A federal judge Friday afternoon floated the possibility that state law making medication for transgender youth illegal could go into effect on Sunday without a ruling on a motion from families of transgender youth and physicians seeking to block the law.
But U.S. District Judge Liles C. Burke said he and his staff would be “doing nothing else” until a ruling on an injunction came down.
“I want a well-reasoned order that is right on the law,” he said. “I just ask that everyone be patient.”
The statement came at the end of a two-day hearing that focused on the research and experience behind current treatments for gender dysphoria, and whether SB 184, which could put doctors in prison for up to 10 years for prescribing puberty blockers and hormones to transgender youth, had a legitimate basis or was a violation of equal protection and free speech guarantees under the U.S. Constitution.
The plaintiffs, who include the parents of transgender children in Alabama from 12 to 17 and two physicians and a minister who work with them, testified throughout the hearing that access to the medications was critical for the physical and psychological health of youths who needed them. Families said in filings with the court that access to puberty blockers or hormones had led to major improvements in their well-being, and doctors and physicians repeatedly stressed that the medications were part of widely accepted standards of gender-affirming care.
Jeffrey Doss, a Birmingham attorney who represented the plaintiffs, said in a closing statement Friday that the law’s blanket ban on transgender treatments was unconstitutional and unprecedented.
“That’s an untested proposal,” he said. “The state proposes an experiment on a grand scale. All transgender youth in Alabama suffering from gender dysphoria should be guinea pigs.”
Attorneys with the Alabama Attorney General’s Office and their witnesses repeatedly questioned the effectiveness of the treatments and emphasized potential risks in the treatments, and focused particularly on potential for reduced fertility later in life.
“In hitting the pause button, Alabama is halting an experiment on our kids,” said Alabama Solicitor General Edmund LaCour in closing arguments. “Nothing in the Constitution requires Alabama to submit to unproven and sterilizing treatments.”
Friday was largely devoted to state witnesses, after plaintiffs mostly finished with their witnesses on Thursday. James Cantor, a psychiatrist based out of Toronto, testified for the state that studies of transgender health outcomes had not done a sufficient job separating outcomes of psychotherapy and medication in assessing the benefits of one or the other.
“The studies that have come out can’t unpack whether psychotherapy or pharmaceuticals making the difference,” said Cantor.
On cross-examination from Melody Eagan, an attorney for the plaintiffs, Cantor acknowledged that he does not treat children or adolescents younger than 16 who suffer from gender dysphoria. Eagan also read off a report Cantor had cited as an example of his argument that showed the authors had studied the effects of psychotherapy and psychotherapy with medication together.
Dr. Armand Antommaria, director of the ethics center at Cincinnati Children’s Hospital, said in earlier testimony Friday that observational studies, in which individuals received treatments and were studied for later effects, provided insight and allowed those who needed medical intervention for gender dysphoria to get it.
“I would have concerns randomized control trials of intervention would be unethical,” he said. “Even if it could be ethically performed, they would have substantial methodological limitations.”
SB 184, one of several passed in recent years by the Alabama Legislature targeting transgender youth, also forbids genital and reconstructive surgeries on youth. Physicians and medical professionals have repeatedly stressed those procedures are not performed in Alabama. It also forbids public and private school officials from withholding “information related to a minor’s perception that his or her gender or sex is inconsistent with his or her sex.”
Health care professionals Thursday compared cutting off the medications to terminating a cancer patient’s care. Antommaria said Friday that the law would force physicians to break the law or violate their ethical obligations to plaintiffs.
“They would be placed in the untenable position of violating ethical obligation to patients to conform with the law or fulfilling professional obligations to their patients and being criminally charged,” he said.
The lawsuit, joined by the U.S. Department of Justice, also argues the law is discriminatory, in that it allows the use of puberty blockers for youth who are not transgender.
Deputy Solicitor General Barrett Bowdre raised that question with Antommaria, asking about the possibilities of people who received gender-affirming care stopping treatment and aligning with their birth sex, a process he called desistance.
Witnesses for the plaintiffs said desistence in their experience was rare and could be reflective of successful treatments earlier in life. Antommaria said in response to Bowdre that “experience in field in the suggests the desistance rate is low.”
Attorneys for the state also cited European studies that questioned the efficacy of the medications, though plaintiffs noted that no European country had banned the treatments as Alabama had.
The state also called Sydney Wright, a 23-year-old from Cedar Bluff who said she had sought and received testosterone treatments in Georgia when she was 19. Wright said a counselor no longer in practice in the state wrote a recommendation for her, but that taking the drug led to ER visits and permanent alteration of her voice.
“At the end of every single day, I was a woman,” she said. “I could not escape what I was trying to escape. Eventually, you have to come to terms with that.”
On cross-examination, Wright said she did not know anything about procedures for treatment in Alabama or about the benefits the plaintiffs in the lawsuit may be experiencing. Wright also acknowledged she had taken the testosterone at 19, as an adult. SB 184 would not make that illegal.
Burke did not suggest how he would rule on the request for an injunction on Thursday or Friday, though he often asked questions about the scope of Alabama’s ban. At one point during Cantor’s testimony, the judge, referring to the testimony about European countries, questioned whether any nations in the world had enacted a ban similar to Alabama’s. Cantor said he was not aware of any.
Dr. Morissa Ladinsky, an associate professor of pediatrics at the University of Alabama Birmingham and a witness for the plaintiffs, said Friday if the law goes into effect Sunday, UAB will stop writing prescriptions for transgender youth. An injunction that came a few days later, she said, would only result in a minimum amount of disruption to patients’ regimens. But she said there would be “grave concerns” should the wait go months.
“It would be only natural for any family with a transgender child to feel anxious, to feel scared, and to feel in a place of limbo,” she said. “So we will hope that the wheels of justice act as they should and we can allay those anxieties sooner rather than later.”
Contact Montgomery Advertiser reporter Brian Lyman at 334-240-0185 or [email protected].