Arkansas Trans Ban Unconstitutional: Judge Declares 311 Statements Of Fact In Ruling

Over 311 statements of fact were established in the Arkansas gender affirming care ban case. Not a single fact was found in the state's favor, and several major talking points were debunked.

In an landmark move today, U.S. District Judge Moody has ruled the Arkansas ban on gender affirming care to be unconstitutional. This decision is the first in the nation where a federal judge has made a definitive ruling on the constitutionality of such a ban. Moody's ruling follows on the heels of several other court victories for LGBTQ+ people, including a scathing ruling by a judge in Florida, who issued a temporary injunction against a similar ban, and an Indiana judge who also halted a prohibition on youth care.

Though the federal decision is explicitly applicable to Arkansas, its implications could reverberate across the country, setting a precedent for numerous ongoing legal battles. The state is expected to challenge the ruling in the 8th Circuit Court. If Moody's decision withstands appeal, it could trigger a domino effect, leading to the reversal of similar bans in multiple states belonging to the 8th circuit court.

The crux of Judge Moody’s ruling lies in the substantial 311 individual statements of fact, many of which decisively dismantle arguments made against gender affirming care. These facts apply to issues from the rarity of detransition to the vital medical benefits that gender affirming care offers transgender youth. The statements also rule on the credibility of the state’s experts as well as the plaintiff’s experts. The court found the plaintiff's experts to be extraordinarily credible, while the state’s experts were deemed to be considerably lacking in credibility and motivated more by religious beliefs than sound policy. Even religious organizations lobbying for anti-transgender laws, such as the Alliance Defending Freedom, are probed within these factual statements.

Here are five key excerpts from the court's opinion that you need to know from the 311 individual statements of fact:

1) Banning Care Causes Irreparable Harm And Increases Suicidality

Page 49, Brandt et al v. Rutledge Final Opinion

Legislative and media discussions surrounding bans on care for trans youth have primarily concentrated on the health risks and benefits of gender-affirming care. After considering numerous witnesses, hundreds of pages of expert testimonies, and briefs filed by medical organizations, the judge definitively concluded that banning gender-affirming care would inflict severe, irreparable harm on transgender youth. One particularly striking fact, Fact 258, was evidenced by Dr. Dan Karasic, a psychiatrist with over three decades of experience treating gender dysphoria. He alerted the court that "not all adolescents with gender dysphoria will survive to 18 if they are denied gender-affirming medical treatment."

Gender-affirming care is indeed lifesaving. A multitude of studies have validated its beneficial impact on transgender individuals, such as research showing a 73% decrease in suicidality and another indicating a 40% drop in recent suicide attempts. The Cornell University Center for the Study of Inequality has assembled over 50 studies emphasizing the benefits of gender-affirming care. Now, a federal judge has established conclusively that the care is indeed lifesaving.

2) Detransition And Regret Are Rare

Page 49, Brandt et al v. Rutledge Final Opinion

A frequent assertion put forth by advocates for anti-trans care bans is the presumption that transgender youth will eventually regret their transition and detransition. Facts 219-224 determined conclusively that this is not the case. For example, Dr. Karasic pointed out that out of the thousands of patients he has treated, not a single one chose to detransition. While a handful did stop taking their medication, it was primarily due to a lack of family support or their insurance discontinuing coverage, not a change in their self-identified gender.

Judge Moody later dissected the notion that levels of "desistance and regret" warrant prohibitions like Arkansas's ban on gender-affirming care. He stated:

To the contrary, the evidence proved that there is broad consensus in the field that once adolescents reach the early stages of puberty and experience gender dysphoria, it is very unlikely they will subsequently identify as cisgender or desist.

The belief that transgender individuals will eventually regret their transition can be traced back to outdated and refuted studies claiming that "80% of transgender youth detransition." This false narrative has been promulgated by the Heritage Foundation, invoked to rationalize bans in several states, and frequently surfaces on conservative news outlets such as Fox News. However, these studies primarily originate from conversion therapists and outdated definitions from a time when it wasn't practically or legally feasible for transgender youth to transition. Contemporary research reveals that a staggering 97.5% of transgender youth continue identifying as transgender.

3) The Witnesses Are Not Credible

Page 62, Brandt et al v. Rutledge Final Opinion

Judge Moody offered a biting critique of the credibility of the witnesses fielded by Arkansas, stating their opinions were "more rooted in ideology than in science." Backing this statement, Moody pointed out the significant lack of training that state experts possessed in providing gender-affirming care. For instance, Dr. Mark Regnerus, a sociologist specializing in sexual relationship behavior and religion, lacks any clinical or psychological experience with transgender individuals. Similarly, Dr. Patrick Lappert, a plastic surgeon, has no experience in mental healthcare, let alone in gender-affirming care. Furthermore, Dr. Paul Hruz, a pediatric endocrinologist put forward by the state, has never treated a patient for gender dysphoria.

Of particular note was the involvement of the Alliance Defending Freedom (ADF) in recruiting the state's experts. Judge Moody highlighted that Dr. Regnerus, Dr. Hruz, and Dr. Lappert were all connected through an ADF seminar in Arizona meant to recruit witnesses for court cases like this one. Given the nature of their testimony and how they were recruited, the judge observed that the state experts were "testifying more from a religious doctrinal standpoint than from the perspective expected of experts."

4) The Term “High Quality Evidence” Is Misused

Page 34, Brandt et al v. Rutledge Final Opinion

Several individuals and organizations opposing gender-affirming care have contended that the evidence supporting this type of treatment is of "low quality." Ohio Representative Gary Click, for example, argued that this supposed "low quality" evidence should warrant a ban on gender-affirming care. A controversial Reuters article, which was met with backlash from transgender healthcare providers and advocates, labeled the evidence as either "low" or "very low," insinuating a lack of solid backing for the care. However, U.S. District Judge Moody vigorously countered this notion.

The term "high quality" evidence refers to a specific category within the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. In essence, the GRADE system reserves the "high quality" designation for randomized controlled trials (RCTs) exclusively. Judge Moody, in examining medical research and its application in either authorizing or prohibiting treatments, determined that numerous medications and medical guidelines are based on evidence deemed "very low-quality" or "low-quality," since it would be either impossible or unethical to conduct randomized clinical trials. In fact, merely one in ten medical treatments rely on "high quality" evidence.

In the case of gender-affirming care, Judge Moody identified Fact 184, asserting that attempting to conduct a randomized controlled trial for this type of care would be both impossible and ethically indefensible. This is due to the fact that withholding known beneficial care from patients contravenes the ethical guideline of "do no harm." Additionally, it would be unfeasible to blind both patients and doctors to the administered care, as the physical effects—such as changes in hair growth and body fat distribution—would become immediately apparent.

Given that no other forms of care are banned by the state based on their GRADE ranking, Judge Moody deemed the ban to be discriminatory.

5) Gender Affirming Care Is Less Risky Than Many Other Procedures

Those advocating for a ban on gender-affirming care often exaggerate the potential risks associated with the treatment, particularly for transgender youth. A witness during the Missouri hearing on the gender-affirming care ban argued that puberty blockers, due to their potential to cause bone density loss and infertility, should be outlawed. In Indiana, a witness went as far as to assert that gender-affirming care presents more risks than brain surgery. Even The New York Times has propagated this misinformation, with an extensive article on bone density loss that was refuted by a comprehensive three-page report from the World Professional Association of Transgender Health, which highlighted all the inaccuracies in the article. Judge Moody, however, established 31 facts affirming that the risks of gender-affirming care are both manageable and rare when properly overseen, and are less serious than those posed by many other medical treatments.

The judge examined these assertions meticulously. Regarding the claim that puberty blockers cause a decrease in bone density, he established that transgender adolescent patients achieve normal bone density levels "within two to three years" of initiating hormone therapy. The impact of bone density loss can be managed by healthcare providers through the administration of vitamin D and calcium. Furthermore, according to Fact 209, the threat to fertility can be reduced by postponing the commencement of puberty blockers or temporarily discontinuing them to preserve fertility. As for other infrequent risks such as "embolism," these risks were found to be no higher than those associated with many other routinely prescribed medications.