(CN) — A federal judge struck down Florida's ban on gender-affirming care for minors on Tuesday, finding the law unconstitutional.
In a 105-page order, U.S. District Judge Robert Hinkle said the ban is not only discriminatory by enforcing differential treatment based on sex and transgender status, but was also motivated by anti-transgender animus instead of a legitimate state interest.
The decision comes after the parents of three transgender children sued the state, arguing they were being stripped of the right to make medical decisions for their children.
Hinkle noted that such animus against transgenders, "includes not only bias of the kind sometimes directed at racial or ethnic minorities or women but also a belief that transgenders should not exist at all — or should not be allowed to pursue their transgender identities."
He added that the state has explicitly admitted that prohibiting or impeding individuals from pursuing their transgender identities is not a legitimate state interest.
"There have also been statements that, while not direct evidence of discriminatory motive, are demonstrably false," Hinkle wrote.
The judge pointed to statements made by Republican Governor Ron DeSantis calling the banned treatments mutilation and saying that gender-affirming care "means castrating a young boy, you’re sterilizing a young girl, and you’re doing mastectomies for these very young girls.”
Affirmative care for transgender minors, other than counseling, consists primarily of puberty blockers or cross-sex hormones, for the purpose of attempting to stop or delay normal puberty to affirm a person’s perception of his or her sex if that perception is inconsistent with the person’s natal sex.
"Those are the treatments now at issue. Mastectomies have been performed on minors in other parts of the country and perhaps in Florida — the record does not confirm or refute this — but are extraordinarily rare and are not involved in this litigation," Hinkle said.
"At least insofar as has been shown by this record, no transgender minor has ever been castrated or intentionally sterilized in Florida or elsewhere. But without any factual basis whatsoever, individuals who had a role in adoption of this legislation repeatedly asserted the contrary. Nobody who voted for the bill expressed disagreement or called the speakers out," he added.
The state cannot flatly deny transgender individuals safe and effective medical treatment with medications such as hormones that are routinely provided to others with the state’s full approval, the judge ruled.
He noted that the treatments have been available in the U.S. for more than a decade and are endorsed by major medical associations, including the American Academy of Pediatrics, as appropriate care for people diagnosed with gender dysphoria, a mental health condition recognized in the Diagnostic and Statistical Manual of Mental Disorders.
The diagnosis applies when specific criteria are met including a marked incongruence between one’s experienced gender identity and natal sex for at least six months, manifested in specified ways, and clinically significant distress or impairment.
With parental consent, persistent dysphoria can be treated with hormones, but typically not until age 16. Guidelines say surgery should be reserved for those ages 18 and older.
Statements from hundreds of medical professionals supporting such care were also filed into the case. "At least as shown by this record, not a single reputable medical association has taken a contrary position," Hinkle said.
He added that there was no evidence presented suggesting that these treatments have caused any substantial adverse clinical results in properly screened and treated patients in compliance with the standards of care set out by the Endocrine Society and the World Professional Association for Transgender Health.
The parents in the case, along with their expert testimony, argued transgender individuals suffer higher rates of anxiety, depression, suicidal ideation, and suicide than the population at large.
"The elephant in the room should be noted at the outset. Gender identity is real. The record makes this clear. The defendants, speaking through their attorneys, have admitted it. At least one defense expert also has admitted it," Hinkle said.
Signed into law last year by DeSantis, Florida's ban prohibits the prescription of puberty-blocking, hormone and hormone antagonist therapies to treat gender dysphoria in minors. It also bans gender-affirming medical procedures or surgeries for minors.
The law further bans the use of state money for gender-affirming care and places new restrictions on adults seeking treatment. Among those restrictions are a requirement that people meet face to face with a doctor — not a nurse or nurse practitioner — and not through telemedicine. Private organizations that provide such care risk any state funding they receive.
Transgender medical treatment for children and teenagers has increasingly been subject to restrictions or outright bans from Republicans across the country.
As of May 2024, at least 24 states have enacted laws restricting or banning gender-affirming medical care for transgender minors, and most of those states face lawsuits.
Last year a federal judge struck down Arkansas’ ban as unconstitutional and judges’ orders are in place temporarily blocking enforcement of bans in Idaho and Montana. A federal judge who had temporarily blocked Georgia’s ban said the state could resume enforcing the restriction after an appeals court panel in September allowed Alabama’s prohibition to be enforced.
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