I have written a couple of prior posts about SB 480 which prohibits gender affirming care for transgender minors regardless of their wishes, their parents’ wishes, or medical advice. Proponents would like this to be seen as a bold stance against kids and maybe their parents recklessly mutilating genitals for, I don’t know, fun and profit. But that’s not what is going on. Gender reassignment surgeries on minors aren’t happening in Indiana. As a practical matter, this is primarily about gender related use of puberty blockers and hormone therapy. Despite knowing that, Gov. Holcomb signed SB 480 into law with a press release leading off with a statement about “permanent gender-changing surgeries.” I’m not a reflexive Holcomb-hater. I think he’s done a lot of the right things in situations where more radical members of his party wanted him to do the wrong things. Still, I’m very disappointed in this. (Although, as a practical matter, a gubernatorial veto is easily over-ridden by the legislature in Indiana.) This legislation won’t help anyone and it will cause harm to a lot people, including families I know.
Within hours, maybe minutes, the ACLU filed suit on behalf of children who are presently receiving or who will, in the future, need gender preserving care; the children’s parents; and medical professionals who want to provide medically appropriate care but, because of SB 480, will not be permitted to do so. I very much recommend reading the Complaint. Ken Falk and the other lawyers at ACLU-Indiana write a good complaint. (I say this despite having been on the opposite end of a couple of them over the years.)
The introduction reads as follows:
Over the sustained objection and concern of medical professionals, Indiana passed Indiana Senate Enrolled Act 480 (“S.E.A. 480”), effective July 1, 2023, which prohibits transgender minors from receiving what the law labels as “gender transition procedures.” These prohibited interventions are evidence-based and medically necessary medical care essential to the health and well being of transgender minors who are suffering from gender dysphoria, a serious condition that can lead to depression, anxiety and other serious health consequences when untreated. By denying this medically necessary treatment to minors, the State of Indiana has displaced the judgment of parents, doctors, and adolescents with that of the government. In so doing, the State has intruded on the fundamental rights of parents to care for their minor children by consenting to their receipt of doctor-recommended and necessary care and treatment. This violates due process. Additionally, by singling out for prohibition the care related to “gender transition,” the law creates a facial classification based on sex and transgender status, violating the equal protection rights of transgender adolescents. It also violates their bodily integrity and is fundamentally irrational, which violates due process. And, to the extent that it prohibits the provision of essential services that would otherwise be authorized and reimbursed by Medicaid, the law violates the federal requirements of the Medicaid Act and the Affordable Care Act. It also intrudes on the First Amendment rights of doctors and other practitioners.
This law takes away critical health care from a group of Hoosiers, leaving them and their parents in dire circumstances. It is vast government overreach into the decision-making of parents and will cause untold harms to the individuals affected and the practice of medicine in Indiana. It is also unlawful and unconstitutional and should be enjoined both as to plaintiffs and the classes they seek to represent.
I particularly appreciated the discussion of gender dysphoria and the use of puberty blockers and hormone therapy. (See generally paragraphs 61 – 90). Puberty blockers delay the onset of puberty and are recommended where the minor’s transgender status “is marked and has been sustained over time” and such treatment is necessary to minimize or prevent the gender dysphoria associated with endogenous puberty. Puberty blockers are reversible. Hormone therapy is a more permanent step and is indicated where gender dysphoria persists and the patient is properly advised of the consequences.
One thing to keep in mind as children, their parents, and medical professionals navigate these situations is that it isn’t a choice between “risk” and “no risk.” Not pursuing gender affirming care where it’s needed has consequences as well including potentially severe gender dysphoria and increased incidents of suicide, self-harm, and other psychological damage. Navigating these questions can be difficult under the best of circumstances and the General Assembly taking options off the table isn’t helping anyone.