A federal appeals court has upheld Indiana’s ban on gender-affirming care for trans minors.

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Republican Gov. Eric Holcomb signed Senate Bill 480 into law in May 2023, banning surgeries, hormone treatment, and puberty blockers for the purpose of gender transition for anyone under 18. Within hours of his signing, a group of Indiana residents, represented by the American Civil Liberties Union and its Indiana affiliate, sued to challenge the law in a case known as K.C. v. Individual Members of the Medical Licensing Board of Indiana.

In June 2023, a lower federal court issued a preliminary injunction blocking enforcement of most of the law’s provisions while the suit proceeds, with U.S. District Judge James Patrick Hanlon saying the plaintiffs are likely to prove their claims that it violates the U.S. Constitution and would cause irreparable harm to those it affects. He allowed the surgery ban to stand, but genital surgeries are almost never performed on minors.

But in February of this year, the U.S. Court of Appeals for the Seventh Circuit placed a stay on Hanlon’s injunction, therefore letting the law go into effect. Now a three-judge panel of the Seventh Circuit has lifted the injunction completely, so the ban will remain in force.

In a 2-1 ruling Wednesday, the appeals court said banning such care is within the scope of Indiana legislators’ duties and that it doesn’t interfere with the constitutional rights of transgender young people, their parents, or their health care providers, the Associated Press reports.

ACLU attorneys argued that the law discriminates on the basis of sex, as treatments not allowed for gender transition are allowed for cisgender youth for other purposes. They also argued that it violates the right of parents to direct their children’s medical care.

But Judge Michael Brennan, writing the majority opinion, rejected both arguments. He said the law doesn’t constitute sex discrimination because it, “bars gender transition procedures regardless of whether the patient is a boy or a girl.”

He further said parental rights are not absolute. That could allow “a path to demand for their children access to a narcotic for a well-meaning medical purpose,” he wrote. Brennan, who was appointed to the court by Donald Trump, was joined in the ruling by Senior Circuit Judge Kenneth Ripple, an appointee of President Ronald Reagan.

Judge Candace Jackson-Akiwumi dissented, and she cited “the same compelling reasons explained by dissenting judges around the country.” These included the dissent of Sixth Circuit Judge Helene White in a case on similar Kentucky and Tennessee laws, saying they “intrude on the well-established province of parents to make medical decisions for their minor children.” Jackson-Akiwumi was appointed by President Joe Biden.

The U.S. Supreme Court is scheduled to hear U.S. v. Skrmetti, U.S. v. Skrmetti, a case challenging the Tennessee ban, December 4.

Regarding the Indiana case, ACLU of Indiana spokesperson Laura Forbes told the AP, “We are weighing our options.” The Advocate has sought comment from the national ACLU but has yet to receive a response.

Indiana Attorney General Todd Rokita wrote on X, formerly Twitter, that the Seventh Circuit’s decision “is a huge win for Hoosiers and will help protect our most precious gift from God — our children.” He also called the banned procedures “dangerous and irreversible,” which they are not. Every major medical group in the U.S. endorses the use of puberty blockers and cross-sex hormones for trans minors.