Court fights are ramping up over states’ transgender health care restrictions

Courts nationwide are delivering a mixed verdict on the future of state laws restricting gender-affirming medical care for transgender youth, as legal battles ramp up over the historic wave of bans enacted this year.

Alabama was allowed to enforce its ban on providing care to young people, a day after Georgia‘s ban was partially blocked. New rulings may be imminent on bans in at least three more states in the coming week.

Here’s a look at recent developments in the cases and where laws on transgender health care stand:

The latest rulings

The 11th U.S. Circuit Court of Appeals ruled on Monday that Alabama can enforce its ban on gender-affirming care for transgender youth, vacating a lower court ruling against the 2022 law. The earlier ruling is still keeping Alabama’s ban on hold until the appeals decision formally takes effect, which could take several days.

This was the second federal appeals panel to allow a state ban to move forward, after a three-judge panel said last month that Tennessee and Kentucky can enforce their bans — for now.

In Georgia, a federal judge on Sunday blocked a ban on doctors starting hormone therapy for transgender people under the age of 18. Since Georgia is part of the circuit that allowed Alabama’s ban to be enforced, the state has asked the judge to reinstate the prohibition.

Where bans stand nationally

At least 22 states have enacted laws banning or restricting gender-affirming care for minors, and most of the bans are being challenged in court.

The most recent state to enact a ban was North Carolina, where Republican lawmakers overrode Democratic Gov. Roy Cooper’s veto of a measure banning medical professionals from providing hormone therapy, puberty-blocking drugs and surgical gender-transition procedures to anyone under 18, with limited exceptions.

North Carolina’s law took effect immediately. But minors who had begun treatment before Aug. 1 may continue receiving that care if their doctors deem it medically necessary and their parents consent. Opponents of the law have vowed to file a lawsuit challenging it.

A federal judge in June struck down Arkansas ' first-in-the-nation ban, and the state has appealed that decision. The judge in that case ruled the prohibition violated the constitutional rights of transgender youth and families, as well as medical providers. He also rejected proponents’ claims that the treatments were experimental.

A federal judge has blocked Indiana’s ban, and Oklahoma has agreed to not enforce its ban while opponents seek a temporary court order blocking it. A Nebraska judge rejected an effort to block that state’s ban before it takes effect Oct. 1. The same federal appeals court panel that allowed Tennessee’s ban to take effect also ruled that Kentucky’s ban could be enforced.

People opposed to such treatments for children argue they are too young to make such decisions about their futures.

Every major medical organization, including the American Medical Association, has opposed the bans on gender-affirming care for minors and supported the medical care for youth when administered appropriately.

The American Academy of Pediatrics earlier this month reaffirmed its support for the treatments, and voted to conduct an external review of research regarding the care.

What cases are next?

A ruling is expected as soon as Friday from a state judge on whether to temporarily block Missouri’s ban on gender-affirming care for minors before it takes effect Monday.

The law would stop Missouri health care providers from providing puberty blockers, hormones and gender-affirming surgeries to minors. Minors prescribed puberty blockers or hormones before Aug. 28 would be able to continue to receive those treatments. The law would also make it easier for patients to sue providers of such care.

A Texas judge is considering whether to block that state’s ban on gender-affirming care for minors before it takes effect on Sept. 1. If Texas is allowed to enforce the ban, it would become the most populous state to restrict the care for minors.

The cases go beyond restrictions on transgender youth. A federal judge in Florida is expected to hold a hearing Tuesday on whether to block a law that has made it difficult, and impossible in some cases, for many transgender adults in that state to get gender-affirming care.

The same judge has already narrowly blocked the portion of the law banning care for transgender youth, prohibiting the state from banning the care for the three children who are challenging it. Opponents are also seeking to expand that ruling to other youth who may be affected by the ban.

In Montana, a state judge is expected to hear arguments in a Sept. 18 hearing on whether to block that state’s ban before it takes effect Oct. 1.

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