genderaffirming

Aug. 13 (UPI) — A federal appeals court has ruled that Arkansas may enforce its ban on minors receiving gender-affirming care, overturning a lower court’s decision that found the law unconstitutional.

The U.S. Court of Appeals for the Eighth Circuit issued its ruling Tuesday, stating the lower court erred in June 2023 when it struck down Arkansas’ Save Adolescents From Experimentation Act for violating the First Amendment and both the 14th Amendment’s Equal Protection Clause and Due Process Clause.

It said the lower court’s ruling was incongruent with a recent Supreme Court decision that upheld Tennessee’s gender-affirming care ban for minors.

“Because the district court rested its permanent injunction on incorrect conclusions of law, it abused its discretion,” the appeals court ruled.

Arkansas’ Republican attorney general, Tim Griffin, celebrated the ruling.

“I applaud the court’s decision recognizing that Arkansas has a compelling interest in protecting the physical and psychological health of children and am pleased that children in Arkansas will be protected from risky, experimental procedures with lifelong consequences,” he said in a statement.

Gender-affirming care includes a range of therapies, from psychological, behavioral and medical interventions with surgeries for minors being exceedingly rare. The medical practice has been endorsed by every medical association.

Despite the evidence and the support of the medical community, Republicans and conservatives, often with the use of misinformation, have been targeting gender-affirming care amid a larger push threatening the rights of the LGBTQ community.

Arkansas passed the SAVE Act in 2021, but then-Gov. Asa Hutchinson vetoed it that same year, calling the ban a “product of the cultural war in America” that would interfere with the doctor-patient relationship. The GOP-majority legislature then overrode his veto, making Arkansas the first state to pass a bill banning gender-affirming care for minors in the United States.

Four transgender minors and their parents then challenged the law, saying it violated their rights, resulting in the 2023 ruling overturning the ban, which marked a victory in the fight for LGBTQ healthcare until Tuesday.

“This is a tragically unjust result for transgender Arkansans, their doctors and their families,” Holly Dickson, executive director of the American Civil Liberties Union of Arkansas, said in a statement.

“As we and our clients consider our next steps, we want transgender Arkansans to know they are far from alone and we remain as determined as ever to secure their right to safety, dignity and equal access to the healthcare they need.”

The ruling comes as Republicans seeking to restrict transgender healthcare have gained a support in the White House with President Donald Trump who has implemented several federal policies that align with their efforts.

On his first day in office, President Donald Trump signed an executive order making it federal policy that there are only two genders, male and female, both of which were determined at “conception.” He has also banned transgender Americans from the military and has sought to bar transgender athletes from competing on teams and in competitions that align with their gender identity.

Twenty-six states and the territory of Puerto Rico have banned gender-affirming care for minors, according to the Movement Advancement Project.

California and a coalition of other liberal-led states sued the Trump administration Friday over efforts to end gender-affirming care for transgender, intersex and nonbinary children and young adults nationwide — calling them an unconstitutional attack on LGBTQ+ patients, healthcare providers and states’ rights.

The lawsuit was brought by California Atty. Gen. Rob Bonta and officials from 15 other states and the District of Columbia. It challenges a Jan. 28 executive order by President Trump that denounced gender-affirming care as “mutilation” and called on U.S. Justice Department officials to effectively enforce a ban, including by launching investigations into healthcare providers.

The lawsuit notes the Justice Department last month sent more than 20 subpoenas to doctors and clinics that have provided such care nationwide, with justice officials suggesting they may face criminal prosecution.

Bonta’s office, in a statement, said such efforts “have no legal basis and are intended to discourage providers from offering lifesaving healthcare that is lawful under state law.” The lawsuit asks a federal court in Massachusetts to vacate Trump’s order in its entirety for exceeding federal authority and undermining state laws that guarantee equal access to healthcare.

The White House did not immediately respond to a request for comment Friday.

Trump made reining in transgender rights a key promise of his presidential campaign. Upon taking office, he moved swiftly to do so through executive orders, funding cuts and litigation. And in many ways, it has worked — particularly when it comes gender-affirming care for minors.

Clinics across the country that had provided such care have closed their doors in response to the threats and funding cuts. That includes the renowned Center for Transyouth Health and Development at Children’s Hospital Los Angeles, one of the largest and oldest pediatric gender clinics in the U.S.

The clinic told thousands of its patients and their families that it was shuttering last month. Other clinics have similarly closed nationwide, radically reducing the availability of such care in the U.S.

Republicans and other Trump supporters have cheered the closures as a major win, and they praised the president for protecting impressionable and confused children from so-called woke medical professionals pushing what they allege to be dangerous and irreversible treatments.

Bonta said in the Friday statement that Trump and his administration’s “relentless attacks” on such care were “cruel and irresponsible” and endangered “already vulnerable adolescents whose health and well-being are at risk.”

“These actions have created a chilling effect in which providers are pressured to scale back on their care for fear of prosecution, leaving countless individuals without the critical care they need and are entitled to under law,” Bonta said.

Mainstream U.S. medical associations have supported gender-affirming care for minors experiencing gender dysphoria for years. They and LGBTQ+ rights organizations have accused Trump and his supporters of mischaracterizing that care, which includes therapy, counseling and support for social transitioning, and can include puberty blockers, hormone treatment and, in rarer circumstances, mastectomies.

Queer advocates, many patients and their families say such care is life-saving, alleviating intense distress — and suicidal thoughts — in transgender and other gender-nonconforming youth. They and many mainstream medical experts acknowledge that gender-affirming care for young people is still a developing field, but say it is also based on decades of solid research by medical professionals who are far better equipped than politicians to help families make difficult medical decisions.

However, as the number of children who identify as transgender or nonbinary has rapidly increased in recent years, that argument has failed to take hold in many parts of the country. Conservatives and Republican leaders have grown increasingly alarmed by such care, pointing to young people who changed their minds about transitioning and now regret the care they received.

“Countless children soon regret that they have been mutilated and begin to grasp the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding,” Trump’s executive order stated.

Trump and others have escalated tensions further by spreading misinformation about kids being whisked away from school to have their gentials mutilated without their parents’ knowledge — which is not happening.

The battle has played out in the courts, in part as a state’s rights issue. In June, the Supreme Court ruled that conservative states may ban puberty blockers and hormone treatments for transgender teens, with the court’s conservative majority finding that states are generally free to set their own standards of medical care.

The Trump administration, however, has not taken the same view. Instead, it has aggressively tried to eradicate gender-affirming care nationwide, regardless of state laws — like those in California — that protect it.

Trump’s Jan. 28 executive order, titled “Protecting Children from Chemical and Surgical Mutilation,” claimed that “medical professionals are maiming and sterilizing a growing number of impressionable children under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions.”

It defined children as anyone under the age of 19, and said that moving forward, the U.S. wouldn’t “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another,” but would “rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures.”

The states’ lawsuit focuses on one particular section of that order, which directed Atty. Gen. Pam Bondi to convene state attorneys general and other law enforcement officials nationwide to begin investigating gender-affirming care providers and other groups that “may be misleading the public about long-term side effects of chemical and surgical mutilation.”

The section suggested those investigations could be based on laws against “female genital mutilation,” or even around a 1938 law known as the Food, Drug, and Cosmetic Act, which authorizes the Food and Drug Administration to regulate food, drugs, medical devices and cosmetics.

On July 9, Bondi announced the Justice Department’s subpoenas to healthcare providers, saying doctors and hospitals “that mutilated children in the service of a warped ideology will be held accountable.”

On July 25, The Times reported that Bill Essayli, the Trump administration’s controversial pick for U.S. attorney in L.A., had floated the idea of criminally charging doctors and hospitals for providing gender-affirming care, according to two federal law enforcement sources who spoke on the condition of anonymity for fear of reprisal.

The targeting of gender-affirming care is part of a wider effort by the administration to eliminate transgender rights more broadly, in part on the premise that transgender people do not exist. On his first day in office, Trump issued another executive order declaring there are only two sexes and denouncing what he called the “gender ideology” of the left.

His administration has sought to limit the options transgender people have to get passports that reflect their identities, and the Justice Department has sued California over its policies allowing transgender girls to compete against other girls in youth sports. Many transgender Americans are looking for ways to flee the country.

Still, many in the LGBTQ+ community fear the attacks are only going to get worse. Among those who are most scared are the parents and families of transgender kids — including those who believe their health records may have been collected under the Justice Department’s subpoenas.

One mother of a Children’s Hospital patient told The Times last month that she is terrified the Justice Department is “going to come after parents and use the female genital mutilation law … to prosecute parents and separate me from my child.”

Bonta is leading the lawsuit along with the attorneys general of Connecticut, Illinois, Massachusetts and New York. Joining them are Pennsylvania Gov. Josh Shapiro and the attorneys general of Delaware, the District of Columbia, Hawaii, Maine, Maryland, Michigan, Nevada, New Jersey, New Mexico, Rhode Island and Wisconsin.

July 9 (UPI) — The Justice Department on Wednesday announced that it had sent more than 20 subpoenas to doctors and clinics performing gender-affirming care for minors, as the Trump administration ramps up its attacks on this marginalized community.

No information about the doctors and clinics subpoenaed was provided by the Justice Department, though it suggested the subpoenas were part of investigations into “healthcare fraud, false statements and more.”

“Medical professionals and organizations that mutilate children in the service of a warped ideology will be held accountable by this Department of Justice,” Attorney General Pam Bondi said in a statement.

On June 18, the Supreme Court upheld a Tennessee law restricting access to gender-affirming care for minors.

The subpoenas come despite every major American medical association supporting gender-affirming care for both adults and youth, including the American Academy of Pediatrics.

Gender-affirming care includes a range of therapies, from psychological, behavioral and medical interventions, with surgeries for minors being exceedingly rare. According to a recent Harvard study, cisgender minors and adults were far more likely to undergo analogous gender-affirming surgeries than their transgender counterparts.

Despite the support of the medical community and the evidence, conservatives, Republicans and the Trump administration have continued to target this community with legislation affecting their medical care and rights.

The subpoenas were announced the same day that the Federal Trade Commission hosted a day-long workshop titled “The Dangers of Gender-Affirming Care for Minors,” during which Melissa Holyoak, an FTC commissioner, said that while they cannot make policy decisions limiting gender-affirming care, they can target the medical practice for deceptive statements.

“The FTC has previously enforced — and will continue to enforce — against deceptive representations made by medical practitioners, including claims in connection with treatments for transgender children,” she said, according to a copy of her remarks.

Also on Wednesday, the Department of Justice sued California over alleged Title IX violations concerning transgender athletes competing in women’s and girls’ sports.

The Democratic-led state has refused to comply with the Trump administration’s ban on transgender women and girls competing in sports that align with their gender identity.

Since returning to the White House in January, President Donald Trump has signed several executive orders targeting transgender Americans, including one directing the federal government to recognize only two sexes determined at “conception,” another restricting gender-affirming care for youth and a third banning transgender Americans from the military.

NASHVILLE, Tenn. — A U.S. Supreme Court decision upholding Tennessee’s ban on gender-affirming care for minors is leaving transgender children and their parents uncertain and anxious about the future.

The court on Wednesday handed President Trump’s administration and Republican-led states a significant victory by effectively protecting them from at least some of the legal challenges against many efforts to repeal safeguards for transgender people.

The case stems from a Tennessee law banning puberty blockers and hormone treatments for transgender minors. Opponents of gender-affirming care say people who transition when they’re young could later regret it.

Families of transgender children argue the ban amounts to unlawful sex discrimination and violates the constitutional rights of vulnerable Americans.

Student says ruling creates an unwelcome world

Eli Givens, who is transgender and testified against Tennessee’s gender-affirming care bill in 2023, said it’s devastating that lawmakers “who have called us degenerates, have told us that we’re living in fiction” are celebrating the court’s ruling.

The nonbinary college student from Spring Hill received mastectomy surgery in 2022 at age 17. They said the legislation inspired their advocacy, and they attended the Supreme Court arguments in the case last December, on their 20th birthday.

“We’re not making a world that trans youth are welcomed or allowed to be a part of,” Givens said. “And so, it’s just a really scary kind of future we might have.”

Jennifer Solomon, who supports parents and families at the LGBTQ+ rights group Equality Florida, called the ruling a decision “that one day will embarrass the courts.”

“This is a decision that every parent should be concerned about,” she said. “When politicians are able to make a decision that overrides your ability to medically make decisions for your children, every family should worry.”

Conservative activists take credit

Chloe Cole, a conservative activist known for speaking about her gender-transition reversal, posted on social media after the court’s decision that “every child in America is now safer.”

Cole was cited as an example by Tennessee Republicans as one of the reasons the law was needed.

Matt Walsh, an activist who was one of the early backers of Tennessee’s law, applauded the high court. Three years ago, Walsh shared videos on social media of a doctor saying gender-affirming procedures are “huge moneymakers” for hospitals and a staffer saying anyone with a religious objection should quit.

“This is a truly historic victory and I’m grateful to be a part of it, along with so many others who have fought relentlessly for years,” Walsh posted on social media.

Fears of what’s next after Supreme Court decision

Rosie Emrich is worried the court decision will embolden legislators in New Hampshire, where legislation banning hormone treatments and puberty blockers for children is expected to reach the governor’s desk.

Lawmakers are weighing whether to block the treatments from minors already receiving them, like Emrich’s 9-year-old child.

“It’s definitely disappointing, and I’m trying to figure out how I’m going to talk to my kid about it,” Emrich said.

Emrich said she and her husband have considered moving from New Hampshire and are waiting to see what will happen.

“The hard part is, like, I’ve grown up here, my husband has grown up here, we very much want to raise our family here,” she said. “And we don’t want to leave if we don t have to.”

A move across the country and other hurdles

Erica Barker and her family moved from Jackson, Mississippi, to North Las Vegas, Nevada, a little over two years ago so one of her children could start receiving gender-affirming care.

Barker’s transgender daughter, then 12, had been in therapy for three years, and the family agreed it was time for medical treatments.

Mississippi passed a ban on gender-affirming care for minors the next year, which Barker said she saw coming.

Barker said the move was complicated, involving a new job for her husband and two mortgages when their Mississippi home was slow to sell, but it also brought access to care for her daughter, now 14.

“Our hearts are hurting for folks who are not having the same experience,” Barker said.

In another state with a ban on gender-affirming care for minors, Oklahoma resident Erika Dubose said finding care for her 17-year-old nonbinary child, Sydney Gebhardt, involves a four-hour drive to Kansas and getting prescriptions filled in Oregon and mailed to their home.

“I just wish the younger folks wouldn’t have to go through this,” Gebhardt said. “These folks deserve to be focusing on their academics and hanging out with their friends and making memories with their families and planning out a safe and happy future.”

Mother says gender-affirming care saves lives

Sarah Moskanos, who lives near Milwaukee, said her 14-year-old transgender daughter went through nearly a decade of counseling before she started medical gender-affirming care but has been sure since the age of 4 that she identified as a girl.

“I would say that there is decades of research on this very thing,” she said. “And we know what works and we know what will save trans kids’ lives is gender-affirming care.”

Wisconsin doesn’t have a gender-affirming care ban, but Moskanos said getting her daughter that care has not been easy. She now worries about what the future holds.

“We are but one election cycle away from disaster for my kid,” she said.

Vowing not to disappear

Mo Jenkins, a 26-year-old transgender Texas native and legislative staffer at the state Capitol, said she began taking hormone therapy at 16 years old and has been on and off treatment since then.

“My transition was out of survival,” Jenkins said.

Texas outlawed gender-affirming care for minors two years ago, and in May, the Legislature passed a bill tightly defining a man and a woman by their sex characteristics.

“I’m not surprised at the ruling. I am disheartened,” Jenkins said. “Trans people are not going to disappear.”

Mattise, Mulvihill and Seewer write for the Associated Press. Mulvihill reported from Cherry Hill, N.J., and Seewer reported from Toledo, Ohio. AP journalists Susan Haigh in Hartford, Conn.; Kenya Hunter in Atlanta; Laura Bargfeld in Chicago; Nadia Lathan in Austin, Texas; and Daniel Kozin in Pinecrest, Fla., contributed to this report.