Federal court upholds Oklahoma law banning gender-affirming care for minors

A federal appeals court upheld an Oklahoma law banning gender-affirming care for minors Wednesday in a ruling hinging on a June Supreme Court decision to uphold a similar law in Tennessee.

Oklahoma’s Senate Bill 613, passed by the state’s Republican-controlled Legislature and signed into law by Gov. Kevin Stitt (R) in 2023, makes it a felony for health care workers to provide treatments including puberty-blocking drugs and hormones to affirm a minor’s “perception of his or her gender or biological sex, if that perception is inconsistent with the minor’s biological sex.”

Five families of transgender children and an Oklahoma City physician specializing in adolescent medicine challenged the state’s ban, arguing it violated their constitutional rights.

The plaintiffs, represented by Lambda Legal, the American Civil Liberties Union (ACLU) and the ACLU of Oklahoma, claimed state lawmakers adopted S.B. 613 with discriminatory intent, citing a 2022 law that froze pandemic relief funding for OU Health, one of the state’s largest hospital systems, unless Oklahoma Children’s Hospital agreed to suspend gender-affirming care for minors.

A federal judge in Tulsa declined to stop S.B. 613 from taking effect in 2023, writing in an order that transition-related care for young people is “an area in which medical and policy debate is unfolding,” and the state “can rationally take the side of caution before permitting irreversible medical treatments of its children.”

An appeal before the 10th U.S. Circuit Court of Appeals was abated pending the Supreme Court’s ruling in U.S. v. Skrmetti. In that case, the justices ruled 6-3 along ideological lines that Tennessee’s ban on gender-affirming care does not amount to sex discrimination, which would have triggered a higher level of constitutional scrutiny.

The court’s majority opinion, authored by Chief Justice John Roberts, agrees with arguments made by Tennessee officials that the law distinguishes based on a treatment’s medical purpose, not sex, and the court should defer to the Legislature’s judgment about regulating medicine for children.

Relying on the high court’s decision, a three-judge panel for the 10th Circuit ruled unanimously on Wednesday that Oklahoma’s law is constitutional.

Tennessee’s Senate Bill 1 and Oklahoma’s Senate Bill 613 “are functionally indistinguishable,” Circuit Judge Joel M. Carson, appointed during President Trump’s first term, wrote in Wednesday’s order.

“Here, like in Skrmetti, both groups include transgender minors, so there exists a ‘lack of identity’ between transgender status and the medical diagnosis excluded under SB 613. And like Tennessee’s SB1, under SB 613, a minor’s ability to receive medical treatment under SB 613 does not turn on the minor’s transgender status—it turns on the minor’s medical diagnosis,” Carson wrote for himself and Circuit Judges Harris L. Hartz, an appointee of former President George W. Bush, and Gregory A. Phillips, appointed by former President Obama.

The order, citing Skrmetti, states Oklahoma’s law neither violates the Constitution nor was intended to discriminate against transgender youth.

“We recognize the importance of this issue to all involved. But this remains a novel issue with disagreement on how to assure children’s health and welfare. We will not usurp the legislature’s judgment when it engages in ‘earnest and profound debate about the morality, legality, and practicality’ of gender transition procedures for minors,” Carson wrote. “While we respect that Plaintiffs disagree with the legislature’s assessment of such procedures’ risks, that alone does not invalidate a democratically enacted law on rational-basis grounds.”

Oklahoma Attorney General Gentner Drummond (R) celebrated the court’s ruling Thursday in a post on the social platform X. “For years, radical left activists pushed the lie of ‘gender transition’ procedures for minors. The truth is much simpler: there is no such thing,” he wrote.

Attorneys for the plaintiffs called Wednesday’s decision “devastating” in a joint statement.

“Oklahoma’s ban is openly discriminatory and provably harmful to the transgender youth of this state, putting political dogma above parents, their children, and their family doctors,” the statement said. “While we and our clients consider our next steps, we want all transgender people and their families across Oklahoma to know we will never stop fighting for the future they deserve and their freedom to be themselves.”