Gender-affirming care ban goes into effect in Alabama

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Story at a glance

  • An Alabama law criminalizing gender-affirming care for transgender and nonbinary minors went into effect Sunday. Under the law, doctors providing gender-affirming care to patients under the age of 19 may face up to a decade in prison.

  • The measure was signed into law last month by the state’s Republican Gov. Kay Ivey and was immediately challenged in several lawsuits filed by affected families, doctors and LGBTQ+ advocacy organizations.

  • More than two dozen bills under consideration in state legislatures also aim to restrict access to gender-affirming health care. One other state — Arkansas — has passed legislation restricting access to gender-affirming care, but its enforcement was blocked by a federal judge in July.

An Alabama law criminalizing gender-affirming care for transgender and nonbinary minors went into effect Sunday, making it a felony — punishable by up to a decade in prison — for doctors in the state to provide or recommend puberty blockers, hormone therapies or other interventions to patients younger than 19 years old.

Alabama’s Republican Gov. Kay Ivey last month signed the measure into law, writing in a signing statement that, “I believe very strongly that if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl.”

The law was immediately challenged in several suits filed by Alabama physicians and families and LGBTQ+ advocacy groups who claim the measure threatens the health and well-being of transgender and nonbinary children, who already face higher rates of depression and anxiety and are at greater risk of attempting suicide.

A two-day hearing in a case filed by groups including the Human Rights Campaign and the Southern Poverty Law Center ended Friday with no signal from U.S. District Judge Liles Burke on whether he will grant a preliminary injunction halting the law’s enforcement while the suit is ongoing.

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Burke told plaintiffs — including four Alabama families, two doctors and a minister — Friday that his and his staff’s sole focus would be dedicated to their case, but that a ruling will likely come after the law takes effect.

“I want a well-reasoned order that is right on the law,” he said, according to the Alabama Political Reporter. “I just ask that everyone be patient.”

The Justice Department late last month joined in the lawsuit, which names Ivey, Alabama Attorney General Steve Marshall and two district attorneys as defendants, writing in a complaint that the state’s new law “denies necessary medical care to children based solely on who they are.”

Just one other state — Arkansas — has passed legislation seeking to restrict access to gender-affirming care for minors, but a federal judge in July blocked its enforcement pending the outcome of a lawsuit filed by the American Civil Liberties Union (ACLU).

More than two dozen bills under consideration in state legislatures also aim to restrict access to gender-affirming health care, according to the group Freedom for All Americans, which tracks such legislation.

But that tally excludes efforts to restrict access to treatments like puberty blockers or hormone therapies outside of state legislatures. In Texas, Gov. Greg Abbott (R) earlier this year ordered state agencies to open child abuse investigations into the parents of transgender and nonbinary minors, alleging they had been “abusing” their children in allowing them to receive gender-affirming care.

Those investigations have since been halted following a statewide injunction from a Texas judge.

Recent efforts have also targeted social transition, which may include a name or pronoun change or a decision to wear more gender-affirming clothing. A recent study published in the journal Pediatrics found that transgender youth are unlikely to “detransition” — or come to identify with the sex they were assigned at birth — five years after their social transition.

Legislators in 20 states as part of a coordinated effort led by the LGBTQ Victory Institute and other advocacy groups have introduced “trans refuge” bills to protect transgender minors and their families from laws targeting access to gender-affirming care.

“While these laws will look different in each state, the objectives are the same: shield trans kids and their families from penalties when seeking gender-affirming care to the greatest extent possible,” the Victory Institute said in a statement.

Gender-affirming care for transgender and nonbinary minors is supported by major medical organizations — including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association — all of which say restrictions on such care put the wellbeing of young people at risk.

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