(CN) — A split three-judge panel in the Seventh Circuit Wednesday greenlit Indiana’s ban on gender-affirming care for minors.
The measure prohibits youth hormone therapy, puberty blockers and gender reassignment surgery. Indiana’s Republican Governor Eric Holcomb signed it into law in April 2023, but before it could take effect that July, U.S. District Judge James Patrick Hanlon, a Donald Trump appointee, issued a preliminary injunction against most of its components.
Hanlon, ruling in a suit brought by a class of transgender youth represented by attorneys from the Indiana ACLU, suspended the moratorium on most gender-affirming medical procedures, though he allowed the ban on gender reassignment surgery to stand. He also blocked a provision of the law which would allow the state to prosecute medical practitioners who help trans youth access those procedures elsewhere.
The decision prompted an appeal to the Seventh Circuit, which heard arguments in February. Eleven days later, in a precursor to Wednesday’s ruling, the appeals court lifted Hanlon’s injunction.
In its final ruling, the Seventh Circuit panel said that the lower court erred in finding that plaintiffs affected by the ban faced irreparable harm.
“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, a Trump appointee, wrote for the majority. “It might be different if Indiana barred all treatment for gender dysphoria, but SEA 480 does no such thing.”
The panel majority also ruled against plaintiffs’ claims that their due process and equal protection rights are infringed by the ban.
“It 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 wrote. “So, sex does not indicate on what basis treatment is prohibited. The law does not create a class of one sex and a class of another and deny treatment to just one of those classes.”
U.S. Circuit Judge Kenneth Ripple, a Ronald Reagan appointee, joined Brennan in the majority decision.
The final judge on the panel, U.S. Circuit Judge Candace Jackson-Akiwumi, wrote a lengthy dissent.
Jackson-Akwiumi, a Joe Biden appointee, focused on a question she said no court has considered yet: whether a state law construed to prohibit medical providers from aiding and abetting out-of-state providers in the provision of gender transition treatment to minors violates the First Amendment.
“The initial, and largest, fault I find in the majority opinion’s analysis is its unexplained silence on a threshold statutory interpretation issue: an analysis of SEA 480 reveals the law bars Indiana providers from giving gender transition treatment to minors, and it bars Indiana providers from aiding and abetting other Indiana providers in doing the same,” Jackson-Akiwumi wrote.
The decision is a blow to civil and transgender rights advocates.
“We are disappointed and are considering our options,” Kenneth Faulk, Legal Director of the ACLU in Indiana, wrote in an emailed statement.
Indiana Attorney General Todd Rokita, a Republican, lauded the decision with a post on X.
“The Seventh District Court of Appeal’s decision today is a huge win for Hoosiers and will help protect our most precious gift from God — our children,” Roitka wrote.
Transgender rights have become a hot-button topic leading up to, and especially after, Trump was elected to a second term as president on Nov. 5. An additional 21 Republican-led states, including South Dakota, Missouri, Alabama and Florida, filed amicus briefs alongside Indiana’s appeal, echoing the state’s position.
Activists argue the the treatment is vital for the physical and mental health of youth struggling with gender dysphoria. The U.S. Department of Health and Human Services, the American Medical Association, the American Academy of Pediatrics and other health organizations have all concluded that transgender minors largely benefit from gender-affirming medical care.
But red states such as Indiana argue those conclusions are of low-quality and are biased. Indiana, for example, argued the hormone treatments increase the risk of bone damage, stroke and infertility and offered no real psychological benefits to minor patients.