The real scandal in Alabama's transgender youth care ban
This much we know: Alabama's gender-affirming care ban will be law for the foreseeable future.
Attorneys for transgender young people and their families sued to overturn it. But after a three-year battle, the plaintiffs and the state moved to dismiss the lawsuit. The attorneys for the families said their clients had 'to make heart-wrenching decisions that no family should ever have to make, and they are each making the decisions that are right for them.'
To be sure, the broader legal landscape looks threatening. The U.S. Supreme Court seems poised to uphold a similar ban on gender-affirming care in Tennessee. One can hardly blame parents for giving up on an unjust legal system.
But Alabama's attorney general wants you to think there's something far worse going on. Shortly after the dismissal, Steve Marshall claimed to have uncovered a 'medical, legal, and political scandal that will be studied for decades.'
OK. What it is it?
'Key medical organizations misled parents, promoted unproven treatments as settled science and ignored growing international concern over the use of sex-change procedures to treat gender dysphoria in minors,' the statement said.
This is not evidence. It's not even anything new from the attorney general's office. They have been making this argument in federal court for three years.
And doing a terrible job with it. During a hearing in 2022, the attorney general's office called witnesses who had never worked with transgender children but harbored strong opinions about how to treat them. When the families called experts and medical professionals who knew something about gender dysphoria, state attorneys struggled to counter their arguments.
U.S. District Judge Liles C. Burke, a Trump appointee, soon blocked the law's ban on puberty blockers and hormones for transgender youth.
But the partisan hacks above Burke tilted the table toward the state and away from common decency. U.S. Circuit Judge Barbara Lagoa lowered the standard of review in the case to pretend the state's witnesses were as knowledgeable as the plaintiffs', mocking the word 'expertise.'
And empowering Marshall to make some questionable assertions.
European countries have reconsidered standards of care for transgender youth. But almost none of them have banned gender-affirming care outright like Alabama has. The NHS in England last year ended new prescriptions for puberty blockers following the release of the Cass Report, which has come under sharp attack from experts. But unlike Alabama, the NHS allowed children receiving puberty blockers to stay on them. A law formalizing the ban in the country never passed.
Health care organizations condemned the NHS' decision. Because the 'unproven treatments' statement is misleading. Two dozen medical organizations endorse gender-affirming care as safe and effective, and it has a high satisfaction rate among patients.
'Certainly, the science is quickly evolving and will likely continue to do so,' Burke wrote in his May 2022 opinion. 'But this is true of almost every medical treatment regimen. Risk alone does not make a medication experimental.'
That leaves us with 'key medical organizations misled patients.'
Step back to the 2022 hearing on the law. Medical providers who work with transgender children testified under oath about the many steps in evaluating gender dysphoria. There are several rounds of counseling with parents and children before medication is even considered.
Some kids may not need medical intervention. Some do, which triggers further rounds of evaluation. Treatment exists on a spectrum. And doctors discuss risks with families.
'They are not 100% guaranteed to happen,' Dr. Morissa Ladinsky, formerly of UAB, told the court in 2022. 'That has to be weighed with the entire team around the gravity of that person's gender dysphoria.'
Doctors testified under oath that they give families the most complete pictures of treatment they can. If Marshall has evidence that they misled these families, he should enter it into the court record as these professionals did. As of this writing, he has not. Which suggests how flimsy the state's case is.
The problem here isn't parents protecting their children from assault by the state of Alabama. It's the state terrorizing a small and vulnerable group of young people.
They banned them from playing sports. They cut off their health care. Every act aims to drive them out of the public sphere. And our leaders seem fine with the destruction they're leaving behind.
So we will have to live with the ban for now.
But transgender people will still be here when the authors of these laws are gone. Eventually the ban will fall like any other attempt to restrain reality.
Yet how many children will suffer before that day? How many Alabama families will have to uproot and build new lives outside the state to get this critical care to their loved ones?
And when families can't, how many tragedies will result?
That's the scandal. And it's the politicians, not the doctors, who bear the blame.
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