Federal judge issues firey ruling against Florida’s trans healthcare ban

A federal judge has struck down parts of Florida’s laws and policies banning gender-affirming care, saying that the bans contradict “widely accepted standards” of medical care. While the judge’s decision only affects three of the seven families of trans youth who sued state officials over the ban, legal observers say the judge’s ruling could help restore healthcare for countless trans Floridians of all ages.

In his 44-page ruling, U.S. District Court Judge Robert Hinkle (appointed in 1996 by President Bill Clinton) affirmed the existence of transgender identities. He also said that the defendants’ families may pursue puberty blockers and hormone replacement therapy (HRT), and their doctors may provide it without fear of criminal or civil penalties.

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The law allows any medical provider or insurer to deny care based on “ethical, moral, or religious beliefs.”

Hinkle’s ruling noted that an estimated 1% of the population identifies as trans and that Florida officials only presented one defense expert (Dr. Stephen Levine) who has actually treated a significant number of transgender patients. Hinkle added that the state’s experts all seemed to hold the “unspoken suggestion… that transgender identity is not real, that it is made up.”

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The judge noted that among the state’s experts, Dr. Paul Hruz called trans identity a “charade” or “delusion,” and Dr. Patrick Lappert called gender-affirming care a “lie,” a “moral violation,” a “huge evil,” and “diabolical.” Hinkle wrote that he considered Cruz “a deeply biased advocate, not as an expert.”

Hinkle noted that other state employees and consultants have called gender-affirming healthcare a “woke idea” or a profiteering scheme by the pharmaceutical industry or doctors.

The judge wrote that “any proponent of the challenged statute and rules should put up or shut up” by stating clearly whether they acknowledge the existence of individuals whose gender identities differ from the sexes they were assigned at birth. “Dog whistles ought not be tolerated,” he added.

Florida’s false concern about “dangerous” hormone treatments

Hinkle noted that puberty blockers and HRT are standard treatments for gender dysphoria “widely followed by well-trained clinicians” and endorsed by the United States Department of Health and Human Services, as well as numerous major U.S. healthcare organizations. He also noted that “no country in Europe or… anywhere in the world entirely bans these treatments,” except for in oppressive anti-LGBTQ+ regimes.

“At least as shown by this record, not a single reputable medical association has taken a contrary position [to offering these treatments],” Judge Hinkle noted. “These medications … have been used for decades to treat other conditions [like endometriosis, prostate cancer, and early onset puberty]. Their safety records and overall effects are well known. The Food and Drug Administration (FDA) has approved their use, though not specifically to treat gender dysphoria.”

Even though the FDA hasn’t approved these drugs for treating gender dysphoria, that “says precisely nothing about whether the drugs are safe and effective when used for that purpose,” Hinkle wrote. “Off-label use of drugs is commonplace and widely accepted across the medical profession,” he added, noting that their non-FDA approved use for gender dysphoria isn’t itself reason enough to claim that such medications are dangerous or should be banned.

The judge acknowledged that the medications’ possible effects present “legitimate concerns about fertility and sexuality that a child entering puberty is not well-equipped to evaluate and for which parents may be less-than-perfect decision-makers.”

But despite any risks these treatments present, they are still “effective” and “appropriate” treatments whose benefits outweigh any risks, he wrote. Even Dr. Levine said that he would regulate the treatments, making sure patients knew of possible risks, rather than banning them outright, Hinkle noted. The consequence of denying these treatments would be deadly, he added.

“Denial of this treatment will cause needless suffering for a substantial number of patients and will increase anxiety, depression, and the risk of suicide,” Hinkle wrote. “There is no rational basis for a state to categorically ban these treatments.”

“The record includes no evidence that these treatments have caused substantial adverse clinical results in properly screened and treated patients,” he continued. “Regret is rare; indeed, the defendants have offered no evidence of any Florida resident who regrets being treated with [puberty blockers] or cross-sex hormones.”

Florida’s ban interferes with “parents’ rights”

“I find that the plaintiffs’ ability to evaluate the benefits and risks of treating their individual children this way far exceeds the ability of the State of Florida to do so,” Hinkle’s decision states. “I find that the plaintiffs’ motivation is love for their children and the desire to achieve the best possible treatment for them. This is not the State’s motivation.”

Hinkle’s decision noted that the Eighth Circuit court placed a preliminary injunction on Arkansas’ own trans healthcare ban. Like that court, Hinkle agreed that banning hormone therapy for trans people is a form of sex-based discrimination that shows bias against gender-nonconforming individuals.

He held that the reason behind Florida’s ban was to dissuade people from identifying as any gender other than the one they were assigned at birth. As proof, he noted that Florida’s Department of Health also opposed non-medical “social transitioning” which allows a child to explore their gender identity presentation at home and in public.

“Nothing could have motivated this remarkable intrusion into parental prerogatives other than opposition to transgender status itself,” Hinkle wrote.

Jane Doe, one of the parents named in the suit, hailed Hinkle’s ruling, saying, “My husband and I have been heartbroken and worried sick about not being able to care for our daughter in the way we know she needs. I’m sure most any parent can imagine the sense of powerlessness that comes from being unable to do something as basic as get medical care for your child.”

“Today my entire family is breathing a huge sigh of relief knowing we can now access the treatment that we know will keep Susan healthy and allow her to continue being the happy, confident child she has been,” Doe said of her child.

Florida’s laws and policies have resulted in transgender adults losing access to gender-affirming care as well. Trans journalist Erin Reed wrote that, after speaking to a few legal experts, medical organizations may be analyzing the case before they start offering such care to adults without fear of penalty. However, to do so safely may first require a separate court case that specifically covers adults.

The families in the case are represented by Southern Legal Counsel, GLBTQ Legal Advocates & Defenders, the National Center for Lesbian Rights, and the Human Rights Campaign.