Appeals court allows Alabama’s gender-affirming care ban to take effect

A federal appeals court has reversed a lower court’s decision to block parts of Alabama’s gender-affirming care ban.

The ban originally went into effect in May 2022 and made it a felony for doctors to provide gender-affirming care to trans youth. Under the law, doctors in the state who prescribe puberty blockers or other gender-affirming care to transgender minors and adults under the age of 19 could face up to 10 years in prison.

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Two trans kids, their families, and two doctors then sued the state to stop the law from going into effect, alleging it violates their Equal Protection and Due Process rights under the Constitution by denying them access to health care specifically because of their identities. U.S. District Judge Liles Burke – who was appointed by former President Donald Trump – issued an injunction against the part of the law that prevented trans youth from receiving gender-affirming medication.

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Burke wrote in his opinion that “the record shows 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.”

But the three-judge panel on the appeals court (all Trump appointees) disagreed with Burke’s decision. U.S. Circuit Judge Barbara Lagoa wrote that the plaintiffs did not provide any evidence supporting “the existence of a constitutional right” to receive gender-affirming care of any kind. Lagoa also said the plaintiffs did not successfully demonstrate that the law “classifies on the basis of sex or any other protected characteristic.”

Lagoa also cited the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade and eliminated federal protections for reproductive rights. The state had cited Dobbs in its argument to the court about why it should lift the injunction, arguing that gender-affirming care is not “deeply rooted in this nation’s history and tradition.” Supreme Court Justice Samuel Alito had written in his Dobbs opinion that any right guaranteed under the Fourteenth Amendment’s due process clause must be “deeply rooted in this Nation’s history and tradition.”

Lagoa then used the same language to explain the court’s decision to lift the injunction, saying that “the use of these medications in general — let alone for children — almost certainly is not ‘deeply rooted’ in our nation’s history and tradition.”

Alabama Attorney General Steve Marshall (R) celebrated the ruling, saying it has allowed the state to “safeguard the physical and psychological wellbeing of minors, even if the United States Attorney General and radical interest groups disapprove. Alabama takes this responsibility seriously by forbidding doctors from prescribing minors sex-modification procedures that have permanent and often irreversible effects. This is a significant victory for our country, for children, and for common sense.”

A statement from the group of LGBTQ+ rights organizations representing the plaintiffs called the decision “deeply disappointing” and “difficult to reconcile with the 11th Circuit’s prior rulings and with the Supreme Court’s clear guidance that discrimination because a person is transgender is sex discrimination.”

“Our clients are devastated by this decision, which leaves them vulnerable to what the district court – after hearing several days of testimony from parents, doctors, and experts – found to be irreparable harm as a result of losing the medical care they have been receiving and that has enabled them to thrive.”

But the organizations vowed to keep fighting.

“While this is a setback, we are confident that it is only a temporary one. Every federal district court that has heard the evidence presented in these cases has come to the same conclusion: these medical treatments are safe, effective, and lifesaving for some youth, and there is no legitimate reason to ban them.”

“We believe that at the end of the day, our nation’s courts will protect these vulnerable youth and block these harmful laws, which serve no purpose other than to prevent parents from obtaining the medical care their children need. Parents, not the government, are best situated to make these medical decisions for their children. These laws are a shocking example of government overreach and a jarring intrusion into private family decisions. This case is far from over, and we will continue to aggressively seek legal protection for these families.”