ensuring that health care professionals adhere to the prevailing standards of care,” Hinkle wrote in his denial of a stay. “The state allowed and even paid for gender-affirming care for many years before enacting the statute and rules at issue in a wave of anti-transgender bias.”

Grant and Luck disagreed with Hinkle. They concluded that the harm the state would suffer from not being able to enforce the will of the Legislature and the need to “avoid irreversible health risks to its children” outweighs the potential harm to individual plaintiffs.

“As to harm to others, even with the law in effect, physicians may continue to prescribe and administer puberty blockers and hormones to adults. And minors who were already receiving them may continue to do so,” they wrote in the Aug. 26 opinion.

Judge Charles Wilson dissented, arguing that there is “sufficient record evidence” to back the claim that the 2023 law was based on “invidious discrimination against transgender minors and adults.”

“On balance, evidence in the record demonstrates that the plaintiffs and class-members would suffer if the stay were granted—withholding access to gender-affirming care would cause needless suffering,” he wrote. “This matter is a medical issue, where patients are best left to make decisions alongside health professionals, with access to complete, unbiased information, as needed.”

The National Center for Lesbian Rights, one of the pro-LGBT advocacy groups litigating the case, said it was “deeply disappointed” by the decision.

“Allowing these discriminatory restrictions to go back into effect will deny transgender adults and adolescents lifesaving care, and prevent Florida parents from making medical decisions that are right for their children,” the group said in a statement.

Florida’s Department of Health didn’t respond to a request for comment by publication time.