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Florida appeals federal judge's trans treatment ruling

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TALLAHASSEE - Florida has appealed a federal judge's ruling that blocked state restrictions on treatment for people with gender dysphoria and wants the ruling put on hold while the appeal plays out.

Lawyers for the state filed a notice Tuesday that is a first step in asking the 11th U.S. Circuit Court of Appeals to overturn the June 11 ruling by U.S. District Judge Robert Hinkle. The state also filed a motion in district court seeking a stay of Hinkle's ruling during the appeal.

Hinkle ruled that a 2023 state law and regulations barring the use of puberty blockers and hormone therapy to treat children for gender dysphoria and making it harder for transgender adults to access care are unconstitutionally discriminatory and were motivated by "animus" toward trans people. Hinkle prohibited state health officials from enforcing the law.

The notice of appeal, as is common, does not detail arguments the state will make at the Atlanta-based appeals court. But the motion for a stay raised a series of arguments, including that putting the ruling on hold would prevent "irreparable harm" to the state and be in the "public interest."

"That's especially so because the underlying issues concern a health-related matter: the appropriate regulation of treatments for gender dysphoria, namely the availability and use of puberty blockers and cross-sex hormones," the motion said. "The state should choose the appropriate line between no restrictions on certain treatments and an outright ban on the treatments."

Hinkle last year also issued a preliminary injunction in the class action lawsuit filed by the parents of two trans children and a transgender man. The state appealed the preliminary injunction, with the appeal pending. Hinkle's June 11 ruling said the preliminary injunction would "expire" with the entry of the new judgment.

In the 101-page ruling, Hinkle wrote that "gender identity is real" and likened opposition to trans 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.

Restricting trans care 

Florida and other Republican-controlled states have approved numerous laws and regulations in recent years focused on trans people. One of the highest-profile issues has been restricting the use of puberty blockers and hormone therapy for minors with 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."

In addition to banning puberty blockers and hormone therapy for minors with gender dysphoria, the 2023 Florida law also affected transgender adults. It allowed only physicians - not nurse practitioners - to approve hormone therapy and barred the use of telehealth for new prescriptions. Opponents argued that the restrictions severely reduced access to hormone therapy for adults.

Hinkle wrote that the "overwhelming weight of medical authority supports the treatment of transgender patients with" hormone agonists and cross-sex hormones when appropriate. He also said state-mandated consent forms that include numerous warnings about treatments ignore "extensive clinical experience showing excellent results."

"The challenged statute and rules ignore the benefits that many patients realize from these treatments and the substantial risk posed by foregoing the treatments - the risk from failing to pursue what is, for many, the most effective available treatment of gender dysphoria," Hinkle wrote.

But the DeSantis administration has long disputed arguments about the effectiveness of the treatments, a position echoed in Tuesday's motion for a stay.

"The state maintains that low-quality evidence supports the efficacy of puberty blockers and cross-sex hormones to treat gender dysphoria," the motion said. "This court has said that the clinical experience shared by plaintiffs' experts shows that the treatments are efficacious when administered through experienced practitioners. But, even then, there's no guarantee that these experienced practitioners will serve as the gatekeepers for such treatment. The testimony of de-transitioners ... who testified before this court, makes that clear. The record further shows that hypnotists and interns with a few hours of training are making diagnoses."

The motion also cited a ruling by a panel of the 11th U.S. Circuit Court of Appeals that rejected a preliminary injunction issued by a district judge against an Alabama ban on puberty blockers and hormone therapy for minors with gender dysphoria. The motion also pointed to debate about such issues at appellate courts in other parts of the country.

"At the very least, all must agree that the legal issues aren't clearcut," the motion said.

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