How the 14th Amendment is changing the fight for gender-affirming care for minors (2023)

LITTLE ROCK, Ark. – In a landmark ruling, a federal judge has overturned a state's law banning gender-affirming health care for minors as near-identical bans are being debated in statehouses across the country.

U.S. District Judge Jay Moody struck down Tuesday Arkansas' first-in-the-nation ban as unconstitutional, arguing it violated young people's right to equal protection under the law and due process, and those of their parents. He also ruled Arkansas' law violated the free speech rights of doctors in the state.

"There's no question this is a huge victory; it's a precedent. We all hope and pray that this will have a ripple effect and an impact on other legislators and courts across the country," Cathy Renna, communications director for the National LGBTQ Task Force, told USA TODAY.

What is gender-affirming care?

Moody's ruling comes after nearly 20 other states have banned or restricted care for transgender youth. Young people who have already socially transitioned (through changes in hair, clothes and name) have said they need access to gender-affirming puberty blockers to avoid developing physical characteristics that would make them have negative feelings of gender dysphoria.

More than half the bans on gender-affirming health care passed in other states have been challenged in court in recent years by groups including the American Civil Liberties Union. In a few states, judges have temporarily blocked bans, which advocates have long argued target vulnerable young people for the purpose of scoring political points from anti-LGBTQ voters. But Moody's ruling is the first in the United States to fully block a gender-affirming care ban.

"We hope that this sends a message to other states about the vulnerability of these laws and the many harms that come from passing them. We’re so thankful for the bravery of our clients and the tireless work of advocates in Arkansas," said Chase Strangio, deputy director for transgender justice at the ACLU’s LGBTQ & HIV Project.

How the 14th Amendment is changing the fight for gender-affirming care for minors (1)

What does the Arkansas case mean for LGBTQ youth in other states?

Across the country, a patchwork of proposed and enacted laws targeting the rights of LGBTQ youth have sparked student protests and forced some families to flee hostile states, USA TODAY has reported.

"Transgender kids across the country are having their own futures threatened by laws like this one, and it's up to all of us to speak out, fight back, and give them hope," said Dylan Brandt, a 17-year-old trans boy in Arkansas and the lead plaintiff in the case.

Moody's decision to overturn Arkansas' ban, which had been on the books for over 18 months, could discourage other states from enacting their own bans, because lawmakers will likely get tied up in court and will have a legal disadvantage because of the precedent Moody's legal opinion sets, legal experts predicted.

This month, in an unprecedented warning to LGBTQ Americans in every state, the Human Rights Campaign declared a state of emergency for LGBTQ rights and urged queer people to be on the lookout for threats of violence and protect each other from harm.

At the same time, the majority of Americans report they oppose the restrictions being passed in GOP-led states, according to a recent poll from the nonpartisan research firm NORC at the University of Chicago and the Williams Institute at UCLA.

"This needs to recharge our batteries," Renna said. "Because the fight is far from over. We're in the middle of a terrible storm and the clouds cleared for a moment, but the storm will start again."

Along with Brandt, three other families of transgender youth and two doctors filed the lawsuit against Arkansas' ban in May 2021.

Conservative state lawmakers who sponsor these kinds of bans argue gender-affirming medical care is harmful because some physical changes can be irreversible. But qualified health care providers have consistently rebutted the claims, arguing many effects of puberty blockers and hormone replacement therapy do stop once treatment is stopped.

Why did Judge Jay Moody overturn Arkansas' ban on trans youth care?

In his decision to overturn the law, Moody said the Constitution's 14th Amendment "forbids states to 'deprive any person of life, liberty, or property, without due process of law.'"

For transgender young people in Arkansas, Moody wrote, “The liberty interest at issue in this case – the interest of parents in the care, custody, and control of their children – is perhaps the oldest of the fundamental liberty interests recognized by this Court."

In last year's trial, a doctor testified Arkansas' law would restrict her freedom of speech by barring her from referring her patients to other health care providers for the treatment they sought and needed.

Moody's agreed with the plaintiff, ruling the law was unconstitutional because it focused solely on speech doctors could make related to gender-affirming care.

Moody ruled the law was a "viewpoint-based regulation" of speech, "because it restricts healthcare professionals from making referrals for 'gender transition procedures' only, not for other purposes," he wrote in his decision.

Legal experts said Moody's legal decision will be a "persuasive" opinion for judges in other states to consider when they preside over similar lawsuits against bans on gender-affirming care.

The most important outcome of Tuesday's ruling is that Moody found Arkansas' expert witnesses to be not credible, Remy Green, a civil rights lawyer in New York City, told USA TODAY.

In his decision, Moody wrote Arkansas' witnesses who testified in support of the ban lacked qualifications to offer their opinions, failed to support their opinions and admitted they were not experts in the treatment of gender dysphoria.

"The state of Arkansas was asked to get the best people they could get and got the medical equivalent of crumbs, loose change and an expired CVS receipt pulled from their pocket," Green said. "These are not serious people. It's absolutely garbage."

In a key victory for LGBTQ advocates, Moody points out in his decision that other states across the country are carting out the exact same expert witnesses that testified in the Arkansas trial, Green said.

Moody wrote in his ruling that the doctors who claimed to be experts on gender-affirming care were recruited by the Alliance Defending Freedom (a Christian legal advocacy group) for the purpose of testifying in court against lawsuits brought by LGBTQ advocates.

"If the Alliance Defending Freedom could have pulled experts that actually had relevant credentials they would have," Green said. "These experts are the best they got."

Arkansas' Republican Attorney General Tim Griffin said in a statement he planned to appeal Moody’s ruling to the 8th U.S. Circuit Court of Appeals, which last year upheld the judge’s temporary order against the law.

If the state of Arkansas appeals, it would be a "mistake," Green said, because officials there will likely lose. At that point, all the other states in the U.S. 8th Circuit Court of Appeals would be "bound" to the appeals ruling out of Arkansas and they would have to overturn their own laws banning gender-affirming care, Green said.

How the 14th Amendment is changing the fight for gender-affirming care for minors (2)

What states have temporarily blocked gender-affirming care bans for minors?

Federal judges in these states have temporarily blocked laws that banned gender-affirming health care for people under 18, the ACLU states on its website.

In 2023 thus far, the ACLU has challenged seven new laws similar to Arkansas’s ban.

How the 14th Amendment is changing the fight for gender-affirming care for minors (3)

What states have passed youth gender-affirming care bans?

A long list of states have passed and/or enacted laws prohibiting gender-affirming care for people under 18. Some of the first bans were passed in 2021, and many states have passed laws throughout 2023. In some states, elected officials banned gender-affirming health care via orders, circumventing the state legislature.

Here are the states that have restricted or banned gender-affirming health care for minors:

  • Florida.
  • Georgia.
  • Idaho.
  • Indiana.
  • Iowa.
  • Kentucky.
  • Mississippi.
  • Missouri.
  • Montana.
  • Nebraska.
  • North Dakota.
  • Oklahoma.
  • South Dakota.
  • Tennessee.
  • Texas.
  • Utah.
  • West Virginia.

What states are set to pass youth gender-affirming care bans?

LGBTQ advocates warn GOP-lawmakers in these states are poised to soon pass bans similar to the one that was just overturned in Arkansas:

How the 14th Amendment is changing the fight for gender-affirming care for minors (4)

When did Arkansas pass gender-affirming ban for youth?

Arkansas Republican lawmakers enacted the ban in 2021, overriding a veto from then-GOP Gov. Asa Hutchinson.

At the time, Hutchinson said the law went too far because it cut off treatments for children who were already on a puberty blocker or hormone replacement therapy treatment.

Moody's decision follows a weekslong trial that took place in the fall of 2022, in which Brandt testified the ban would force him to leave his home state to get treatment legally elsewhere.

The ACLU celebrated the judge's decision Tuesday, saying lies about gender-affirming care presented by defendants fell apart in court.

"This decision sends a clear message. Fear-mongering and misinformation about this health care do not hold up to scrutiny," said Holly Dickson, executive director of the ACLU of Arkansas.

Brandt said the ban would have endangered many people's lives.

“I’m so grateful the judge heard my experience of how this health care has changed my life for the better,” said Brandt.

Contributing: The Associated Press


How the 14th Amendment is changing the fight for gender-affirming care for minors? ›

How the 14th Amendment is changing the fight for gender-affirming care for minors. LITTLE ROCK, Ark. – In a landmark ruling, a federal judge has overturned a state's law banning gender-affirming health care for minors as near-identical bans are being debated in statehouses across the country.

What is the gender affirmation policy? ›

Broadly speaking, a GAP is a policy document that outlines an organisation's position and supports available for employees who are affirming, transitioning or questioning their gender identity or expression.

Can you get HRT without parental consent? ›

For now, you can legally get HRT across the United States on your own if you're 18+, or with a parent's consent if you're under 18. But access isn't just about the law: Some health care providers require both parental consent and a minimum age requirement for people younger than 18.

How old do you have to be to get hormone blockers? ›

You may need to wait until you are 16 to begin hormone treatment, but you may be able to take puberty blockers in the meantime. Does hormone treatment also work as birth control?

Do puberty blockers cause infertility? ›

Taking puberty blockers alone should not affect your ability to have a baby in the future. But if you also take estrogen or testosterone, this can affect it. If your body has ovaries that produce eggs, taking testosterone can affect the ability to produce them.

What is the main purpose of gender policy? ›

The GPC covers a range of issues—including economic security, health, gender-based violence and education—with a focus on gender equity and equality, and particular attention to the barriers faced by women and girls.

What is the US Gender Recognition Act? ›

What is the Gender Recognition Act (GRA)? The Gender Recognition Act or GRA is a comprehensive bill that updates and clarifies many issues related to name changes and correcting sex designations/gender markers on identity documents (IDs) for transgender and nonbinary New Yorkers and those born in New York State.

Can you start testosterone at 14? ›

Doctors can prescribe estrogen or testosterone at gradually higher amounts to mimic the puberty of the female or male gender. The Endocrine Society recommends that kids start taking these hormones around age 16, but doctors will start them as early as 13 or 14.

What is the oldest age to start HRT? ›

Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.

Does Planned Parenthood use informed consent for HRT? ›

Transgender hormone therapy is available through our expanded online care services. Planned Parenthood uses an informed consent model.

At what age can gender dysphoria be diagnosed? ›

Gender dysphoria and/or coming out as transgender can occur at any age. The DSM-5-TR* distinguishes between Gender Dysphoria in Childhood for those who experience Gender Dysphoria before puberty. The diagnosis of Gender Dysphoria in Adolescents and Adults can occur at any age.

Can you get top surgery at 13? ›

Is it possible to be 'too young' for top surgery? Yes, it's possible to be too young for top surgery. Many surgeons will not perform top surgery on adolescents under age 16. Additionally, many insurance providers do not cover top surgery or other gender affirming surgeries for adolescents under age 16.

Are puberty blockers FDA approved for gender dysphoria? ›

The FDA hasn't approved them for gender dysphoria, and their effects are serious and permanent. The fashion for transgenderism has brought with it a new euphemism: “gender-affirming care,” which means surgical and pharmacological interventions designed to make the body look and feel more like that of the opposite sex.

What is a long-term side effect of puberty blockers? ›

Use of GnRH analogues also might have long-term effects on:
  • Growth spurts.
  • Bone growth.
  • Bone density.
  • Fertility, depending on when the medicine is started.
Jun 14, 2023

What happens when a woman takes testosterone to become a man? ›

Your body will begin to redistribute your weight. Fat will diminish somewhat around your hips and thighs. Your arms and legs will develop more muscle definition, with more prominent veins and a slightly rougher appearance, as the fat just beneath the skin becomes a bit thinner.

Do puberty blockers stop brain development? ›

Puberty blockers delay the start of puberty, including development of secondary sex characteristics. Surprisingly, even though puberty blockers are widely used to help transgender adolescents go through gender transition, their impact on brain function during this critical stage of brain development is largely unknown.

What are the benefits of gender equality policy? ›

Gender equality prevents violence against women and girls

men's control of decision-making and limits to women's independence. rigid gender roles and stereotypes. male relationships that emphasise aggression and disrespect towards women.

How can we promote gender equality? ›

  1. Women earn 10 to 30 per cent less than men for the same work. Pay inequality persists everywhere. ...
  2. Find a Goal 5 charity you want to support. ...
  3. Be aware of gender stereotypes. ...
  4. Stand up against harassment. ...
  5. Find female mentors/leaders. ...
  6. Share the workload at home. ...
  7. Stay informed.

Why gender is a development issue? ›

Thus gender is culture specific. Gender not only varies from one culture to another but it also varies within cultures over time; culture is not static but evolves. S societies become more complex, the roles played by men and women. are not only determined by culture but by socio-political and economic factors.

What states can you change your gender? ›

In all 50 states, transgender individuals can legally change their gender on their driver's license. But the process can be challenging. Some states require a birth certificate amendment and/or proof of gender-affirming surgery.

What is gender neutrality in USA? ›

Gender neutrality emphasizes the equal treatment of men and women and people of any other gender legally with no discrimination whatsoever. This goal is, in principle, shared with both feminists and masculists.

What are gender mandates? ›

Gender Mainstreaming Mandates. 107. (q) Adopt specific preventive measures to protect women, youth and children from any abuse - sexual abuse, exploitation, trafficking and violence, for example - including the formulation and enforcement of laws, and provide legal protection and medical and other assistance.

Can a 13 year old take estrogen? ›

While the Endocrine Society's guidelines suggest 16, more and more children are starting hormones at 13 or 14 once their doctors, therapists and families have agreed that they are mentally and emotionally prepared.

Can 14 year olds take estrogen? ›

Hormonal therapy is safe for almost all girls and teens to use, even those using other medications.

What does male testosterone do to a 14 year old boy? ›

Purpose: During human puberty, there is an approximate 30-fold increase in testosterone production in boys. This increase is often linked to changes in mood and behavior in adolescence such as aggression, an increase in risk taking, and depression.

At what age should a woman stop taking estrogen? ›

If you are healthy, most experts agree that HRT is safe to use at the lowest dose that helps for the shortest time needed. If you're 59 or older, or have been on hormones for 5 years, you should talk to your doctor about quitting.

Should a 70 year old woman take estrogen? ›

There is good news for older women age who are experiencing menopause symptoms like hot flashes and night sweats. You can safely get relief with hormone therapy (HT), according to the North American Menopause Society (NAMS).

Do you age slower with HRT? ›

In addition to increasing longevity, hormone replacement therapy can help to address many of the changes we experience as we grow older. Estrogen therapy is associated with healthier and younger-looking skin in women.

How much does male to female transition surgery cost? ›

Cost of undergoing Sex Reassignment Surgeries (SRS) at Private hospitals or clinics can range between Rs 2 to Rs 5 lakh for a male to female (MTF) transition, for a female to male (FTM) is anywhere between Rs 4 to Rs 8 lakh.

How much does male to female surgery cost? ›

Gender reassignment surgery cost varies depending on the type of transition. For male to female (MTF) transition, the cost ranges from $2438 to $6095. For female to male (FTM) transition, the cost falls between $4876 and $9752.

Is hormone therapy reversible? ›

Many of the effects of hormone therapy are reversible, if you stop taking them. The degree to which they can be reversed depends on how long you have been taking them. Some breast growth, and possibly reduced or absent fertility are not reversible.

What is the root cause of gender dysphoria? ›

No one knows exactly what causes gender dysphoria. Some experts believe that hormones in the womb, genes, and cultural and environmental factors may be involved.

Can children feel gender dysphoria? ›

Children are typically diagnosed with gender dysphoria if they have experienced significant distress for at least six months and at least six of the following: strong desire to be of the other gender or an insistence that they are the other gender. strong preference for wearing clothes typical of the opposite gender.

Can gender dysphoria start at 14? ›

While symptoms of gender dysphoria often appear in early childhood, it's not uncommon for them to first appear during adolescence or, in some cases, even adulthood.

What is the regret rate for gender affirming surgery? ›

In a review of 27 studies involving almost 8,000 teens and adults who had transgender surgeries, mostly in Europe, the U.S and Canada, 1% on average expressed regret. For some, regret was temporary, but a small number went on to have detransitioning or reversal surgeries, the 2021 review said.

How much is top surgery for a 14 year old? ›

The two- to four-hour procedure costs anywhere from $9,000 to $17,000, depending on facility and anesthesia fees. The procedure is often not covered by insurance until patients turn 18.

Can a 13 year old get breast implants? ›

There are no specific laws in the United States that prevent teenagers from getting cosmetic surgery; however, parental consent is required for patients under the age of 18.

What is the lowest age for puberty blockers? ›

Clinicians who treat transgender children wait until the start of puberty, which can begin as early as 8 or 9, before considering puberty blockers. Rafferty says most of his patients on puberty blockers are between the ages of 10 and 12.

What is the FDA warning for puberty blockers? ›

The warning informs users of the possibility of developing something called a pseudotumor cerebri. According to Mayo Clinic, pseudotumor cerebri happens when there is increased pressure inside the skull “for no obvious reason.” Symptoms mimic those of a brain tumor.

Is there medication to stop gender dysphoria? ›

Medical treatment

Some people use hormone therapy to seek maximum feminization or masculinization. Others might find relief from gender dysphoria by using hormones to minimize secondary sex characteristics, such as breasts and facial hair.

What is gender inclusive policy? ›

Gender Inclusiveness Policy promotes gender-balanced management and takes gender perspectives into consideration in every decision-making, planning, and administration process at every level of the state government.

What is the policy of gender neutrality? ›

Description. Policies that are not specifically aimed at either women or men and are assumed to affect both sexes equally.

What is the meaning of gender responsive policy? ›

Gender-responsive policymaking helps more than just women — it is about addressing the different needs and priorities of all persons regardless of their sex. Doing so helps ensure that all members of a community are equally valued, policies are more effective, and the world is more just, productive and peaceful.

Is gender affirmation the same as gender transition? ›

Gender affirmation (aka Gender transition)

Gender affirmation may involve social, medical and/or legal steps that affirm a person's gender. Affirming our gender doesn't mean changing gender, 'having a sex change' or 'becoming a man or a woman', and transition isn't the same as being trans.

What is the gender inclusion policy in schools? ›

AB 1266 requires a pupil be permitted to participate in sex-segregated school programs, activities, and facilities including athletic teams and competitions, consistent with his or her gender identity, regardless of the gender listed on the pupil's records.

What are examples of gender inclusive? ›

Some examples include:
  • Folks, folx, or everybody instead of guys or ladies/gentleman.
  • Humankind instead of mankind.
  • People instead of man/men.
  • Members of Congress instead of congressmen.
  • Councilperson instead of councilman/councilwoman.
  • First-year student instead of freshman.
Aug 27, 2018

What are some gender equality policies? ›

Empowering Women at Work: Company Policies and Practices for Gender Equality
  • Achievement of equal pay for work of equal value;
  • Prevention and elimination of violence and harassment;
  • Creating a harmonious work-life balance for both women and men;
  • Equal representation of women in business and management roles;

What are 3 policies to address the gender pay inequality in the US? ›

  • Don't prohibit workers from discussing pay. To counter pervasive gender bias, state policymakers in several states have passed laws banning pay secrecy. ...
  • Don't base employee pay on salary history. ...
  • Make salaries public.
Apr 10, 2018

What are the cons of gender neutrality? ›

Possible Cons of gender-neutral Parenting

Possible drawbacks of gender-neutral parenting include: Increased risk of bullying: Other children are quick to notice differences among their peers, and children who don't follow gender norms may be subject to teasing or bullying.

Which policy created a gender imbalance? ›

Overall, the one-child policy has resulted in a surplus of 32.5 million men in China aged 5 to 39. This gender imbalance, created by the one-child policy, makes it more difficult for men to find partners and start families.

What is the gender equality strategy Save the Children? ›

Our vision is for a world where all girls and boys are equally heard and valued, where they have equitable access and time to devote to education, to work, to rest and to play.

What are gender policy strategies? ›

The Gender Equality Strategy 2022-2025 sets out an ambitious agenda to help countries embrace complexity and find new solutions, responding with flexibility and promoting learning instead of compliance or rigid responses to gender equality.

What is the gender equality strategy plan? ›

What is a gender strategy? A gender equality strategy outlines the vision for combatting gender inequality in an organisation and holds the organisation accountable by setting measurable objectives for progress.

What are the types of gender-affirming care for minors? ›

Gender affirmation can include various procedures such as hormone therapy, genital reconstruction, breast reconstruction, facial plastic surgery, speech therapy, urologic and psychiatric services and primary care.

How do you affirm gender identity? ›

Encourage and affirm self-identification
  1. Use "updated" in the place of "preferred" when referring to a name transition.
  2. Use "pronouns" in place of "preferred pronouns."
  3. Do NOT assume gender or pronouns.
  4. Introduce yourself with your pronouns. ...
  5. If you do introductions, suggest that individuals say their names and pronouns.

What is the most common type of male to female gender affirmation surgery? ›

The most common surgeries are vaginoplasty for the transfeminine population, and phalloplasty and metoidioplasty for transmasculine patients.


Top Articles
Latest Posts
Article information

Author: Jeremiah Abshire

Last Updated: 17/01/2024

Views: 6424

Rating: 4.3 / 5 (54 voted)

Reviews: 93% of readers found this page helpful

Author information

Name: Jeremiah Abshire

Birthday: 1993-09-14

Address: Apt. 425 92748 Jannie Centers, Port Nikitaville, VT 82110

Phone: +8096210939894

Job: Lead Healthcare Manager

Hobby: Watching movies, Watching movies, Knapping, LARPing, Coffee roasting, Lacemaking, Gaming

Introduction: My name is Jeremiah Abshire, I am a outstanding, kind, clever, hilarious, curious, hilarious, outstanding person who loves writing and wants to share my knowledge and understanding with you.