Published July 7, 2022
On July 5, 2022, the Ethics and Public Policy Center filed a “friend-of-court” brief in support of an Alabama law protecting children from harmful and irreversible transitioning treatments (puberty blockers, cross-sex hormones, and surgeries).
The brief, submitted by EPPC Fellows Rachel N. Morrison and Mary Rice Hasson, asks the Eleventh Circuit Court of Appeals to reverse a district court’s preliminary injunction prohibiting enforcement of Alabama’s law. The brief explains that there is no medical consensus regarding an authoritative standard of care for gender dysphoria or transitioning treatments and that such treatments can lead to serious harms, especially for children.
A summary of their argument is below.
Since the first gender clinic for minors opened in the U.S. in 2007, the number of minors seeking and receiving medical transitioning treatments (puberty blockers, cross-sex hormones, and surgeries) has skyrocketed. This unprecedented surge in transitioning treatments for minors carries a high cost. These treatments are unproven, life-altering, and can lead to significant and irreversible harms, including sterilization, loss of sexual function, and serious mental health problems. Despite the poor evidence base underlying these treatments and the lack of medical consensus supporting them, gender clinicians continue to provide transitioning treatments to minors and medical associations continue to endorse them.
Alabama’s legislature was rightly concerned about the reported harms to vulnerable children and acted constitutionally to weigh the risks and benefits of transitioning treatments for minors. It determined that the state’s compelling interests in protecting Alabama’s children required it to prohibit these experimental medical interventions. Alabama’s legislature constitutionally sought to protect Alabama’s minors from lifelong medical harm when, after assessing the risks and benefits of transitioning treatments, evaluating medical evidence, weighing expert opinion, and considering witness testimony, it prohibited the transitioning treatments for minors.
Instead of deferring to the Alabama legislature’s evidenced-based findings that transitioning treatments pose an unacceptable risk of harm to minors, the district court deferred to eminence-based medicine, stating multiple times 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.” The court’s conclusion that Parent Plaintiffs had a “fundamental right to treat their children with transitioning medications” gave undue weight to World Professional Association for Transgender Health (WPATH) guidelines endorsed by “major medical associations.”
But endorsements neither create a standard of care nor imply a fundamental right to access controversial medical treatments. Contrary to the district court’s assumption, WPATH guidelines are not the standard of care. There is no national or international medical consensus regarding an authoritative standard of care for the treatment of gender dysphoria or the use of transitioning treatments. This lack of medical consensus has been recognized by the federal government, is reflected in state action, and continues to generate controversy in the medical profession.
Under the district court’s preliminary injunction, children in Alabama will continue to have access to and suffer from the harmful, irreversible, and sterilizing transitioning treatments. The Court should reverse.