Medical treatment

Doctors testify against Alabama law criminalizing medical treatment of transgender people

A UAB pediatrician testified Thursday that an Alabama law criminalizing medical gender transition treatment for transgender youth would force doctors to choose between committing a crime and violating the Hippocratic Oath.

“It will force us to risk a felony conviction for providing evidence-based care or turning our backs on the Hippocratic oath and literally doing harm,” said Dr Morissa Landisky, associate professor at the University of Alabama Birmingham who works with transgender children.

The testimony was presented before U.S. District Judge Liles C. Burke on the second day of a hearing on a motion to block the law, known as Senate Bill 184, from becoming law. law is due to come into force on Sunday. “It would be an unprecedented request from us to abruptly stop this care and treatment.”

The lawsuit was filed on behalf of four families of transgender children, two doctors who care for them, and a pastor who works with transgender youth. The lawsuit argues that the law discriminates against transgender youth because treatments are available to cisgender minors.

Linda Hawkins, co-director of the Gender and Sexuality Development Clinic at Children’s Hospital of Philadelphia, told the court that stopping medical care for transgender youth would be tantamount to abruptly stopping cancer treatment.

“The benefits of young people receiving medical care, medical and mental health care that has been identified as ideal for this patient – it would be like taking someone’s cancer treatment away and expecting that he’s fine,” she said. “It would be devastating.”

When cross-examining the doctors, attorneys representing the state attempted to lay the groundwork that the effectiveness of medical treatment for gender dysphoria is uncertain and could cause irreparable harm to minors.

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Alabama Deputy Solicitor General Barrett Bowdre cited the Diagnostic and Statistical Manual of Disorders of Mental Health, Fifth Edition, more commonly known as DSM-5 and pressed Hawkins for his assertion that a majority of minors suffering with gender dysphoria ultimately align with their biological sex.

He cited a section of the manual indicating persistence rates of gender dysphoria of 2-30% in natal males and 12%-50% in natal females.

“This would indicate that between 50% and 88% of girls diagnosed with gender dysphoria abstain, and 70% to 97% of boys abstain,” Bowdre said.

Hawkins cautioned that these findings are based on diagnoses of gender dysphoria as defined in DSM-4, the manual’s fourth edition, which she called a “broader” term that could have encompassed young people who don’t should not have been included.

In earlier testimony, in response to plaintiff’s attorney Melody Egan, Hawkins questioned a separate study that found a high rate of young people whose gender dysphoria resolved naturally.

“When a study offers this high rate of what’s called ‘refusal’ of gender exploration to sex assigned at birth, what we tend to find is that the initial cohort given that the diagnosis of gender dysphoria is actually wrong,” says Hawkins. “There is a typical amount of gender exploration that is part of childhood and adolescence. Not all of them should have been called gender dysphoric…Eighty percent of children who put on a tutu are not transgender.

“Based on clinical experience, transgender adolescents, once they hit puberty, don’t come out of gender dysphoria, if they really had gender dysphoria.”

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Doctors have stressed the rigor of determining whether a teenager begins to receive medical care. They described the thorough evaluation of minors, usually over a period of years, as well as discussions with their families and primary pediatricians before referring the patient to an endocrinologist to determine if they are ready to receive blood-blocking drugs. short-term puberty.

Ladinsky testified that puberty blockers are given for one to three years and pointed out that they are given at a very early stage of puberty, which ensures the process is reversible.

Hawkins said that’s important because in cases where a child decides to identify with their birth gender, there’s no harm done.

With respect to patients who receive cross-sex hormones, Hawkins and Ladinsky both testified that they have not seen a single patient who received cross-sex hormones express regret or a desire to identify as their sex assigned at birth.

Ladinsky instead described a positive transformation of adolescents.

“To see gender dysphoria reduced, you’ll see radiance, self-confidence, but most importantly, we see teenagers who have been sullen, withdrawn, academically unsuccessful, uninterested in the activities and peer groups they used to be joining the world in ways they’ve never seen before,” Ladinsky said. “We see graduation, higher education, seeing young people who have exhibited anxiety and depression severe, even self-harm – to see that it’s been so long is incredible.”

Hawkins said the focus has shifted from keeping patients alive to helping them succeed.

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“Before, mental health providers just tried to keep kids alive until they grew up,” Hawkins said. “Now what we see is the opportunity for children not just to survive, but to thrive. We see more kids going to college and fewer funerals. This tells us that drugs are an important addition to treatment plans.

State prosecutors disputed whether science could show whether minors receiving puberty blockers would have persisted in seeking gender-affirming medical care if puberty had been able to progress.

“What studies do you rely on to claim that only puberty blockers and cross-sex hormones, and not therapy alone, would reduce suicides? Bowdre asked Hawkins.

Hawkins had testified that there are limits to the way studies are conducted because it would be considered unethical to deny medical treatment to certain patients.

Alabama Solicitor General Edmund LaCour asked Ladinsky if it was appropriate to allow a minor to consent to cross-sex hormones that might prevent them from having sexual pleasure or function.

“How can a child fully understand what it might mean to never have sexual intimacy, if they never went through puberty but were put on puberty blockers?” asked LaCour.

“The care we provide is a very robust risk-benefit analysis,” Ladinsky replied. “It’s not 100% guaranteed to happen. It has to be weighed around the severity of gender dysphoria versus the risk-benefit of gender incongruence. It’s the decision that is weighed.

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Ladinsy and Hawkins warned of dire situations if the law is allowed to go into effect and described some of the situations that could qualify as clinical distress to trigger a diagnosis of gender dysphoria.

Hawkins described a wide range of signs of clinical distress in children with classic childhood-onset gender dysphoria.

“For children at this age, we will often see the manifestation of this distress in difficulty sleeping, a desire not to go to school,” Hawkins said. “Preschools and kindergartens are very gender segregated, children are told to line up in one line or the other. I had a 5 year old who told me he wanted to jump out of a moving car and kill himself.

The risk of self-harm only increases with age, Ladinsky said.

“It will take these young people to very dark places,” Ladinsky said. “We are very aware of where they come from. The potential is there for self-harm and possible suicidality. A year ago, when Arkansas signed this law into law despite the governor’s veto, my counterpart there saw five young people come forward with serious suicide attempts. One was in the operating room for 10 hours as they tried to save his life. We are in Alabama, we are better than that.

The hearing is scheduled to continue at 9 a.m. today. The US Department of Justice, which has also filed a lawsuit to block the law, is conferring on whether to bring its only witness, and the state should then bring its witnesses. The hearing is expected to end this afternoon

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