Federal appeals court allows Florida's trans treatment restrictions
TALLAHASSEE - A federal appeals court has at least temporarily allowed Florida to move forward with restrictions on treatments such as puberty blockers and hormone therapy for transgender people.
A panel of the 11th U.S. Circuit Court of Appeals on Monday issued a stay of a ruling by U.S. District Judge Robert Hinkle that blocked the restrictions. The stay effectively means the restrictions can take effect while the appeals court considers an underlying appeal of Hinkle's decision.
Hinkle in June issued an injunction against the restrictions, finding, in part, that they were motivated by "animus" toward transgender people and violated equal-protection rights.
But in a 2-1 decision, the appeals court panel said Hinkle likely misapplied a legal presumption that the Legislature "acted in good faith" when it passed the restrictions in 2023.
The law prevented minors from beginning to receive puberty blockers and hormone therapy for treatment of gender dysphoria. Also, it allowed only physicians - not nurse practitioners - to approve hormone therapy for adults and barred the use of telehealth for new prescriptions. Opponents argued that the restrictions severely reduced access to hormone therapy for adults.
Gov. Ron DeSantis' administration has long disputed arguments about the effectiveness of gender dysphoria treatments, particularly for minors. The appeals court majority said Florida would suffer harm if it could not enforce the restrictions.
"As to harm to others, even with the law in effect, physicians may continue to prescribe and administer puberty blockers and hormones to adults," said the majority opinion shared by Judges Britt Grant and Robert Luck. "And minors who were already receiving them may continue to do so."
But Judge Charles Wilson dissented, saying he would "not find that the district court misapplied the law nor abused its discretion."
"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," Wilson wrote. "In contrast, denying the stay would support a ruling grounded in the public interest. 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 Republican-controlled Legislature passed the restrictions as Florida and other GOP-led states in recent years have approved numerous laws and regulations focused on transgender people. One of the highest-profile issues has been restricting the use of puberty blockers and hormone therapy for minors with gender dysphoria.
Gender dysphoria
The federal government defines gender dysphoria clinically as "significant distress that a person may feel when sex or gender assigned at birth is not the same as their identity."
Attorneys for a transgender man and parents of trans children filed the class-action lawsuit challenging the Florida restrictions. In a 101-page ruling, Hinkle wrote that "gender identity is real" and likened opposition to transgender people to racism and misogyny.
"The state of Florida can regulate as needed but cannot flatly deny transgender individuals safe and effective medical treatment - treatment with medications routinely provided to others with the state's full approval so long as the purpose is not to support the patient's transgender identity," he wrote.
Florida appealed and sought a stay of Hinkle's injunction "as soon as practicable."
"The state suffers irreparable harm because its laws have been enjoined," the motion for a stay said. "And the state and its citizens face the prospect of risky, possible ineffective, and certainly life-altering treatments being administered."
A coalition of organizations representing the plaintiffs issued a statement Monday night saying it was "deeply disappointed" in the appeals court's decision to grant the stay.
"Allowing these discriminatory restrictions to go back into effect will deny transgender adults and adolescents life-saving care, and prevent Florida parents from making medical decisions that are right for their children. As the district court found based on voluminous evidence, the record shows that these extraordinary restrictions were based on disapproval of transgender people and serve no purpose other than to harm transgender Floridians," said the statement issued by GLBTQ Legal Advocates & Defenders, the Human Rights Campaign Foundation, the National Center for Lesbian Rights Southern Legal Counsel and the firm Lowenstein Sandler LLP.
The stay was the Atlanta-based appeals court's second ruling in less than a week that sided with Florida on transgender-related issues. A panel of the court on Thursday blocked a new federal rule about sex-based discrimination in education programs while a legal battle continues to play out.
The panel granted a request from Florida, Alabama, Georgia, South Carolina and other plaintiffs for an injunction against the rule, which deals with Title IX, a landmark 1972 law that bars discrimination in education programs based on sex. The rule has drawn opposition from Republican-led states across the country, largely because it would extend Title IX regulations to apply to discrimination based on gender identity.