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Appeals court lifts injunction on Alabama gender affirming care ban

The ruling by the three-judge federal appeals court removed an injunction issued in May 2022 by U.S. District Judge Liles Burke.

Alabama can now enforce a ban prohibiting gender-affirming care for transgender youth following a decision by the 11th Circuit Court of Appeals on Monday.

The ruling by the three-judge federal appeals court removed an injunction issued in May 2022 by U.S. District Judge Liles Burke, who was appointed by former President Donald Trump.

The injunction was a result of litigation filed against Alabama by several families of transgender children regarding the Vulnerable Child Compassion and Protection Act, which was signed into law by Gov. Kay Ivey last year. The law would criminalize doctors administering puberty blockers and hormones to individuals under 19 years of age with the punishment being a felony of over 10 years in prison.

Burke stated in his decision that Alabama had no evidence to prove transitioning medicine to be experimental and outweigh “evidence-based treatments.”

“The uncontradicted record evidence is that at least twenty-two major medical associations in the United States endorse transitioning medications as well-established, evidence-based treatments for gender dysphoria in minors,” Burke wrote. 

However, in an opinion written by U.S. Circuit Judge Barbara Lagoa, the appeals court stated the district court “abused its discretion” when issuing the injunction. 

“On review, we hold that the district court abused its discretion in issuing this preliminary injunction because it applied the wrong standard of scrutiny,” Lagoa wrote. “The plaintiffs have not presented any authority that supports the existence of a constitutional right to “treat [one’s] children with transitioning medications subject to medically accepted standards.” Nor have they shown that section 4(a)(1)–(3) classifies on the basis of sex or any other protected characteristic.”

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The opinion also stated that prior due process cases did not grant a right to gender-affirming care and that parents did not have a “derivative fundamental right to obtain a particular medical treatment for their children as long as a critical mass of medical professionals approve.”

Lagoa and the other two judges who ruled to allow the ban, U.S. District Judge Jean-Paul Boulee and U.S. Circuit Judge Andrew Brasher, are all Trump appointees as well.

The organizations representing the families in the litigation include the Human Rights Campaign, the Southern Poverty Law Center, the National Center for Lesbian Rights, and others. In a statement following the decision, the groups stated on behalf of the plaintiffs how disappointing the ruling was but also vowed that “this case is far from over, and we will continue to aggressively seek legal protection for these families.”

“This is a deeply disappointing decision that is difficult to reconcile with the 11th Circuit’s prior rulings and with the Supreme Court’s clear guidance that discrimination because a person is transgender is sex discrimination. Our clients are devastated by this decision, which leaves them vulnerable to what the district court—after hearing several days of testimony from parents, doctors, and experts–found to be irreparable harm as a result of losing the medical care they have been receiving and that has enabled them to thrive.” 

Attorney General Steve Marshall also issued a press release discussing his approval of the decision by the court.

“The Eleventh Circuit reinforced that the State has the authority to safeguard the physical and psychological wellbeing of minors, even if the United States Attorney General and radical interest groups disapprove,” said Attorney General Steve Marshall. “Alabama takes this responsibility seriously by forbidding doctors from prescribing minors sex-modification procedures that have permanent and often irreversible effects. This is a significant victory for our country, for children, and for common sense.”

APR reported last week that Marshall’s office is looking to pay an outside legal firm called the Child and Parental Rights Campaign over 75,000 in state funds to help fight similar legislation. 

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Other states have introduced similar legislation to Alabama but those laws have been routinely blocked by federal courts. In June a federal court struck down Arkansas’s ban on gender-affirming care. However, in July, an appeals court allowed a ban on gender-affirming care to take place in Tennessee the first such ruling in favor of banning the treatments. 

Many reputable and experienced medical organizations including the American Academy of Pediatrics have stated their support for gender-affirming care. There are also countless studies that routinely show the mental and emotional benefits for trans people and youth who receive gender-affirming care.

Patrick Darrington is a reporter at the Alabama Political Reporter. You can reach him at [email protected].

More from APR


Alabama lawmakers passed a law last year that would criminalize doctors or parents for helping trans youth access gender-affirming care.


On Aug. 21, a panel of the 11th Circuit ruled to lift a preliminary injunction blocking a law banning gender-affirming care.


Advocates have come together to launch resources to support families navigating this challenging period. 


The Alabama AG's office recently entered contracts for nearly $1 million for outside attorneys to defend the transgender care ban.