The U.S. Court of Appeals for the Eighth Circuit on Tuesday upheld Arkansas’s first-in-the-nation ban on gender-affirming medical care for minors, reversing a lower-court ruling and clearing the way for the statute to take effect. In an 8–2 en banc decision, the St. Louis-based court said the 2021 law can bar doctors from prescribing puberty blockers, hormone therapy, gender-affirming surgery or making formal referrals for anyone under 18. Writing for the majority, Judge Duane Benton said the measure withstands constitutional scrutiny under the rational-basis standard, echoing the U.S. Supreme Court’s June ruling in United States v. Skrmetti that upheld Tennessee’s similar restrictions. The court found no violation of the Equal Protection Clause, concluding the law does not discriminate on the basis of sex or transgender status. The panel also rejected plaintiffs’ arguments that the ban infringes parents’ substantive due-process rights or doctors’ First Amendment rights, holding that states may prohibit medical treatments they deem inappropriate for minors and that any burden on speech is incidental to regulating medical conduct. Judge Jane Kelly, joined by one colleague, dissented on the equal-protection and parental-rights questions, citing what she called a “startling lack of evidence” linking the ban to child protection. Tuesday’s ruling overturns a 2023 district-court judgment that had declared the statute unconstitutional after blocking it in 2021. Arkansas’s action has since inspired a wave of similar legislation; comparable bans are now in force in 25 states. The American Civil Liberties Union of Arkansas, which represents a group of transgender youths, their parents and medical providers, called the decision unjust and said it is weighing further appeals.