Indiana’s gender-affirming care law prohibits physicians from providing puberty blockers, cross-sex hormones, or transition-related surgeries to anyone under 18, while leaving adult access to these treatments untouched. The ban is codified at Indiana Code 25-1-22, was enacted as Senate Enrolled Act 480 in 2023, and is now fully enforceable after the U.S. Supreme Court upheld a nearly identical Tennessee statute in June 2025.
What the Law Prohibits for Minors
A physician or practitioner in Indiana cannot knowingly provide a gender transition procedure to a patient under 18. The statute covers surgeries that alter or remove physical characteristics typical of a person’s sex, surgeries that create characteristics resembling a different sex, and the prescribing of puberty-blocking drugs or cross-sex hormones for the purpose of gender transition.1Indiana General Assembly. Indiana Code 25-1-22-5 – Gender Transition Procedures
The ban also reaches providers who aid or abet another physician or practitioner in delivering these procedures to a minor.2Indiana General Assembly. Senate Bill 480 – Gender Transition Procedures for Minors A doctor who helps arrange prohibited care for a minor patient can face the same consequences as one who provides it directly. Whether that extends to every kind of informational conversation between doctor and patient hasn’t been tested in court, so Indiana providers tend to be cautious.
Exceptions That Remain Legal for Minors
The same medications and procedures stay legal for minors in several specific situations. The exceptions are narrower than many families expect, and physicians document carefully to show the care falls inside them.
The clearest exception covers children with a medically verifiable disorder of sex development. That includes patients with ambiguous external sex characteristics that cannot be clearly classified, chromosomal variations such as 46 XX with virilization or 46 XY with undervirilization, both ovarian and testicular tissue, or other conditions confirmed through genetic or biochemical testing showing atypical sex chromosome structure or hormone production.1Indiana General Assembly. Indiana Code 25-1-22-5 – Gender Transition Procedures
Puberty blockers prescribed for precocious puberty also remain legal, because the treatment addresses early-onset physical development rather than gender identity. The statute additionally permits treatment for complications caused by prior gender transition procedures, emergency care necessary to prevent death or serious bodily harm, and mental health or social services that don’t involve the prohibited medical interventions. Any condition unrelated to a gender dysphoria diagnosis falls outside the ban entirely.1Indiana General Assembly. Indiana Code 25-1-22-5 – Gender Transition Procedures
What Adults Can Still Access
None of Indiana’s restrictions apply to residents 18 and older. Adults can access the full range of gender-affirming medical care, including hormone therapy, puberty blockers in the rare adult cases where they’re indicated, and both genital and non-genital surgical procedures. Standard informed consent and clinical guidelines govern these treatments the same way they govern any other adult medical decision.
Insurance Coverage
Indiana has no state law requiring private insurers to cover gender-affirming care, and no blanket prohibition on coverage either. Whether a particular plan covers hormone therapy, surgery, or related mental health services depends on the employer’s benefit design and the insurer’s medical policies. Review your specific plan documents or call the number on your insurance card before assuming anything is covered.
For adults on Medicare, there is no national coverage mandate for gender-affirming surgery. Decisions are made case by case by local Medicare Administrative Contractors evaluating medical necessity. Part D generally covers hormone medications, and Part B covers related outpatient consultations. Procedures classified as purely cosmetic are not covered.
Penalties for Providers Who Violate the Ban
Providers who violate the ban face discipline through Indiana’s general licensing framework. Under Indiana Code 25-1-9-9, the licensing board can impose any of the following, individually or in combination:
- Permanent license revocation
- License suspension
- Censure
- A letter of reprimand
- Probation with conditions such as restricted practice areas, supervised continuing education, or community service
- Fines up to $1,000 per violation, with the board required to consider the practitioner’s ability to pay3Indiana General Assembly. Indiana Code 25-1-9-9 – Disciplinary Sanctions
The statute also establishes civil enforcement. The bill’s digest references civil enforcement actions, meaning providers can face lawsuits resulting in monetary damages on top of any board discipline.2Indiana General Assembly. Senate Bill 480 – Gender Transition Procedures for Minors The combination of professional and financial exposure is why many Indiana providers have adopted conservative policies around these treatments, including for conditions that technically fall within the exceptions.
Where the Law Stands After Skrmetti
The ban survived a two-year federal court battle. A district court initially blocked enforcement with a preliminary injunction in July 2023. The Seventh Circuit stayed that injunction in February 2024, allowing the ban to take effect, and in November 2024 reversed the district court entirely and vacated the injunction.4Justia Law. K.C. v. Individual Members of the Medical Licensing Board
The decisive development came on June 18, 2025, when the U.S. Supreme Court decided United States v. Skrmetti, a challenge to Tennessee’s nearly identical ban. In a 6-3 opinion written by Chief Justice Roberts, the Court held that state laws banning gender-affirming medical treatments for minors do not violate the Equal Protection Clause of the Fourteenth Amendment.5Supreme Court of the United States. United States v. Skrmetti, No. 23-477 The Court found that these laws classify by age and medical purpose, not by sex, and therefore deserve only rational basis review. Under that standard, Tennessee’s reference to ongoing scientific debate about the risks and benefits of these treatments for minors was sufficient. As of June 2025, 25 state bans remain in place as a result.
For Indiana, Skrmetti closes the door on the main constitutional theory challengers had relied on. Providers and families should treat the law as settled for the foreseeable future. Challenges based on due process (parental rights to direct a child’s medical care), Section 1557 of the Affordable Care Act, or state constitutional provisions could still be raised, but none has succeeded against Indiana’s law to date.
Privacy of Medical Records
There is no special federal protection for medical records related to gender-affirming care. A 2024 HHS rule restricts healthcare providers from disclosing patient records in response to investigations into lawful reproductive healthcare, preventing covered entities from sharing protected health information for the purpose of imposing liability on someone for seeking, obtaining, or providing reproductive care that was legal where it occurred.6U.S. Department of Health & Human Services. HIPAA and Reproductive Health That rule is explicitly limited to reproductive healthcare and does not cover gender-affirming care. HHS’s own guidance references abortion care and related services but does not extend the 2024 protections to gender transition treatments.7U.S. Department of Health & Human Services. HIPAA Privacy Rule Final Rule to Support Reproductive Health Care Privacy – Fact Sheet
Standard HIPAA protections still apply. A provider generally cannot disclose your records without authorization except in specific circumstances like court orders, qualifying law enforcement requests, or mandatory reporting obligations. There is no extra layer of privacy shielding gender-affirming care records the way there now is for reproductive health records.
Federal Nondiscrimination Protections
Section 1557 of the Affordable Care Act prohibits discrimination in federally funded health programs. The Biden administration finalized a 2024 rule that explicitly included gender identity within the definition of sex discrimination, which would have required covered insurers and providers to treat gender-affirming care the same as other medically necessary treatments.
That interpretation is no longer being enforced. HHS rescinded its 2022 guidance on anti-discrimination protections for gender-affirming care, and federal courts have questioned whether Section 1557 covers gender identity discrimination at all. The Skrmetti decision reinforces the view that treating gender dysphoria differently from other conditions does not automatically constitute sex discrimination. Indiana residents should not rely on federal nondiscrimination law to guarantee access to or insurance coverage for gender-affirming care, particularly for minors.