## Facts

- Georgia enacted Senate Bill 140 (SB 140), effective July 1, 2023, prohibiting licensed providers from administering “hormone replacement therapies” to minors when used to treat gender dysphoria; the statute continued to allow puberty blockers and separately banned certain surgeries for minors.
- Plaintiffs were three transgender minors diagnosed with gender dysphoria, their parents, and an organization supporting parents of transgender minors.
- Plaintiffs sought medically recommended gender-affirming care, including cross-sex hormone therapy, and challenged only SB 140’s hormone-therapy ban (not the surgical prohibitions).
- Defendants were Georgia officials and regulators responsible for implementing and enforcing SB 140, including the Commissioner of the Georgia Department of Community Health and officials connected to medical licensing and discipline.
- Plaintiffs filed a 42 U.S.C. § 1983 action asserting Fourteenth Amendment Equal Protection and substantive due process violations and moved for emergency relief.
- After an evidentiary hearing with expert reports, declarations, exhibits, and live testimony, the court ruled on the motion for a preliminary injunction.

## Issues

1. Whether plaintiffs showed a substantial likelihood of success that SB 140’s hormone-therapy ban violates the Equal Protection Clause by discriminating based on sex and/or transgender status.
2. Whether plaintiffs showed a substantial likelihood of success (or otherwise raised a sufficiently weighty claim) that SB 140 violates substantive due process by interfering with parents’ medical decision-making for their children.
3. Whether plaintiffs established irreparable harm and that the balance of equities and public interest supported preliminary injunctive relief.

## Decision

- The court granted plaintiffs’ motion in part and preliminarily enjoined enforcement of SB 140 to the extent it prohibited licensed providers from initiating or continuing hormone therapy to treat gender dysphoria in minors.
- The injunction did not disturb SB 140’s surgical prohibitions.
- The court found plaintiffs were likely to succeed on their Equal Protection claim and that the remaining preliminary-injunction factors favored relief.
- The court identified serious concerns supporting the parental-rights due process claim but grounded the injunction principally in equal protection.

## Legal Principles

- A preliminary injunction requires showing (1) a substantial likelihood of success on the merits, (2) irreparable injury absent relief, (3) that the balance of harms favors the movant, and (4) that an injunction serves the public interest.
- A law that, on its face or in operation, treats individuals differently based on sex is subject to heightened scrutiny; the government must show an important interest and that the law is substantially related to achieving that interest.
- A prohibition that restricts a medication only when used to align a transgender minor’s physical characteristics with gender identity, while permitting the same medication for other medically accepted purposes, supports a finding of sex-based and transgender-status classification for equal protection purposes.
- Under heightened scrutiny, a categorical ban may fail where the state’s asserted health-and-safety rationale is undermined by selective targeting of a particular group or indication and by weak means–ends fit.
- Denial or forced interruption of medically indicated treatment associated with severe psychological distress and risk of self-harm can constitute irreparable injury not compensable by money damages.
- The public interest is served by preventing likely constitutional violations and avoiding severe health harms while litigation proceeds.

## Conclusion

The court preliminarily barred Georgia from enforcing SB 140’s prohibition on hormone therapy for minors with gender dysphoria, concluding that plaintiffs were likely to prove the ban unlawfully discriminates under the Equal Protection Clause and that immediate, irreparable harms and equitable considerations supported interim relief, while leaving the statute’s surgical restrictions in place.


Koe v. Noggle, 688 F. Supp. 3d 1321 (N.D. Ga. 2023)