A federal judge has blocked parts of an Alabama law that criminalized doctors for prescribing gender-affirming health care treatments to transgender people individuals under the age of 19.
U.S. District Judge Liles Burke, of the Northern District of Alabama, issued a preliminary injunction to stop the state from enforcing the ban, which took effect on May 8. That injunction will remain in place until a lawsuit challenging the law’s constitutionality is decided on its merits. A similar law was passed in Arkansas last year but has since been blocked from taking effect by a federal judge.
Alabama Attorney General Steve Marshall has indicated his office will appeal the injunction, reports The Associated Press.
The lawsuit was brought by four families with transgender children ranging in age from 12 to 17, arguing that the law was discriminatory, violated their rights to equal protection and free speech, and intruded into family medical decisions. All four families are proceeding anonymously under pseudonyms in order to avoid criminal prosecution by the state, as well as to protect their privacy and safety.
More than 20 medical and mental health organizations signed onto amicus briefs urging Burke to issue the injunction and ultimately declare the law unconstitutional, while 15 attorneys general from conservative-leaning states filed briefs urging him to uphold the law. The U.S. Department of Justice later joined the lawsuit, arguing that the law — passed largely on party lines by the Republican majority in the legislature — should be overturned.
In his opinion, Burke, a Trump nominee, ruled that the state had provided no credible evidence to back up its contention that gender-affirming treatments are “experimental” and should be delayed until adulthood, regardless of individual medical needs.
“While Defendants offer some evidence that transitioning medications pose certain risks, the uncontradicted record evidence is that at least twenty-two major medical associations in the United States endorse transitioning medications as well-established, evidence-based treatments for gender dysphoria in minors,” Burke wrote. “Indeed, according to Defendants’ own expert, no country or state in the world categorically bans their use as Alabama has. Certainly, the science is quickly evolving and will likely continue to do so. But this is true of almost every medical treatment regimen. Risk alone does not make a medication experimental.
“Moreover, the record shows that medical providers have used transitioning medications for decades to treat medical conditions other than gender dysphoria, such as central precocious puberty, a condition in which a child enters puberty at a young age,” Burke added. “Doctors have also long used hormone therapies for patients whose natural hormone levels are below normal.
“Based on the current record, Defendants fail to show that transitioning medications are experimental. Thus, Parent Plaintiffs are substantially likely to show that the Act violates their fundamental right to treat their children with transitioning medications subject to medically accepted standards.”
Burke also found that the parents and the transgender minors at the center of the lawsuit would likely suffer “irreparable harm” if the state was not blocked from trying to enforce the law while the case is litigated in the courts. Specifically, the children in question are likely to experience medical harm in the form of anxiety, depression, eating disorders, substance abuse, self-harm, and suicidal ideation, in addition to the deterioration of parent-child relationships and poorer academic performance if they are unable to receive these medications.
As an example, Burke cite testimony from one of the plaintiff parents, known as “Megan Poe,” who told the court how her transgender daughter, “Allison,” had suffered from severe depression and suicidal ideation due to gender dysphoria prior to beginning to take puberty blockers in sixth grade, but is now “thriving.” Asked what might occur if those medications were withdrawn, Poe expressed fear that Allison would attempt suicide.
“[T]he Court finds that the imminent threat of harm to Parent Plaintiffs and Minor Plaintiffs — i.e., severe physical and/or psychological harm — outweighs the harm the State will suffer from the injunction. The Court further finds that an injunction is not adverse to the public interest,” Burke concluded. “To the contrary, enjoining the Act upholds and reaffirms the ‘enduring American tradition’ that parents — not the States or federal courts — play the primary role in nurturing and caring for their children.”
However, Burke also left in place parts of the law outlawing surgical interventions on transgender youth, which medical experts testified is not typically recommended for minors and is not being performed on those under the age of consent in Alabama. He also left in place two “mandated reporter” provisions in the law that require counselors and school officials to “out” students to their parents if a minor discloses that they believe they are transgender.
Alabama Gov. Kay Ivey, a Republican who signed the law into effect, called Burke’s ruling a “temporary legal roadblock” and expressed confidence that those seeking to bar minors from obtaining gender-affirming treatments and transitioning too soon — lest they regret it later — would ultimately prevail.
Lawyers for the plaintiffs celebrated the injunction, which allows transgender youth to continue receiving hormonal treatments that block the onset of puberty or facilitate a gender transition.
“This ruling means that parents of transgender children in Alabama will continue to be able to make the healthcare decisions that are best for their families. It is an extraordinary relief,” Jennifer Levi, the director of GLBTQ Legal Advocates & Defenders. “Parents should not be punished for wanting to do what’s best for their kids.”
Poe called the injunction a “tremendous relief,” noting that her daughter, Allison, would be able to continue receiving medically necessary care which “has allowed her to become the confident, engaged teenager she is.”
“Like any parent my biggest daily concern is that my child is healthy, happy and safe,” Poe said in a statement. “While I know many people may not understand what it means to have a transgender child, I am grateful the court listened to the experience of my family and other families like ours who have been terrified about what SB 184 will bring. Blocking the law means we can breathe just a little easier until we hopefully see it stopped for good.”
James Zoe, the father of a 13-year-old transgender son, Zachary, expressed similar sentiments.
“Alabama is our home and we hope this cruel law will not be allowed to force us from it,” he said. “We are fighting for our child and will continue fighting so that he and all transgender youth in Alabama remain able to receive appropriate medical care.”
“Parents want and need to be able to seek trusted medical advice and care to support their children’s health, and interrupting care mid-treatment can have devastating consequences,” Dr. Rachel Koe, a pediatrician in private practice in rural Southeast Alabama, added in a statement. “This ruling is a reprieve for transgender children who can continue to get the care they need and for parents who want to do what’s best for their kids.”
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