Federal appeals court allows Tennessee ban on gender-affirming care for transgender minors to take effect

By Rebekah Riess, Jessica Jordan and Zoe Sottile, CNN

(CNN) — Tennessee’s ban on gender-affirming care for minors will now take effect after a federal appeals court lifted an injunction against the law.

The appeals court granted a stay of a lower court injunction, which had been blocking enforcement of a part of the state’s ban. The ban prohibits health care providers from performing gender-affirming surgeries and administering hormones or puberty blockers to transgender minors, pending the duration of the appeal.

After determining the law, Senate Bill 1, likely violated the Equal Protection and Due Process Clauses, a district court had previously issued an injunction blocking the state’s enforcement of the ban on gender-affirming treatments as hormone therapies and puberty blockers. The district court ruling, however, allowed Tennessee’s ban on gender transition surgical procedures for minors to take effect. The state of Tennessee then appealed and moved for an emergency stay of the district court’s order.

“Because Tennessee is likely to succeed on its appeal of the preliminary injunction, we grant the stay,” a panel of the Sixth Circuit Court of Appeals ruled on Saturday.

The law, which was passed in March, was originally set to take effect on July 1 and will now take effect in full immediately.

“The case is far from over, but this is a big win. The court of appeals lifted the injunction, meaning the law can be fully enforced, and recognized that Tennessee is likely to win the constitutional argument and the case,” Tennessee Attorney General Jonathan Skrmetti said in a statement Saturday.

However, in their opinion, the court acknowledged their views were “initial” and “may be wrong,” expediting the appeal of the preliminary injunction, with the goal of resolving it no later than September 30, 2023, “in an effort to mitigate any potential harm from that possibility.”

The American Civil Liberties Union called the lifting of the injunction “a heartbreaking development” in a statement.

“This ruling is beyond disappointing and a heartbreaking development for thousands of transgender youth, their doctors, and their families,” the ACLU said. “As we and our clients consider our next steps, we want all the transgender youth of Tennessee to know this fight is far from over and we will continue to challenge this law until it is permanently defeated and Tennessee is made a safer place to raise every family.”

The text of the law stipulates Tennessee medical providers cannot perform procedures which “enable a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or “treat purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”

The ruling comes after a string of Republican states have enacted legislation to severely limit or ban gender-affirming care for minors, which may include therapy, hormone treatment and surgery in rare cases. A total of 19 states have passed such laws, most of them this year, as CNN previously reported. In five states, providing gender-affirming care to minors is now a felony.

Major medical associations including the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, agree gender-affirming care is clinically appropriate for transgender children and adults.

The World Professional Association for Transgender Health provides guidelines for treating transgender children and adolescents. The association says gender-affirming care creates “effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being and self-fulfillment.”

CLARIFICATION: This story has been updated to note that a part of the Tennessee ban on gender-affirming care for transgender minors took effect on July 1.

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