Texas, Missouri Judges Issue Contrasting Rulings on Transgender Treatments for Minors

A bathroom is set aside for transgender students at the University of California Irvine, in Irvine, Calif., on Sept. 25, 2020. John Fredricks/The Epoch Times

Judges in Texas and Missouri issued separate, contrasting rulings on Friday regarding whether people under 18 can receive certain gender transition procedures in the respective states.

In Texas, a judge ruled against the state’s ban on gender transition procedures for minors, stopping it from taking effect next week as she continues to review amid an ongoing legal challenge.

Over in Missouri, a separate judge declined to block a ban on gender transition procedures that’s due to take effect on Aug. 28.

The two decisions were issued just hours apart.

Texas Freezes Judge’s Decision

The office of Texas Attorney General Ken Paxton, a Republican, in response to the ruling from state District Judge Maria Cantu Hexsel, swiftly filed an appeal (pdf) to the Texas Supreme Court to have the ban on gender transition—also known as Senate Bill 14—back on track to take effect on Sept. 1.

Texas operates under a legal framework within which an appeal instantly freezes the decision in question, which means Judge Cantu Hexcel’s ruling has been put on hold pending a decision by the Texas Supreme Court.

In a statement on Friday, Mr. Paxton’s office said it “will continue to enforce the laws duly enacted by the Texas Legislature and uphold the values of the people of Texas by doing everything in its power to protect children from damaging ‘gender transition’ interventions.”

Judge Cantu Hexsel, who was elected and ran as a Democrat, had ruled (pdf) in favor of a group of doctors and families of children with gender dysphoria. The American Civil Liberties Union (ACLU) of Texas and Lambda Legal had sued on their behalf to challenge the law, which Mr. Abbott signed in June. The plaintiffs had argued the law would violate parents’ rights and have devastating consequences for the gender dysphoric minors.

The law’s “prohibition on providing evidence-based treatment for adolescents with gender dysphoria stands directly at odds with parents’ fundamental right to make decisions concerning the care of their children,” the judge wrote in her decision.

She also determined that the state’s ban would discriminate against gender dysphoric minors who seek the procedures, and would require doctors “to disregard well-established, evidence-based clinical practice guidelines, and their training and oaths, thereby significantly and severely compromising the health of their patients with gender dysphoria” under threat of losing their license to practice medicine.

“The court decision is a critical victory for transgender youth and their families, supporters and health providers against this blatantly unconstitutional law,” Brian Klosterboer of the ACLU of Texas, a lawyer for the families, said in a statement, prior to the decision being stayed due to the appeal.

Mr. Paxton’s office said Friday that Senate Bill 14 “prohibits hospitals from administering experimental hormones or conducting mutilative ‘gender transition’ surgical procedures on minors.”

“These unproven medical interventions are emphatically pushed by some activists in the medical and psychiatric professions despite the lack of evidence demonstrating medical benefit, and even while growing evidence indicates harmful effects on children’s mental and physical welfare,” the office stated.

Missouri’s Ban on Gender Transition for Minors

In Missouri, a ruling by St. Louis Circuit Judge Steven Ohmer means that health care providers will be barred from performing transgender surgeries on minors starting Aug. 28.

Minors already on puberty blockers or hormones prior to Aug. 28 can maintain their regimen, but new access for others will be restricted, according to the law, Senate Bill 49, signed on June 7 by Gov. Mike Parson, a Republican.

Also under the law, funding through Medicaid for these procedures will be halted for adults, and prisoners and inmates won’t be offered these surgeries by the state.

Doctors who breach the law risk losing their licenses and facing lawsuits from patients. The legislation streamlines the process for former patients to file lawsuits, offering them a 15-year window and ensuring a minimum of $500,000 in damages if they win.

Judge Ohmer on Friday rejected a request to temporarily block Missouri’s legislation as the court challenge against it plays out. He said in his order (pdf), “petitioners have not clearly shown a sufficient threat of irreparable injury absent injunctive relief.”

The legal challenge (pdf) was filed in July by ACLU of Missouri, Lambda Legal, and Bryan Cave Leighton Paisner, on behalf of doctors, LGBT organizations, and three families of minors with gender dysphoria. They argued that Missouri’s law is discriminatory and would “cause severe and irreparable harm” to the gender dysphoric minors.

“Withholding or restricting gender-affirming medical care from individuals with gender dysphoria when it is medically indicated puts them at risk of severe, irreversible harm to their health and well-being,” the groups wrote in the lawsuit.

Judge Ohmer wrote in his Friday ruling: “The science and medical evidence is conflicting and unclear. Accordingly, the evidence raises more questions than answers. As a result, it has not clearly been shown with sufficient possibility of success on the merits to justify the grant of a preliminary injunction.”

The judge also said that the plaintiffs’ arguments were “unpersuasive and not likely to succeed.”

The next hearing in the case is scheduled for Sept. 22.

‘Gender Affirming Care’

At least 20 U.S. states have passed laws that shield minors from transgender surgeries and related procedures. Proponents of the procedures call them “gender-affirming care,” while opponents consider gender dysphoria to be a psychological issue that needs psychological solutions.

In recent years, the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) have issued statements in support of “gender-affirming care.”

Both groups assert that gender transition procedures can improve a gender dysphoric person’s mental health and result in lower rates of suicide, and that forgoing such care puts the patient at higher risk of anxiety, stress, substance abuse, and suicide.

But the groups’ statements don’t acknowledge that some gender transition procedures render the individual highly unlikely to be able to reproduce or make other changes that are irreversible.

The Association of American Physicians and Surgeons (AAPS) in February issued an official statement to warn about “unknown and unknowable long-term risks” it says are inherent to “gender-affirming care” in minors, noting that the consequences of gender transition surgery are irreversible.

More Experts Warn Against Transgender Procedures

Earlier in July, 21 clinicians and researchers from nine countries—Finland, the United Kingdom, Sweden, Norway, Belgium, France, Switzerland, South Africa, and the United States—signed a letter to say that the “best available evidence” doesn’t support treating gender dysphoria with various transgender procedures, as is being done in the United States.

“Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty,” the international experts wrote in their letter published in the Wall Street Journal on July 13.

The risks, however, are significant, they said in their letter. Risks include “sterility, lifelong dependence on medication, and the anguish of regret.”

Because of this, “more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth,” they wrote.

The experts also disputed the assertion that gender transition reduces suicides, writing, “There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.”

“The politicization of transgender healthcare in the U.S. is unfortunate,” they said. “The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.”