A Ray of Hope in The Sunshine State

On Tuesday, for the first time, a Federal court permanently blocked a law targeting Trans healthcare from taking effect, after issuing a preliminary block last June following passage of the law — Florida SB 254. The ruling from the U.S. District Court for the Northern District of Florida (Tallahassee Division) not only blocked just about all of Florida Statute 456.52 as unconstitutional, but also similar sections of the Florida Administrative Code.

Though the ruling itself is a hopeful sign for how similar challenges may play out, the actual text of the 105-page ruling is quite phenomenal. I’ve included highlights below (read the whole ruling at tinyurl.com/FCNP0624qr).

The ruling begins as one would expect (boring), with a section defining the background: the plaintiffs (four Trans adults and seven parents of Trans minors) and defendants (Florida), followed by a section explaining the challenged provisions.

The third section, however, made things clear in its title: “III. Gender identity is real.” It began to say that more than 99 percent of people have external sex characteristics and chromosomes — what the ruling calls “natal sex” — that match their gender identity. For Trans folks, which the ruling says represents less than one percent, the two do not match.

The Elephant In The Room

“The elephant in the room should be noted at the outset. Gender identity is real. The record makes this clear. The defendants, speaking through their attorneys, have admitted it. At least one defense expert also has admitted it.

“…[that expert] explicitly stood by his prior testimony [from a similar case], and he again acknowledged that gender-affirming care is sometimes appropriate. He said ending a patient’s cross-gender identity should not be a goal of treatment — that that kind of treatment is ill-informed and unrealistic.”

Not A Single Reputable Medical Association

“The overwhelming weight of medical authority supports treatment of transgender patients with GnRH agonists and cross-sex hormones in appropriate circumstances. Organizations who have formally recognized this include the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, American Medical Association, American Psychiatric Association, and at least a dozen more. The record also includes statements from hundreds of professionals supporting this care.

“At least as shown by this record, not a single reputable medical association has taken a contrary position.”

Not Different In Kind Or Intensity

“Despite the defense admissions, there are those who believe that cisgender individuals properly adhere to their natal sex and that transgender individuals have inappropriately chosen a contrary gender identity, male or female, just as one might choose whether to read Shakespeare or Grisham. Many people with this view tend to disapprove [of] all things transgender and so oppose medical care that supports a person’s transgender existence.

“The defendants have explicitly admitted that prohibiting or impeding individuals from pursuing their transgender identities is not a legitimate state interest. But the record shows beyond any doubt that a significant number of legislators and others involved in the adoption of the statute and rules at issue pursued this admittedly illegitimate interest.

“For some, the denial that transgender identity is real — the opposition to transgender individuals and to their freedom to live their lives — is not different in kind or intensity from the animus that has attended racism and misogyny, less as time has passed but still today. And some transgender opponents invoke religion to support their position, just as some once invoked religion to support their racism or misogyny”

In The Meantime

The courts continued, “In the meantime, the federal courts have a role to play in upholding the Constitution and laws. 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.”

The Bottom Line

What remains of Florida 456.52 is still unacceptable, requiring a physician to be “physically present in the same room” before providing Trans adults with “sex-reassignment prescriptions or procedures,” which excludes telemedicine, though not for follow-up care. The court deemed this mild enough to let slide.

This may not seem like a big deal, but it is of critical importance. The courts said, without reservation, that this law was passed in pursuit of an “admittedly illegitimate interest” of the state. Why should any of it remain?

How can the courts call their opposition “not different in kind or intensity from the animus that has attended racism and misogyny,” but still offer them a consolation prize?

What message does it send that, even in loss, the hateful still managed to move the needle — if ever so slightly — against their Trans neighbors?