Arkansas State Capitol – Photo: HAL333, via wikimedia
A federal appeals court has upheld an order blocking an Arkansas law that sought to bar transgender youth from accessing gender-affirming health care treatments, and penalize doctors who prescribe such interventions.
On Thursday, the 8th U..S. Circuit Court of Appeals upheld a lower court’s injunction blocking the state from enforcing the law after four transgender youths, their parents, and two doctors filed suit, arguing that the ban violates transgender youths’ right to free speech (including self-identification) and equal protection under the law, infringes on their parents’ right to decide what sort of care they receive, and violates physicians’ free speech rights by preventing them from recommending the treatments that are best for their patients.
In its ruling, the appeals court found that, “[b]ecause the minor’s sex at birth determines whether or not the minor can receive certain types of medical care under the law,” the ban discriminates on the basis of sex. As such, the law will continue to be blocked while case is decided on its merits.
The lower court judge who issued the injunction last year, U.S. District Judge James Moody, Jr., of the Eastern District of Arkansas, is slated to hear oral arguments on October 17 on whether the law should be permanently blocked, reports Politico.
The law, passed on largely party-line votes in the Republican-led state House and Senate, was initially vetoed by Gov. Asa Hutchinson last year over concerns that the law — which also allows health insurers to deny coverage for any transition-related care, even for adults — was overly broad, infringed on parental rights, and failed to exempt youth who were already receiving care, further disrupting their treatments. But Republicans overrode Hutchinson’s veto, prompting the plaintiffs to sue. Seven days before the law was slated to go into effect, Moody issued his injunction preventing the law from being enacted.
Multiple medical groups, including the American Medical Association, oppose the ban and have argued that transition-related treatments can be safely administered. LGBTQ advocates and civil rights advocates noted that, in addition to potentially being unconstitutional, the law would harm transgender youth, potentially exacerbating their gender dysphoria and leading to depression, anxiety, and suicidal ideation.
But Arkansas Attorney General Leslie Rutledge, arguing on behalf of the state and the state medical board, argued that the state has the authority to regulate medical practices, especially those that could be potentially harmful. Rutledge also argued that the restriction on transgender health care is needed to protect transgender youth from making rushed or uninformed decisions about their health that they may later regret if they choose to pursue “irreversible” hormone therapy or surgery.
LGBTQ advocates celebrated the 8th Circuit’s decision, hailing it as a victory not only for the plaintiffs, but all transgender youth.
“Today, the 8th Circuit Court of Appeals affirmed that no child should be denied medical care they need,” Holly Dickson, the executive director of the ACLU of Arkansas, said in a statement. “We are relieved for trans youth. Research shows that denying gender-affirming care to transgender youth contributes to depression, isolation, eating disorders, self-harm, and suicide. Transgender people deserve the right to live healthy lives without fear and discrimination. It’s time for the Arkansas Legislature to protect trans kids, not target them.”
“This is a critical victory for transgender adolescents in Arkansas, their families, and their medical providers,” Chase Strangio, the deputy director for Transgender Justice at the ACLU’s LGBTQ & HIV Project, said in a statement. “The 8th Circuit was abundantly clear that the state’s ban on care does not advance any important governmental interest and the state’s defense of the law is lacking in legal or evidentiary support. The state has no business categorically singling out this care for prohibition. We know adolescents thrive with this care, support, and love, and we’re determined to keep fighting until this baseless law is permanently struck down.”
Similar laws seeking to restrict access to gender-affirming care by youth have passed in Tennessee and Alabama, although the Movement Advancement Project, a pro-LGBTQ think tank, has noted that the specific language in Tennessee’s law — which bans hormone therapy for “prepubertal minors” — is based on a flawed understanding of transgender health care, and may allow minors who have already started puberty (as standards of care generally recommend) to begin receiving hormone therapy. The Alabama law has since been blocked from being enforced by a federal judge.
The state of Arizona passed a similar law that only restricts surgical interventions for transgender youth, but does not ban hormones or puberty blockers. Meanwhile, the state of Texas has encouraged state agencies to investigate families with transgender youth for “child abuse” if their children access gender-affirming care. While courts have allowed investigations to resume in general, two separate injunctions have been issued blocking state agencies from going after specific families who claimed they were targeted by the Texas Department of Family and Protective Services.
Congressional lawmakers have approved a measure that would bar Medicaid -- the federal health insurance program for low-income Americans -- from covering gender-affirming care, including hormonal and surgical interventions, for minors.
The "Do No Harm in Medicaid Act," sponsored by U.S. Rep. Dan Crenshaw (R-Texas), is the third in a series of Republican-backed efforts to block people under 18 from accessing medical treatments that assist in a gender transition.
The measure passed by a 215-201 vote, with four Democrats -- Reps. Henry Cuellar (Texas), Vicente Gonzalez (Texas), Don Davis (N.C.) and Marie Gluesenkamp Perez (Wash.) -- joining Republicans in support of the ban.
The Trump administration has proposed two federal rules that would restrict access to gender-affirming care for transgender minors nationwide.
The proposed regulations, issued by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS), would bar federal Medicaid funds from covering transition-related care for transgender youth under 19 and threaten to strip federal funding from hospitals that provide gender-affirming treatments to minors.
HHS officials told NBC News that CMS will begin the federal rule-making process with a 60-day public comment period, after which the rules could be finalized.
A recent study of injectable pre-exposure prophylaxis found that twice-yearly injections of lenacapavir -- marketed as Yeztugo by Gilead Sciences -- do not have clinically significant interactions with gender-affirming hormone therapy.
"In the most gender-diverse Phase III PrEP trial conducted to date, lenacapavir had no clinically significant impact on feminizing or masculinizing gender-affirming therapy concentrations," the study’s researchers concluded, as reported by POZ.
The study, led by Dr. Jill Blumenthal of the University of California San Diego, examined whether lenacapavir interacts with gender-affirming hormone therapy, including estradiol (a form of estrogen) and testosterone. Because those hormones are metabolized by enzymes such as CYP3A4 -- which lenacapavir can inhibit -- the researchers analyzed whether the drug altered hormone levels.
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