Gender-affirming health care for transgender youth is outlawed in Kentucky after a federal judge temporarily reversed an earlier order blocking the statewide ban.
In a surprising turn, the same federal judge who, in late June, blocked the portion of Senate Bill 150 banning gender-affirming health care for trans youth, granted a stay of that injunction on Friday, fulfilling a request from Republican Attorney General Daniel Cameron. Friday’s stay gives Cameron the power to, for the first time, enforce the statewide health care ban.
U.S. District Judge for the Western District of Kentucky David Hale’s reversal of his own order came a week after the Sixth Circuit Court of Appeals overturned a temporary injunction halting enforcement of a similar law in Tennessee. The appellate court’s ruling restored the Volunteer State’s gender-affirming care ban and consolidated both Kentucky’s and Tennessee’s cases in the same appeals process.
The preliminary ruling is a victory for Cameron, who had petitioned the appellate court in late June to overturn the lower court’s order and let him enforce the law. After the appellate court reversed Tennessee’s injunction, Cameron filed an emergency motion for Judge Hale to stay his injunction. And on July 14, Hale agreed.
“In light of (the Sixth Circuit’s) ruling, the court sees no basis to deny the requested stay . . . pending resolution of the appeal,” Hale wrote in his order.
Cameron celebrated the stay on Friday, calling the ruling “a win for parents and children.” He vowed to “continue to defend Senate Bill 150 and stand up for the right of children to be children, free from the influences of leftist activists and radical gender ideology.”
The district court’s stay of the injunction is not final, but it could remain in effect until the early fall, or until the appellate court considers arguments for a full appeal of the ban from lower courts in Tennessee and Kentucky. A final ruling is expected by September 30, the appellate court said in its July 7 order.
Kentucky’s health care ban is part of Senate Bill 150, a controversial omnibus law the GOP-controlled legislature passed earlier this year over Democratic Gov. Andy Beshear’s veto. It not only makes gender-affirming care illegal for trans youth, it restricts K-12 teaching on gender and sexuality, and mandates schools create policies that prevent trans students from using restrooms and locker rooms that match their gender identity.
The law’s school-related provisions took immediate effect after passage this spring. The medical portion of the law was slated to take effect June 29, until Judge Hale’s order blocked it a day before it was set to take effect. The other provisions of the law have yet to be challenged in court.
Seven trans kids and their families sued the state to challenge the law’s prohibition on hormones and puberty blockers in May, arguing that barring them from accessing that treatment under a doctor’s care violates their Fourteenth Amendment rights. They claim the law denies trans kids equal protection, and it denies parents of their due process rights to obtain evidence-based medical care for their children.
The American Civil Liberties Union of Kentucky, serving as attorneys for the plaintiffs, said in a Friday statement, “lawmakers have no place inserting themselves into the personal medical decisions of families of transgender youth and their health care providers. This is a temporary setback, but it is not the end of the fight.”
Rebecca Blankenship and Michael Frazier of Ban Conversation Therapy Kentucky said that while the order was disappointing, “it is not a final ruling on the merits of the case. Our united front for LGBTQ Kentuckians continues to believe that the law and the courts have the legal means to protect trans youth. We fight onward with an undaunted spirit, unwavering for all LGBTQ Kentuckians.”
What is gender-affirming care?
Friday’s temporary order is the latest legal volley in a case that has become a wedge issue for Cameron, who is running for governor to unseat Beshear.
In his motion for appeal in late June, Cameron wrote that by keeping gender-affirming medical care legal in Kentucky, trans kids were at risk of being “irreparably harmed” by a medical profession “pushing these treatments.”
Once the appellate court issued its preliminary ruling last week in Tennessee, Cameron filed an emergency motion asking for the same thing in Kentucky, saying it was “indefensible that leftist activists are disguising sterilization and genital surgeries as pediatric care for vulnerable children.” Cameron called gender-affirming care “child mutilation,” and vowed to “protect Kentucky kids from this radical agenda (and) irrational ideology.”
In his initial order granting a temporary injunction, Hale chided Cameron for using “unnecessarily inflammatory language.”
Gender-affirming health care includes a broad spectrum of patient-provider behavior and treatment, from calling a patient by their preferred name and pronouns, to the prescription of hormones and puberty blockers. Though not every trans patient will receive the same treatment regimen, the practice of patient-tailored gender-affirming care is the standard of care, according to all major U.S. medical associations.
Cameron, in his motion for appeal, wrote that the “evidence of the unscrupulous motives on the part of some in the medical profession pushing for these treatments abounds.” Senate Bill 150 will “protect children from treatment that causes long-term irreversible damage” as well as “abuse, neglect, (and) mistakes,” he wrote.
This claim was disputed in court filings by medical associations, including the American Medical Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry, which signed an amicus brief in support of the plaintiffs challenging the constitutionality of the law.
In that 34-page brief, which delves into the clinical understanding of gender dysphoria and effective treatment for it, more than 20 major medical associations explained why SB 150 will put trans youth at “risk of significant harm.”
Gender dysphoria, the brief explains, is a “clinical condition that is marked by distress due to an incongruence between the patient’s gender identity and sex assigned at birth.”
The “widely accepted recommendation of the medical community, including that of the respected professional organizations participating here . . . is that the standard of care for treating gender dysphoria is gender-affirming care,” they wrote.
What constitutes gender-affirming care varies for patients of different ages. For instance, for children who haven’t yet gone through puberty, the evidence-based standard of care is to provide mental health care to the patient and their family, not medical intervention, according to the brief.
At its root, gender-affirming care should begin with an evaluation by someone who has clinical expertise in gender identity development and child, adolescent and family mental health. That provider then helps a patient develop a tailored treatment plan.
If gender dysphoria is left untreated, or “treated improperly, (it) can result in debilitating anxiety, depression and self-harm, and is associated with higher rates of suicide,” the brief reads. “As such, the effective treatment of gender dysphoria saves lives.”
SB 150, the medical associations wrote, “denies adolescents with gender dysphoria in Kentucky access to medical interventions that are designed to improve health outcomes and alleviate suffering, and that are grounded in science and endorsed by the medical community.”
