More often than not, public school employees call students by the pronouns matching the gender on their birth certificate, no matter the child’s preference and it is a misdemeanor to use restrooms in public buildings that do not correspondent to the person’s gender at birth. If lawmakers advance bills that mandate the same, how do we expect discrimination against transgender individuals to diminish?
Four transgender adults and seven parents of transgender minors challenged the constitutionality of a Florida statute that prohibited transgender minors from receiving widely accepted gender-affirming medical care and impose restrictions on how such care can be provided. The Plaintiffs had urged the Court to specifically block one part of the law that bars doctors and nurses from prescribing or administering transition-related medication to children, and another part that exposes medical providers to criminal liability and professional discipline for doing so.
The kinds of care at issue are puberty blockers and cross-sex hormones. For many years, the State of Florida allowed use of these medications to
treat gender dysphoria. Yet, while other states restricted the use of state funds to pay for transgender care, Florida was the first to restrict care for transgender adults who were not relying on Medicaid. “But then the political winds changed,” wrote Judge Robert L. Hinkle of Federal District Court in Tallahassee.
Last June, Judge Hinkle temporarily blocked enforcement of parts of the law for the children of the three families who filed the lawsuit. He ruled specifically that three transgender children can be prescribed puberty blockers despite the new state law, which also added new hurdles for adults seeking similar care.
Psychiatry Expert Witness
Dr. Stephen B. Levine is an expert in gender dysphoria and gender identity. He is a Distinguished Life Fellow of the American Psychiatric Association and a professor with many years of experience in the fields of gender and sexuality.
Levine chaired a committee that crafted a pioneering set of standards of care for individuals suffering from gender dysphoria, and he has been a senior editor for three editions of the Handbook of Clinical Sexuality for Mental Health Professionals. He also founded a gender identity clinic in 1974, which he continues to lead as co-director.
Levine did a psychiatric internship and residency at University Hospitals of Cleveland, working in that hospital’s Sexual Dysfunction Clinic. In 1993 the clinic separated from University Hospitals to become The Center for Marital and Sexual Health (now called DELR).
Discussion by the Court
The challenged statute prohibited gender-affirming care for minors—for patients under age 18—subject to a grandfather provision allowing minors who were already receiving this care to continue do so. It restricted the manner in which gender-affirming care could be provided to adults and to grandfathered minors. Such laws deprive parents of their fundamental right to make medical decisions for their children and underestimate the impact denial of transition care has on the physical and mental health of the children.
Judge Hinkle said that “gender identity is real” and that a “widely accepted standard of care” includes puberty blockers and hormone treatments that Florida unlawfully banned. He added, “The State of Florida can regulate as needed but cannot flatly deny transgender individuals safe and effective medical treatment.” Not just the Defendants, but also defense expert Dr. Stephen B. Levine with his extensive experience treating a significant number of transgender patients admitted it.
Stephen B. Levine
At a committee hearing, a minor from another state gave comments indicating she received gender-affirming care and a mastectomy, without meeting the prerequisites to such care under the Endocrine Society and WPATH guidelines.
Hinkle noted that Levine’s testimony providing a legitimate, nondiscriminatory basis for restricting the availability of gender-affirming care for minors met the Daubert standard.
Levine has repeatedly testified about the many risks associated with “affirming” transgender identity in children in various cases. According to Levine, both the long-term and short-term implications of life as a transgender individual are crucial when it comes to social transitioning. He has cited multiple studies from different nations that have documented the increased vulnerability of the adult transgender population to substance abuse, mood and anxiety disorders, suicidal ideation, and other health problems.
Levine casts doubt on the claim that puberty blockers are completely reversible. He adds that there are social risks associated with delayed puberty. Levine writes, “individuals in whom puberty is delayed multiple years are likely to suffer at least subtle negative psychosocial and self-confidence effects.”
However, at one point in this case, Levine testified that treatment with GnRH agonists and cross-sex hormones is sometimes appropriate. He would demand appropriate safeguards, as discussed below, but he would not ban the treatments. Levine suggested prerequisites to gender-affirming care.
Held
Hinkle found Levine’s arguments in favor of restricting the availability of gender-affirming care persuasive but sided with advocacy groups and three families who had said that the law deprived them of parents’ rights to make medical decisions for their transgender children.
He declared key parts of a Florida law banning gender transition care for minors and imposing hurdles on adults seeking such care unconstitutional.
Key Takeaway:
Puberty blockers and other forms of gender transition care for children give transgender adolescents and their families time to weigh important medical decisions. Studies report that teens who had access to puberty blockers and hormone therapy require fewer gender-affirming surgeries as adults. Plaintiffs, in this case, challenged the constitutionality of a statute that denied transgender individuals safe and effective medical treatment.
The legislation codified policies adopted last year by the Florida Board of Medicine and Board of Osteopathic Medicine — whose members are appointed by the governor — that banned hormone treatments for people under 18 unless they were already receiving such care.
While laws prohibiting access to gender transition care might end up causing irreparable harm, it is equally important weigh in social risks associated with delayed puberty.
Levine is of the opinion that ushering gender-dysphoric children toward social transition to the opposite sex is an experimental therapy that exposes these vulnerable children to more mental health risks.
Case Details:
| Case Caption: | Jane Doe V. Joseph A. Lapado |
| Docket Number: | 4:23cv114 |
| Court: | United States District Court for the Northern District of Florida, Tallahassee Division |
| Order Date: | June 11, 2024 |
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