A federal judge in Atlanta has put a temporary freeze on the application of a Georgia law that prohibits the use of cross-sex hormones to treat minors who identify as transgender.
U.S. District Court Judge Sarah Geraghty granted a preliminary injunction on Aug. 20 (pdf) in a lawsuit challenging Georgia's ban on hormone replacement therapy for the treatment of gender dysphoria in children.
Georgia banned child gender transition when Senate Bill 140, which prohibits sex change surgeries and hormone replacement therapy for minors, was signed into law by Republican Gov. Brian Kemp on March 23.
That law became the subject of a lawsuit by several transgender-identifying children, their parents, and a community organization, in a case known as Koe v. Noggle.
In justifying her order blocking the hormone therapy ban to treat gender dysphoria in kids, Ms. Geraghty said that it appears "substantially likely" that the plaintiffs will succeed in permanently striking the law as unconstitutional.
The temporary injunction will remain on hold until the case makes its way through the legal system.
About a half dozen federal courts have blocked bans on so-called "gender-affirming care" for children, which proponents argue is "medically necessary" to lower the likelihood that people suffering from gender dysphoria will commit suicide.
Opponents have pushed back on the claim that transgender procedures reduce suicidality, with a study in March purporting to be the first ever to evaluate mental health outcomes solely from the standpoint of likelihood of suicide finding that the results are inconclusive.
That's in part because most of the underlying research failed to control for the time elapsed after transgender procedures, with the researchers suggesting that people who get such procedures may be subject to an initial "honeymoon period" that evaporates over time as they revert to similar levels of suicidal ideation as before.
"There may be implications for the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed," the study authors wrote.
In her order, Ms. Geraghty acknowledged that hormone therapy carries risks, though she suggested these can be adequately managed in a process that involves examining each case in an individualized manner, with the consultation of mental health and medical experts and taking into account parental consent, to "ensure that treatment is medically necessary."
“The imminent risks of irreparable harm to Plaintiffs flowing from the ban—including risks of depression, anxiety, disordered eating, self-harm, and suicidal ideation—outweigh any harm the State will experience from the injunction,” the judge wrote.
The question of whether transgender treatments are "medically necessary" has been the subject of debate and it has come up in other litigation, including in a case that challenged Florida's rule that banned the use of taxpayer funds to cover transgender procedures.
The plaintiffs—two transgender-identifying adults and two transgender-identifying minors—argued in court filings that so-called "gender affirming care" should be seen as "medically necessary, safe, and effective" for both adults and adolescents.
“Florida’s comprehensive review does not support the use of puberty blockers, cross-sex hormones, and reassignment surgeries as safe and effective treatments for gender dysphoria; and the Sunshine State should be allowed to follow the science,” Louisiana Attorney General Jeff Landry said in a news release announcing that his state had filed a legal brief supporting Florida's regulation that denies Medicare coverage for procedures relating to gender transition.
The Georgia bill that Mr. Kemp signed into law notes there's been a "massive unexplained rise in diagnoses of gender dysphoria among children over the past 10 years, with most of those experiencing this phenomenon being girls."
Georgia's legislature has found that several aspects of this trend have little scientific support, including that no large-scale studies have tracked long-term satisfaction with child sex-change procedures, per the bill.
"Under the principle of 'do no harm,' taking a wait-and-see approach to minors with gender dysphoria, providing counseling, and allowing the child time to mature and develop his or her own identity is preferable to causing the child permanent physical damage," the bill states.
The legislature has "an obligation to protect children" because children aren't developed enough to make irreversible medical choices, the bill concludes.
On these facts, the ban in the bill targets "irreversible procedures or therapies," including sex reassignment surgeries and hormone replacement therapy.
The bill provides exceptions for hormone replacement therapy and surgery for medical conditions other than gender dysphoria, including hormone insensitivity, those born with ambiguous genitalia, those with chromosomal abnormalities, and children already being treated for gender dysphoria using hormones.
Following the judge's decision to block the Georgia cross-sex hormone therapy ban for minors, the counsel for the plaintiffs released a statement hailing the order and saying that the ruling "restores parents' rights to make medical decisions that are in their child's best interest, including hormone therapy for their transgender children when needed for them to thrive and be healthy."