Federal Judge Blocks Trans Care Ban In Georgia, Debunks "Experimental" Talking Point

A Federal Judge in Georgia has blocked a gender affirming care ban from taking effect. In doing so, she also debunked several anti-trans talking points, including the idea of "low quality evidence."

A Federal Judge in Georgia, Judge Sarah E. Geraghty, has blocked a gender affirming care ban in the state from taking effect. The bill responsible for the ban is SB140, a bill passed in March of this year. In hearing a challenge to the ban, the judge evaluated the constitutionality of the law as well as evidence for and against gender affirming care to make a final decision. In blocking the law via temporary injunction, the judge assigned low weight to the anti-trans experts and rebuked common talking points used to justify such bans.

The law banning gender-affirming care is the only one of its kind passed in a state carried by Joe Biden. Enacted on March 22, it featured a series of "legislative findings" intended as factual statements to be considered in court. These include false claims that a majority of transgender youth eventually reject their trans identity and that therapy alone can sufficiently address their needs, insinuating support for conversion therapy. While these statements were presumably added to defend the law in court, the judge dismissed them as lacking credibility.

Three experts testified against the law, while three testified in its favor. Representing the plaintiffs and arguing that the law was unsupported by evidence and likely unconstitutional were Dr. Daniel Schumer, medical director of Michigan Medicine's Comprehensive Gender Services Program; Dr. Meredithe McNamara, an adolescent medicine physician and assistant professor of pediatrics at Yale School of Medicine; and Dr. Ren Massey, a Georgia-based clinical psychologist who has treated more than 600 children and adolescents with gender dysphoria. The state's defense presented Dr. Paul Hruz, Dr. Michael Laidlaw, and Dr. James Cantor. This latter group opposes transgender rights and has been discredited in several courts for alleged lack of experience and perceived ideological bias. The judge ultimately assigned high weight to plaintiff’s experts, while assigning low weight to defense experts - in line with those other courts.

The judge, in evaluating the law, ruled that the plaintiffs had standing (they would be reasonably injured by the law). The judge also ruled that heightened scrutiny applies because the law discriminates on the basis of sex: those assigned male at birth would be banned from receiving estrogen, and those assigned female at birth would be banned from receiving testosterone. The final evaluation, under heightened scrutiny, comes in determining if the law serves a legitimate state interest and is narrowly tailored - ane the judge must do so using the evidence available over the care. It is on this final point that the law failed.

The judge determined that the defense’s case rested on three points (emphasis mine):

Much of what is disputed at this stage, both in the paper record and in the expert testimony before the Court, has concerned (1) what the medical evidence shows about the risks and benefits of hormone therapy as a treatment for gender dysphoria; (2) the strength of that evidence, i.e. the Defendants’ contention that hormone therapy is medically controversial and unsupported by sufficient research of sufficient strength; and (3) stray suggestions that care is pushed upon undesiring parents or unready youth. The Court addresses each in turn. 

The court ruled on each of these points:

• Gender affirming care is beneficial and risks can be managed. The judge ruled that gender affirming care reduces suicidality, improves well-being, alleviates depression and anxiety, and improves social and psychological functioning. The judge also ruled that risks such as infertility and bone density loss can be managed in healthcare settings according to experts in transgender care.

• The evidence is comparably strong to the vast majority of other medical treatments, care is not “experimental.” Dr. McNamara testified that gender affirming care’s evidence basis under the “GRADE” score that the state’s experts used to justify banning that care is comparable to 85% of all other pediatric medication.

• No evidence care is “pushed” on patients. The judge ruled that doctors are following the standards of care and that the defense failed to substantiate this claim. Furthermore, the judge noted that if doctors are acting irresponsibly, there are already mechanisms in law to deal with those doctors - namely, patient lawsuits.

The judge was particularly harsh on defense experts on that second point, noting that they required a “high level of evidence” for benefits but did not hold themselves to that same standard when evaluating risks or claiming ideological bias in medical organizations:

Page 61 on order blocking ban on gender affirming care.

The judge ruled that, given these facts, the law appears to discriminate based on sex in an excessively broad manner. This likely infringes on the plaintiff's rights under the Fourteenth Amendment. Consequently, the law will be suspended until a definitive judgment is reached. This decision marks the seventh instance where a court has halted a gender-affirming care ban in the U.S. So far, only the 6th Circuit Court, which governs Tennessee and Kentucky, has sustained such a ban.

These bans are expected to make their way through the courts in the upcoming months. Multiple states are currently holding hearings on their respective bans. Trans individuals in these states might find solace in recent judgments from Georgia and the other six states that have halted their bans. In the end, it's probable that these bans will reach the Supreme Court, even though the cases are advancing at a gradual pace. Meanwhile, trans youth in Georgia can take comfort in the knowledge that their care remains safeguarded.