Doctors Try to Shoot Down Arkansas Ban on Transgender Treatments for Minors

Attorneys push a cart laden with files in the complex case of Brandt v. Rutledge, which challenges the constitutionality of an Arkansas law banning transgender medical treatments for minors, as a trial begins on Oct. 17, 2022. Janice Hisle/The Epoch Times

LITTLE ROCK, Ark.—Two doctors testified on Oct. 17 in support of child transgender procedures as part of the opening day of the nation’s first federal court challenge of a statewide ban on the controversial treatments.

Transgender-identifying teens who were born female often seem “’over-the-moon’ happy” after mastectomies, as they see their bodies better “aligned” with a masculine gender identity, said Dr. Deanna Adkins, a North Carolina pediatric endocrinologist who has recommended these “top surgeries” for some of her patients.

In contrast, Adkins has also seen what can happen when gender-distressed youths do not get the interventions they’re seeking.

Adkins’ voice cracked as she said, “I lost a patient to suicide because (the patient) did not make it to their second visit.” That’s when the patient would have begun “gender-affirming” care, Adkins said. Such treatments can include puberty blockers, cross-sex hormones and surgeries.

Adkins was one of two doctors who testified on Oct. 17 in an Arkansas federal court, supporting the American Civil Liberties Union’s attempt to invalidate the nation’s first law banning transgender medical interventions for minors.

Judge James Moody will hear testimony through Oct. 21 in U.S. District Court, Little Rock. Then the case will recess until a few witnesses can be scheduled to testify, the judge said.

SAFE Act in Danger

The case revolves around the Save Adolescents from Experimentation (SAFE) Act. That law, which Arkansas lawmakers approved in April 2021, has been on hold pending the outcome of the ACLU’s challenge.

The closely watched trial comes at a time when “detransitioners,” people who regret using hormones and surgeries to change their bodies, have grown increasingly vocal.

They say euphoria over the procedures can fade, leaving lasting physical and mental scars—and lifelong medical costs.

But Dr. Dan Karasic, a California psychiatrist who testified for the plaintiffs, said, “There’s not this incredible explosion” of detransitioners, as far as he can see. He thinks media reports about this phenomenon are overblown.

Karasic and Adkins both testified that they consider gender-transitioning medical procedures to be safe and effective for minors when administered after careful evaluation—a contention that the defendants dispute.

Several European nations have curtailed gender-transition drugs for youths because evidence is lacking and concerns are rising.

However, the two doctors who testified against the SAFE Act say that young people suffering from gender dysphoria, a diagnosis of persistent distress over gender incongruity, frequently see dramatic improvement in their distress after going on these treatments.

Karasic and Adkins each treated hundreds of adolescents for gender dysphoria;  neither has recommended genital surgery for anyone under the age of 18, and they said few doctors do. Karasic learned of at least one report of a 15-year-old undergoing genital surgery.

The ACLU used the two doctors’ testimony to chip away at assertions that SAFE Act supporters have made in court records and are expected to repeat when they appear for live testimony.

Stickers on the back of a car show support for the American Civil Liberties Union of Arkansas and for "Trans Magic," on a vehicle parked outside U.S. District Court, Little Rock, Ark, on Oct. 17, 2022. Janice Hisle/The Epoch Times

Guidelines

Karasic and Adkins say they think few doctors are doing what SAFE Act supporters allege: pushing young patients and their parents to go along with escalating medical treatments, with little or no assessment and inadequate warnings about the risks.

“It’s not good practice” to propel patients along a certain path for the sake of an agenda, as alleged, Karasic said. “It’s not our role to tell them who they should be,” he said.

He and Adkins both described detailed processes for identifying underlying issues that could affect gender-dysphoric children, such as autism, family dysfunction, sexual abuse, trauma or behavioral disorders.

“Every patient gets an individualized care plan,” Adkins said. Puberty blockers are used fairly rarely in her practice, which spans 22 years and involves treatment of all types of endocrine issues in children.

They also said patients’ treatment plans change as time passes, not a one-time consultation, in their medical practices. Patients’ situations change, and so does research, the doctors noted.

Since Adkins began treating patients for gender dysphoria, she has treated about 600 such youths. Twelve  of those patients were put on puberty blockers; nine remain on the drugs. Some can stay on them for years, even into their 20s, to prevent undesired changes in their bodies’ appearance.

Unconstitutionality

The ACLU’s lawsuit was filed on behalf of four transgender youths, ages 9-16, their families, and two doctors who provide treatment to gender-dysphoric youths in Arkansas.

State lawmakers say the SAFE Act is just the latest example of the state fulfilling its obligation to protect minors. If the law were to take effect as written, any doctor caught violating it could face professional discipline, and minors who underwent the procedures would have the right to sue for 20 years past their 18th birthday.

But the ACLU alleges that the SAFE Act is unconstitutional for three reasons.

It “discriminates on the basis of sex and transgender status,” the lawsuit says, and also interferes with parents’ rights to make healthcare decisions for their children.

Lastly, the ACLU argues, the SAFE Act infringes upon doctors’ First Amendment right to communicate with patients, as it would forbid doctors from making referrals to providers who can perform the procedures.