February 5, 2023

The testimony ended Thursday in a state court case that will rule on the constitutionality of the nation’s first ban on gender-affirming health care for minors, with a St. Louis pediatric endocrinologist who said he’s been studying the issue for 10 years and is of the opinion come to know that until more is known, physicians providing such care are doing so unethically.

dr Paul Hruz, who specializes in childhood diabetes, stood on the witness stand for four hours Thursday as he delved into many of the medical details of pediatric endocrinology and denounced previous studies that only proved that more studies of such treatments are needed.

At one point, U.S. District Judge James M. Moody Jr., the presiding judge who will rule on the matter, grew impatient and urged defense attorney Dylan Jacobs to hurry.

“He’s been testifying to that at length,” Moody said, annoyed, “for hours.”

Moody has not provided a timeline for a decision on the matter.

The trial — which will be held before a judge rather than a jury — is scheduled to rule on the constitutionality of Arkansas Act 626 of 2021, the Save Adolescents From Experimentation Act. The law passed in March 2021 after both the State House and Senate voted by large majorities to override a veto by Gov. Asa Hutchinson. It was challenged the next month in a lawsuit filed by the American Civil Liberties Union, and three months later, a week before the law was due to go into effect, Moody issued an injunction preventing it from enforcing it while the matter was pending dish is .

A three-judge panel of the 8th US Circuit Court of Appeals upheld Moody’s injunction in August. The court ruled earlier this month that it would not take the matter up for reconsideration by the entire 8th Circuit, denying an appeal of Moody’s decision filed by Attorney General Leslie Rutledge’s office. The lawsuit, filed by the American Civil Liberties Union on behalf of the plaintiffs, alleges that the law violates the equal protection and due process clauses of the 14th Amendment and the protections of freedom of speech under the First Amendment.

The plaintiffs in this case, represented by attorneys from the American Civil Liberties Union, are Dylan Brandt, Parker Saxton, Sabrina Jennen and Brooke Dennis and their parents, Joanna Brandt, Donnie Saxton, Aaron and Lacey Jennen, Shayne and Amanda Dennis, and two physicians who provide medical care to transgender teenagers, Dr. Michele Hutchison and Dr. Kathryn Stambaough.

The defendants in this case, represented by a legal team from the Attorney General’s Office, are Rutledge, Amy Embry, Director of the Medical Board, and the 14 members of the State Medical Board.

Testifying that there are uses for puberty blockers and hormone therapy in the treatment of underage patients, Hruz went over these treatments in great detail, but he steadfastly maintained that not enough is known about the effectiveness or long-term safety of their use to warrant their use in the treatment of gender dysphoria.

Gender dysphoria is defined by the Mayo Clinic in Rochester, Minnesota, as the feeling of discomfort or distress that can occur in people whose gender identity differs from their birth gender or gender-related physical characteristics. Current treatments for the condition range from psychotherapy to sex-affirming hormone treatments to surgery, some of which have been detailed in testimonies over the past four days.

Hruz said off-label use of testosterone for purposes such as increasing muscle mass in athletes or in adolescents concerned about body image would be frowned upon by the medical community. He said that for a child who has experienced normal puberty and is at what is medically considered normal developmental stage, “most if not all practitioners would consider it malpractice to induce increased lean body mass for that person’s desires. “

“That’s why testosterone is a controlled substance,” he added.

Regarding testosterone therapy for transgender boys, which Hruz considered female, “I am not aware of any reference where we would give testosterone to a woman.”

The trial ended Thursday after eight days of testimony, interrupted by a five-week break due to scheduling difficulties. Attorneys for the ACLU closed their case in October during the first week of the trial with testimony from multiple medical and psychiatric experts and testimony from multiple plaintiffs, including Dylan Brandt, whose name appears in the title of the lawsuit, Brandt et al. vs Rutledge et al.

During the testimony, the strapping 17-year-old, with a full beard and confident demeanor, testified about the anxiety and depression he suffered as he hit puberty, when his body began to change in ways that clash with his gender identity, and he said he came out to his mother as transgender was like a weight being lifted from his shoulders. Hormone replacement therapy, he said, further alleviated his depression.

“My outside finally corresponds to how I feel inside,” he said in court.

Joanna Brandt, Dylan’s mother, described her son as “an extraordinary human being” who she said was “wise beyond his years and one of the most emotionally intelligent people I know.”

Donnie Saxton and Aaron Jennen both spoke about their fears for their children, Parker Saxton and Sabrina Jennen, both 17. Both men described their reactions when their children came out as transgender to them and the efforts they made to protect themselves educate about the problem and what the medical procedures entailed.

Hutchison, the former medical director of the Gender Spectrum Clinic at Arkansas Children’s Hospital in Little Rock, testified that the impact of transgender therapy on the patients she treated was transformative. She said most came to her with depression and anxiety and became socially withdrawn. She said many patients have had a history of suicidal thoughts or self-harming behavior.

“Very rarely have I ever had a patient come to that first visit who has talked about their future,” she said.

Stamboough, the current medical director, echoed Hutchison’s testimony. In response to the state’s claim that underage patients can simply wait until they turn 18, she said holding back care for these patients makes time a ticking time bomb as their bodies develop in ways that does not fit their gender identity.

“Not every patient would make it to 18,” she said.

During testimony this week, Moody heard from experts on the other end of the spectrum, including Hruz; dr Stephen Levine, clinical psychiatrist at Case Western Reserve University School of Medicine in Ohio; dr Mark Regnerus, sociologist at the University of Texas at Austin; dr Patrick Lappert, a cosmetic surgeon practicing in Decatur, Alabama; and dr Roger Hiatt, a child and adolescent psychiatrist working in Arkansas and Tennessee.

Levine testified Monday that the standards of care set by the World Professional Association for Transgender Health are designed to advocate for transgender affirmation therapies and not to address the root causes of gender dysphoria.

On Wednesday, anti-transgender activists Laura Smaltz of Oklahoma and Louisiana native Billy Burleigh, both former transgender people who transitioned and exited as adults, testified about the religious conversions they experienced that convinced them to become theirs return birth sex.

Also on Wednesday, Hiatt advocated a ban on hormones, puberty blockers and surgery for transgender youth and said he has worked with hundreds of transgender teenagers over the past 25 years. He said that despite the fact that most remain trans identities, he supports the underage health care ban.

After the conclusion of Hruz’ testimony Thursday, Moody signaled the end of the trial with a simple, “Okay, we’re adjourned,” without specifying what, if any, direction he might be leaning on. The judge gave no indication of when a decision might be expected, other than telling lawyers early in the trial not to expect a quick change in his sentence.

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