Appeals Court Upholds Oklahoma Ban on Gender-Affirming Care for Youth, Citing Skrmetti Decision

The U.S. Court of Appeals for the Tenth Circuit has rejected a challenge to Oklahoma’s Senate Bill 613 (SB 613), which bans all forms of gender-affirming medical care for transgender youth. The August 7, 2025, ruling upholds the state’s restrictions and marks one of the first major appellate decisions since the Supreme Court’s precedent-setting U.S. v. Skrmetti case, which affirmed states’ rights to enact such bans on transgender health care for minors .

The challenged law, SB 613, prohibits health care providers from offering puberty blockers, hormone therapy, and gender-affirming surgeries to individuals under the age of 18. Providers who violate the law face felony charges and possible loss of their medical licenses . The law specifically targets care for transgender youth, while allowing similar treatments for non-transgender minors with other medical needs, a distinction that has been at the heart of legal challenges on equal protection grounds .

Plaintiffs in the case included transgender adolescents, their families, and a medical provider, with representation from the American Civil Liberties Union (ACLU), ACLU of Oklahoma, and Lambda Legal. They argued that SB 613 violates both the Equal Protection Clause of the Fourteenth Amendment and Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of sex in federally funded health programs .

The Tenth Circuit’s decision closely followed the Supreme Court’s June 2025 ruling in U.S. v. Skrmetti, involving a Tennessee law with similar provisions. The Supreme Court found that states have the constitutional authority to prohibit gender-affirming care for minors, effectively closing the door to many ongoing legal challenges at the lower court level .

Judge Joel M. Carson III, writing for the Tenth Circuit’s three-judge panel, stated: “Relying on Skrmetti, we affirm the district court’s preliminary injunction denial,” referencing the trial court's earlier refusal to block enforcement of SB 613 while the case proceeded .

Reaction to the ruling was swift and forceful from LGBTQ+ organizations and civil rights advocates. In a joint statement, the ACLU, ACLU of Oklahoma, and Lambda Legal called the decision “a devastating outcome for transgender youth and their families across Oklahoma and another tragic result of the Supreme Court’s errant and harmful ruling in Skrmetti. 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 organizations emphasized that SB 613 effectively denies transgender minors access to “medically necessary care,” while allowing non-transgender peers to receive similar treatments for other conditions. They reiterated their commitment to continue advocacy and legal efforts, stating, “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” .

Oklahoma’s SB 613 is part of a wave of state legislation across the U.S. restricting access to gender-affirming care for minors. Supporters of such laws argue they protect youth from irreversible medical decisions, while leading medical associations—including the American Academy of Pediatrics and American Medical Association—maintain that gender-affirming care, when provided according to established guidelines, is evidence-based and essential for the well-being of transgender youth .

The federal government, through the U.S. Department of Justice, has previously filed statements supporting challenges to Oklahoma’s law, arguing that it violates constitutional and statutory protections by singling out transgender youth for unequal treatment .

The Tenth Circuit’s decision, aligned with the Supreme Court’s direction, means that these state bans are likely to remain in effect for the foreseeable future, barring Congressional action or a change in the Supreme Court’s approach.

Legal advocates for transgender rights are now considering their next steps, which could include seeking reconsideration by the full Tenth Circuit, pursuing state-level remedies, or focusing on legislative advocacy.

Transgender youth, their families, and supportive providers in Oklahoma and other affected states face continued uncertainty and significant barriers to medically recommended care. As the legal and political landscape shifts, LGBTQ+ organizations stress the importance of community support, accurate information, and ongoing advocacy to protect the health and rights of transgender youth nationwide .