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Alabama’s ban on medication for trans youths is blocked by judge

In a first for the nation, the ban on gender-affirming care for trans minors had been in effect for a week.

(iStock/Washington Post illustration)
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Last Sunday, Alabama became the first state in U.S. history to make gender-affirming care a felony, punishable by up to 10 years in prison and fines of up to $15,000 for anyone providing that care to someone under 19. Less than a week later, a federal judge in Alabama has blocked the ban from being enforced, saying it would cause “severe physical and/or psychological harm” to Alabama’s trans youths and their families and likely violates their constitutional rights.

Judge Liles C. Burke in the Northern District of Alabama issued the highly anticipated ruling late Friday night. It came the same day that the Texas Supreme Court issued a decision on Republican Gov. Greg Abbott’s directive to investigate gender-affirming care as “child abuse.”

Burke wrote in his opinion that parents have “a fundamental right to direct the medical care of their children subject to accepted medical standards” and that “discrimination based on gender-nonconformity equates to sex discrimination.”

Burke’s opinion, which cites Supreme Court and federal court precedent, blocks the part of the Alabama law that would prevent doctors from providing minors with age-appropriate gender-affirming care such as puberty blockers and hormone therapy.

But the ban on surgeries for minors remains, as does a section of the law that requires school officials to share with a child’s parents any information related to the child’s gender identity. (Neither of these sections was challenged by the plaintiffs. Gender-affirming surgeries are not performed on youths in Alabama, according to doctors.)

Transgender rights advocates and legal experts say Burke’s decision is a “huge initial victory” for Alabama’s trans minors and their families as their challenge to the ban on gender-affirming care proceeds through the courts.

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The challenge was mounted by multiple LGBTQ rights advocacy organizations, which described the ban as unconstitutional and said it would cause “immediate and irreparable” harm to the plaintiffs, including four Alabama families, two physicians and a minister.

Last month, the Department of Justice joined the complaint against Alabama, alleging that the banning legislation, titled the Vulnerable Child Compassion and Protection Act, violates the 14th Amendment’s equal protection clause. The Justice Department asked the court to prevent the law from going into effect while it is being challenged.

In a statement shared with The Washington Post, Alabama Gov. Kay Ivey (R) vowed to continue “fighting to protect Alabama’s children from these radical, unproven, life-altering drugs, despite this temporary legal road block.”

Shannon Minter, the legal director of the National Center for Lesbian Rights and a lawyer working on behalf of the Alabama plaintiffs, was “delighted” with the court’s ruling.

The issue of gender-affirming care is new for most courts, Minter noted. Burke’s decision “sets up a clear legal framework and evidentiary foundation that this is well-established medical care.” He said he hoped the ruling could deter states that are contemplating bills similar to Alabama’s.

The decision is a huge relief for Alabama trans youths, their families and their health-care providers, some of whom told The Post that they had been holding their breath since the law took effect this week.

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In a statement shared with The Post, Morissa Ladinsky, an associate professor and co-leader of the University of Alabama Birmingham’s multidisciplinary gender team, which provides gender-affirming care to minors in the state, wrote: “I’m thrilled by the outcome of the decision.”

“This decision will ensure transgender children can continue to receive this life-saving care,” she added.

Jeff Walker, the parent of a trans daughter and an outspoken critic of the law, said he had slept little in the past week.

He woke up to the news of the preliminary injunction at 6 a.m. Saturday, he said.

“I woke up the whole house,” Walker said, adding that he got “the biggest hug” he’s ever gotten from his daughter, Harleigh, in response.

“It was a huge wake-up call, literally,” said Harleigh, 15. “It was really nice to hear, and a great moment to have.”

The law had dominated family conversations, with the Walkers constantly comparing notes on the latest in the current legal battle over the health-care ban, Walker said. At his home office, Walker dedicated one screen to monitoring any new developments. The family had been researching care out of state, eyeing the calendar to sort out when to take time off to meet with a new team of doctors. They considered relocating.

“Of all the things I’ve done in my life, I’ve never thought getting health care for my kid was going to make me an outlaw,” Walker said in an interview earlier in the week.

With a preliminary injunction in place, the Walkers feel that they can finally focus on their lives again: school finals, summer vacation, tee-ball games with the extended family.

Alabama state Rep. Wes Allen (R), one of the ban’s champions, told The Post last month that the ban on gender-affirming care “is about protecting children from making decisions as children that their brains are not yet developed enough to understand.”

“Just as we do not allow children, even with parental permission, to drink alcohol or vape, we passed this legislation to protect children,” he added. He did not respond to a request for comment on the latest ruling.

In Texas, the state’s Supreme Court issued a nuanced ruling Friday on Abbott’s directive to child welfare workers to investigate gender-affirming care for minors as “child abuse.”

The state’s highest court unanimously found that neither Abbott nor Attorney General Ken Paxton, together the architects of the guidance, had the authority to order such investigations in the first place, meaning child welfare agents are not required to follow Abbott’s directive.

The court also clarified the Department of Family Protective Services’ role, writing: “DFPS’s preliminary authority to investigate allegations does not entail the ultimate authority to interfere with parents’ decisions about their children, decisions which enjoy some measure of constitutional protection whether the government agrees with them or not.”

The court did lift a statewide injunction on the directive but upheld the injunction for the family suing the state alleging civil rights violations related to the governor’s order.

The American Civil Liberties Union of Texas and Lambda Legal said in a joint statement that the decision was “a win for our clients and the rule of law.”

Alabama and Texas are part of a historic deluge of legislation targeting LGBTQ communities. As NBC news reports, more than 200 such bills have been filed in the first quarter of this year alone, with many of them focused on restricting the rights of trans youths.

In March, Florida Gov. Ron DeSantis (R) signed a bill limiting the discussion of gender identity and sexual orientation for younger students. Conservative lawmakers across the country have since introduced similar bills in their own legislatures.

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In Arizona, Gov. Doug Ducey (R) signed two bills that would restrict gender-affirming care for transgender youths and prohibit transgender girls from playing on female sports teams. And in Missouri, several bills have been introduced this session that would restrict the rights of trans people, including one that would penalize doctors who provide gender-affirming care for minors.

But even among a historic wave of nationwide legislation targeting gender-affirming care, Alabama’s laws stand apart.

Its education restrictions, set to take effect this fall, are the most aggressive to become law thus far. Coming as a last-minute amendment to a bill that originally restricted which bathrooms and lockers trans youths could use, the law now bars school staffers from discussing gender and sexuality with students from kindergarten through the fifth grade.

Arkansas’s legislature passed the country’s first ban on gender-affirming care last year, but it did not include criminal penalties, and it was blocked before it could take effect.

In testimony last week, an expert speaking on behalf of the state said no country in the world categorically bans the use of gender-affirming care in the way Alabama has.

On the day Ivey signed the bills into law, she called them “Alabama common sense.”

“We’re going to go by how God made us: If the Good Lord made you a boy, you’re a boy, and if he made you a girl, you’re a girl. It’s simple,” Ivey tweeted.

Alabama families and physicians had been preparing over the past month for the law to take effect.

Ladinsky testified before Burke last week as an expert medical witness, while her UAB gender clinic partner, Hussein Abdul-Latif, worked around-the-clock to refill prescriptions in advance for current patients. The law does not criminalize pharmacists for dispensing medications prescribed before the law took effect, she noted, and the medications can be refilled between six and 12 months in advance.

The gender health team is unique in the state. It is the only interdisciplinary team offering gender-affirming care to trans youths — bringing together mental health and endometrial specialists, as well as primary care physicians, to coordinate care for young patients.

This kind of care is difficult for many trans youths and their families to obtain, experts say. The UAB team sees patients from Alabama, Mississippi and Florida, Ladinsky said, as well as youths from southern Tennessee, western Georgia and the Atlanta area.

Only a fraction of the trans children they see are taking puberty blockers and hormone treatments, according to Ladinsky.

Puberty blockers are sometimes prescribed to trans adolescents as a way to pause hormonal changes and give them time to confirm their gender identity. If they continue to identify as transgender, they may start taking gender-affirming hormone therapy under the guidance of their doctor and parents.

Alabama lawmakers, as with others who have tried to ban or criminalize gender-affirming care for trans youths, have argued that puberty-blocking medication and hormone treatment could cause lasting damage, including a loss of bone density and sterilization.

A recent Yale School of Medicine report examining these claims in depth found many of those arguments to be exaggerated or incorrect.

“These are not close calls or areas of reasonable disagreement,” the authors wrote in their executive summary. “The AG Opinion and the Alabama Law’s findings ignore established medical authorities and repeat discredited, outdated, and poor-quality information.”

Burke weighed this testimony in his ruling, finding that the state presented “no credible evidence to show that transitioning medications are ‘experimental.’”

Minter said he thinks trans youths and their families should be “relieved and encouraged” by the Texas and Alabama decisions.

Walker was hopeful the ruling could have an impact outside Alabama, noting that other states had introduced similar bans after Alabama’s had been passed.

“Maybe a decision like this will take the wind out of those sails,” he said.

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