Did the state of South Carolina impose a double standard on transgender individuals, denying them access to basic medical care? That is the argument put forward in a lawsuit filed Thursday by the American Civil Liberties Union and its South Carolina chapter on behalf of seven transgender individuals and their family members in opposition to a new state law, banning many forms of gender-affirming care.
The lawsuit, filed along with New York-law firm Selendy Gay , alleges that the law, H. 4624 , “gravely threatens the health and well-being of transgender adolescents and adults in South Carolina.”
Signed into law by South Carolina Gov. Henry McMaster in May, the “Help Not Harm” law prevents doctors from providing medical interventions including surgeries, puberty blockers and hormone replacement therapies for people under the age of 18 who are looking to transition to another gender.
The law also prohibits either public funds or Medicaid from covering gender-affirming care, regardless of the age of the patient.
The plaintiffs of the case, all but one who have filed anonymously, include two minors and their parents, who would lose access gender-affirming care when the law’s full ban on treatment take effect Jan. 31, 2025. The other plaintiffs are three adults whose access to gender-affirming care has already disrupted by changes, which took effect in August.
While many of these medical remain available for South Carolinians seeking treatment for conditions such as cancer or hormonal condition, or for non-medical reasons in the case of some breast augmentation surgeries, the law limits, and in some cases bans their use for individuals seeking those treatments for the purposes of gender-affirming care.
This double standard “violates the Equal Protection Clause of the Fourteenth Amendment because it draws distinctions based on sex and transgender status,” according to the lawsuit, filed in U.S. District Court for South Carolina in Charleston.
“A law that takes away healthcare from people, that strips away the ability of parents to make medical decisions for their children, that criminalizes doctors who follow the established standards of care isn’t just mean-spirited and harmful – it’s also unconstitutional,” said Jace Woodrum, executive director of the ACLU of South Carolina in a statement . “Transgender South Carolinians should be able to get the medical care they need without politicians coming into their doctors’ offices with them.”
The lawsuit names as defendants South Carolina Attorney General Alan Wilson, South Carolina Department of Health and Human Services and its Director Robert Kerr, South Carolina Public Employee Benefit Authority and its director Peggy Boykin, as well as the Medical University of South Carolina and its board of directors.
Representatives of both the Attorney General’s Office and health and human services declined to comment, stating that they did not comment on pending litigation.
The State contacted both the benefit authority and MUSC.
What’s in the lawsuit?
While supporters of the new law have characterized gender-affirming care for minors as experimental and permanently life-altering , the ACLU argues that the procedures have been found medically necessary and come with sufficient guardrails for minors.
The 61-page lawsuit is seeking to block three key provisions in the new law. This would effectively overturn prohibitions on medical professionals providing gender-affirming care to South Carolinians under age 18, as well as prohibitions on the use of public funds for gender-affirming care for South Carolinians of all ages and the coverage of gender-affirming care under South Carolina’s Medicaid program.
Before the passage of H. 4624, the ACLU argued that health care providers in South Carolina followed evidence-based guidelines from organizations like World Professional Association for Transgender Health and the Endocrine Society, which are recognized by the all major American medical associations, including the American Medical Association and the American Academy of Pediatrics.
Many of these treatments, including hormone replacement therapies and breast augmentations and reductions, are available to people who identify with the sex they were assigned at birth.
Hormone treatments, for instance, are used in the treatment of endometriosis, polycystic ovary syndrome, as well as prostate and breast cancers. Puberty blockers are used in the treatment of central precocious puberty — a condition that causes the early onset of puberty. However, they are not available for the purposes of gender reassignment.
“This distinction reveals that the purpose of H. 4624 is not to regulate harmful medical practices or protect the public but to deny transgender people seeking treatment for gender dysphoria—and only transgender people seeking treatment for gender dysphoria — access to medical care permitted for nontransgender people,” according to the lawsuit.
Who are the plaintiffs?
Sterling Misanin, a 32-year-old transgender man living in Charleston, S.C., is one of seven plaintiffs named in the lawsuit. He is the only one not using a pseudonym. In the lawsuit, Misanin describes asking to be referred to as “he” and “him” as early as the age of five. While he started dressing in a masculine fashion during college, he did not come out until 2020, during the COVID-19 pandemic, according to the lawsuit.
Earlier this year, after receiving pre-authorization through his private insurer, he planned to have gender-affirming surgery at a MUSC health facility. But following the passage of H. 4624, MUSC denied the treatment , citing the new law.
“The actions by MUSC have caused me significant harm, and I am devastated that my state has interfered in my access to life-saving health care. I am an adult, and I know myself better than my state does, and I cannot stay silent about the very real harms that this law inflicts on transgender people like me,” Misanin said in a statement released through the ACLU.
Like Misanin, the other plaintiffs characterized the new law as preventing them from receiving necessary medical care.
All seven plaintiffs are described as being diagnosed with gender dysphoria, defined by the Mayo Clinic as a feeling of “discomfort or distress” that can occur when an individual’s gender identity differs from their sex assigned at birth or sex-related physical characteristics.
17-year-old Grant Goe, a pseudonym, described experiencing anxiety and “mental anguish” throughout puberty because he did not feel like he fit in his body.
Another plaintiff, 15-year-old Nina Noe, also a pseudonym, described how similar feelings of distress lessened after she was able to, with her parent’s support, take estrogen through hormone replacement therapy, which will no longer be available to her after law’s statutory “taper-off” period ends Jan. 31, 2025. According to the lawsuit, Noe also no longer has access to insurance coverage through this treatment through Medicaid due to the law’s ban on Medicaid coverage for gender-affirming care.
One adult plaintiff, 32-year-old Jane Doe, had to cancel her planned surgeries after the benefit authority said that the treatment would no longer be covered by insurance under of H. 4624.
As a result of the new law, some are taking dramatic steps, according to the ACLU. Transgender individuals and the parents of transgender teens with the means to do so are “making plans to uproot their lives and their families by fleeing the State in order to protect their children’s health and safety,” according to the lawsuit.
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