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Alabama’s transgender youths can use medicine to transition, judge rules


State Representative Neil Rafferty of Alabama speaking at a transgender rights rally.

By Rick Rojas


A federal judge late last week blocked portions of an Alabama law that prevent medical professionals from providing care that helps transgender children and teenagers transition, making it a felony offense that is punishable by up to 10 years in prison.


The severity of the punishment — which also includes threats of criminal prosecution for parents and educators who support a child in transitioning — has stood out even amid a wave of legislation by conservative lawmakers that has focused on transgender young people, including efforts to thwart access to what doctors call gender-affirming care and barring some transgender students from participating in school sports.


The Alabama law, which was signed by Gov. Kay Ivey and went into effect May 8, was challenged in federal court by several families with transgender children, physicians who work with transgender patients and the U.S. Justice Department.


In an order issued late Friday, Judge Liles Burke of the U.S. District Court for the Northern District of Alabama temporarily halted the state from enforcing parts of the law that make it a felony to prescribe hormones or puberty-blocking medication while the court challenge continued.


Burke found that particular element of the law most likely unconstitutional, writing that parents have a fundamental right to direct the care of their children within medically accepted standards and that limiting care to gender-nonconforming children amounted to sex discrimination.


However, Burke ruled that other parts of the law remained in place. Medical professionals are still forbidden to perform gender-affirming surgical procedures on children. (Doctors had testified that such operations were not being performed on children in Alabama before the law had been enacted.) And educators and school nurses are not allowed to withhold — or “encourage or coerce” students to withhold — from their parents “the fact that the minor’s perception of his or her gender or sex is inconsistent with the minor’s sex.”


Supporters of the law, named the “Vulnerable Child Compassion and Protection Act,” contend that it was intended to safeguard children, arguing that the treatment was experimental and that doctors were “aggressively pushing” minors to take medication to transition. “Alabama children face irreversible damage from unproven, sterilizing and permanently scarring medical interventions pushed by ideological interest groups,” lawyers representing the state said in court documents.


But in his ruling, Burke, who was appointed by President Donald Trump, wrote that the state failed to produce “credible evidence to show that transitioning medications are ‘experimental.’”


“Parents, pediatricians and psychologists — not the state or this court — are best qualified to determine whether transitioning medications are in a child’s best interest on a case-by-case basis,” Burke wrote. He added that the state’s “proffered purposes — which amount to speculative, future concerns about the health and safety of unidentified children — are not genuinely compelling justifications based on the record evidence.”


Burke also said the medical establishment largely endorsed transition medications as “well-established, evidence-based treatments for gender dysphoria in minors.”


The American Medical Association has criticized legislative efforts such as the Alabama law as “government intrusion into the practice of medicine that is detrimental to the health of transgender and gender-diverse children and adults.”


In a letter to the National Governors Association last year, the organization said that transition-related care was medically necessary and that forgoing it could have devastating consequences. Transgender people are up to three times as likely as the general population to report or be diagnosed with mental health disorders and have a heightened risk of suicide.


A study published this month that provided one of the first large data sets on transgender young people found that children who go through a so-called social transition at a young age are likely to continue identifying by the new gender after five years.


The families who brought the challenge worried that the law jeopardized the emotional well-being of their children. Parents testified that transitioning had helped their children improve their mental health, and that they feared stopping the treatment would undo the progress that had been made.


“The possibility of losing access to my medical care because of this law causes me deep anxiety,” one of the plaintiffs, a 15-year-old identified in court records by her initials, H.W., said in a statement. “I would not feel like myself anymore if this lifesaving medication was criminalized.”


The U.S. Justice Department had also joined the challenge in Alabama, contending that the law violates the Constitution’s equal-protection clause because it discriminates against transgender youths and “denies necessary medical care to children based solely on who they are.”


Last year, a federal judge found that a similar law in Arkansas “would cause irreparable harm” as he blocked it from being enforced. The Arkansas law, known as the “Save Adolescents From Experimentation Act,” was passed by lawmakers after overriding a veto from Gov. Asa Hutchinson, a Republican, who contended that the legislation “puts a very vulnerable population in a more difficult position.”


Still, elected officials in conservative states have pursued a range of aggressive measures this year meant not just to limit transgender youth’s access to medical care but also to penalize parents and medical professionals who are helping them transition.


On the same day that Ivey signed the Alabama bill on medical care, she also approved legislation that required students to use restrooms and locker rooms for the sex listed on their original birth certificates, as well as limits on classroom discussions on gender and sexual orientation — a version of what critics call a “Don’t Say Gay” measure that has been enacted by other states.


“I believe very strongly that if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl,” Ivey, a Republican, said in a statement after signing the bill. “We should especially protect our children from these radical, life-altering drugs and surgeries when they are at such a vulnerable stage in life.”

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