Judge finds state statue would cause child plaintiffs 'irreparable harm'...
By Ernest A. Canning on 6/14/2023, 9:57am PT  

Last week, a U.S. District Court judge in the Southern District of Florida issued an important preliminary injunction [PDF] to a cruel state measure blocking medical treatment for transgender kids.

Relying upon medical science and a U.S. 8th Circuit Court of Appeal decision handed-down last year, Judge Robert Hinkle temporarily enjoined provisions of a Republican-engineered state statute and rules issued by state medical boards to enforce it, which make it a crime and grounds for terminating a license to practice medicine, for physicians who furnish minors (under 18) with gender-affirming care.

In his 44-page ruling, Judge Hinkle found that the plaintiffs (adolescent transgender children and their parents) were likely to succeed in their claims that the state's new restriction on gender-affirming care violates the Due Process and Equal Protection Clauses of the 14th Amendment to the U.S. Constitution. Allowing the law to take effect, he explained, was likely to cause "irreparable harm" to the child plaintiffs...

Medical science

Judge Hinkle brushed aside the bias and hysteria that led to passage of FL's statute. That bias and hysteria could be found in the remarks of one defense "expert" who claimed that "gender-affirming care is a 'lie', a 'moral violation,' a 'huge evil,' and 'diabolical'." Those assertions, along with claims that "treatment of transgender individuals is either a 'woke idea' or profiteering by the pharmaceutical industry or doctors" amounted to nothing more than "dog whistles", according to the court.

As conceded by the medical defendants, including the Sunshine State's Surgeon General and the physician members of the state's medical boards, "gender identity is real."

"With extraordinarily rare exceptions," the court noted, "every person is born with external characteristics, male or female, and chromosomes to match." This is what is known as a person's "natal" sex. For more than 99% of individuals, "gender identity" matches each person's natal sex. Thus, more than 99% of individuals are "cisgender". "For less than 1%, the natal sex and gender identity is opposite" ("transgender").

Transgender people face a much higher risk of mental health disorders, the judge found, including gender dysphoria. He wrote that the established and widely accepted standards of care in such cases begin with a "comprehensive biopsychosocial assessment", followed by...

First, for patients at or near the onset of puberty, medications known as GnRH agonists can delay the onset or continuation of puberty and thus can reduce the development of secondary sex characteristics inconsistent with the patient's gender identity...

Second, cross sex hormones --- testosterone for transgender males, estrogen for transgender females --- can promote the development and maintenance of characteristics consistent with the patient’s gender identity and can limit the development and maintenance of characteristics consistent with the patient's natal sex.

Irreparable harm

Judge Hinkle found that the "adolescent children [plaintiffs] will suffer irreparable harm --- the unwanted and irreversible progression of puberty in their natal sex --- if they do not promptly begin treatment."

"The treatment," the court concluded, "will affect the patients themselves, nobody else." Gender-affirming care does not harm either society or the defendants in this case.

The court's description of the lead plaintiff, Susan Doe, an 11-year old transgender girl, underscores that conclusion.

"From a young age," the decision recites, Susan "consistently told her mother she was a girl. She experienced extreme anxiety and distress about wearing boys clothing. Wearing girls clothes made her 'happy, glowing and sincere'."

Susan, it turns out, is not only known as a girl by her school peers but is also described as a female in her government issued ID.

All of her medical providers determined GnRH agonists will be medically necessary when she begins puberty. But the statute and rules would force her to go through male puberty. This will "out" her as a transgender to her peers and will have devastating physical, emotional and psychological effects.

Beyond Florida and Arkansas

Judge Hinkle cited a decision handed down last year by the U.S. 8th Circuit Court of Appeal, Brandt v. Rutledge. In Brandt, the 8th Circuit upheld a District Court decision to enjoin a near identical anti-gender-affirming care law passed in Arkansas.

But Arkansas and Florida are not the only Red States in which unscientific, anti-trans hysteria has led to bans on necessary, physician-recommended medical care. Nearly 31% "of transgender youth live in states that have passed bans on gender affirming care," according to the Human Rights Campaign.

Critically, both Judge Hinkle's and the 8th Circuit's decision may now be cited as precedent by organizations like the ACLU, which has filed lawsuits challenging anti-gender-affirming care in Indiana and Montana. There are a number of challenges to similar laws in other states, as more and more Republicans endeavor to come between patients and their doctors.

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Ernest A. Canning is a retired attorney, author, and Vietnam Veteran (4th Infantry, Central Highlands 1968). He previously served as a Senior Advisor to Veterans For Bernie. Canning has been a member of the California state bar since 1977. In addition to a juris doctor, he has received both undergraduate and graduate degrees in political science. Follow him on twitter: @cann4ing

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