“Detransitioned” adults defend Arkansas ban on gender-affirming care for minors

Two individuals who “detransitioned,” or lived as transgender but now live as their gender assigned at birth, testified in favor of the Arkansas law banning gender-affirming health care for transgender minors Wednesday in federal court.

Plaintiffs’ attorney Aviv Halpern asked Laura Perry Smalts of Oklahoma City if she was assigned female at birth.

“I was born female, yes,” she said.

Neither Smalts nor Clifton “Billy” Burleigh Jr. has ever lived or sought medical care in Arkansas, and both transitioned as adults. They both said their Christian spiritual awakenings led them to denounce their gender transitions.

Smalts is the author of a 2019 book, Transgender to Transformed, and describes herself on the book’s website as “a former transgender set free by the resurrecting power of Jesus Christ.”

The state, represented by lawyers from Attorney General Leslie Rutledge’s office, called Smalts and Burleigh to help defend Act 626 of 2021, known as the Save Adolescents From Experimentation (SAFE) Act. It prohibits physicians from providing “gender transition” treatments like hormones, puberty blockers and surgeries to minors.

The law has been blocked by a federal judge’s injunction since mid-2021.

Two physicians who have treated transgender youth in Arkansas testified in October that they rarely prescribe puberty blockers because most transgender minors come out after puberty, and they do not recommend or perform gender-affirming surgeries for minors.

Burleigh and Smalts both had surgeries they said they regret, and the state and its other witnesses have claimed that minors who transition might regret their decisions as adults.

The plaintiffs’ witnesses included the parents of four transgender Arkansans under 18. All four parents said their children’s mental health and self-image have improved significantly since socially and medically transitioning. Dylan Brandt, the primary named plaintiff and a transgender teenager from Greenwood, testified in October that receiving testosterone has “changed [his] life for the better.”

Transgender minors have continued receiving gender-affirming care since U.S. District Court Judge James Moody blocked Act 626 in July 2021. A three-judge panel of the 8th U.S. Circuit Court of Appeals upheld the injunction the following month. The state requested a rehearing on the panel’s ruling, but the full 8th Circuit Court rejected the request earlier this month.

The trial is the first in the country over such a ban. In October, Moody denied a motion from the defense to dismiss the case.

If Act 626 goes into effect, the only ways for transgender minors to continue receiving gender-affirming care would be to travel or move, creating major financial and emotional burdens for the four families, the parents said.

Smalts and Burleigh said they both traveled cross-country to get the care they sought.

Burleigh had a total of eight gender-related surgeries, both to transition and to detransition, he said. He considered transitioning again and had facial feminization surgery as a result, but he said he then considered the whole process “ridiculous” and no longer struggles with his gender identity.

“I’m free,” he said. “I’m done with the battle.”

The medical professionals who testified for the plaintiffs said regret over transitioning is very rare.

Dr. Jack Turban, a San Francisco-based psychiatrist with a research focus on LGBTQ health, said in October that detransitioning is a “broad heterogeneous term” that usually means discontinuing gender-affirming medical treatment. People might do this for several reasons — losing health insurance, experiencing harassment or being satisfied with the changes their bodies have experienced so far — and these reasons do not necessarily mean they no longer consider themselves transgender, Turban said.

Difficulties and regrets

Burleigh and Smalts both said they started thinking and feeling at very young ages that they might not identify with the genders they were assigned at birth. After much emotional turmoil, they said, both transitioned in their twenties and received both hormone therapy and various surgeries. Burleigh had surgeries on his genitals and vocal chords, and Smalts had a mastectomy, a hysterectomy and an ovariectomy.

They each came to realize after about a decade that their transitions had not made them happy, they said.

Smalts wanted to be seen as a man but did not want anyone to know she was transgender, so she made up stories about her childhood if anyone asked, she said.

“As much as I felt like a man, as much as I wanted to be a man — I had these feelings all my life — I knew I was still biologically female, and I began to feel like I was living a lie, and it began to torment me,” Smalts said.

As part of Burleigh’s destransition, he stopped receiving estrogen and progesterone, and he started receiving testosterone since his body no longer produced it. Smalts stopped testosterone and now receives estrogen and laser-treatment facial hair removal.

Burleigh and Smalts said they both have regular appointments with endocrinologists to ensure their hormones are balanced.

Smalts legally changed her name during her transition but changed it back as part of her detransition, which began in 2016. She received breast implants earlier this year and said she is “grateful in a sense” for them, but they feel uncomfortable and “unnatural” sometimes.

Burleigh started detransitioning in 2009 and sought a reversal of his genital surgeries. Both the initial surgery and the reversal led to complications and difficult recoveries, and Burleigh said he was “most likely” informed of the potential problems in advance.

“I was so dead-set on having the surgery that I didn’t care,” he said.

The plaintiffs’ witnesses have emphasized the constant practice of informed consent before administering gender-affirming care to minors.

Both Burleigh and Smalts have gotten married since detransitioning. Burleigh has two stepchildren, while Smalts said she wishes she could have biological children but cannot because of her surgeries while transitioning.

“I know there are other women who struggle with [infertility], but the fact that I did this to myself is just a grief that I can’t get over, and there’s nothing I can do about it,” Smalts said.

Apparent religious motivations

The state’s attorneys did not ask Burleigh or Smalts about the influence of religion on their decisions to detransition. Both witnesses had discussed this in their depositions earlier this year, and the plaintiffs’ attorneys brought it up during cross-examination.

State attorney Amanda Land objected multiple times to the questions about religion, claiming irrelevance, but Moody overruled the objections.

Burleigh and Smalts both said dedicating their lives to Christianity led them to denounce their transgender lives because they believe God never approved of their transitions.

Halpern asked Smalts if she believes transgender people “defy God’s creation.” She said “yes,” though she acknowledged with prompting from Halpern that she cannot speak for all transgender people.

The plaintiffs’ attorneys also claimed religion as a potential bias for Dr. Roger Hiatt, another state witness and a psychiatrist in West Memphis. All 15 board members are named defendants in the case.

Some of Hiatt’s patients are transgender children, but they are admitted to the hospital because of mental health problems. The “focus [of treatment] is neither to reinforce nor to discourage a transgender identity,” Hiatt said.

When the SAFE Act was a bill moving through the state Legislature in March 2021, the conservative Family Council asked Hiatt to write a letter to Gov. Asa Hutchinson in support of the bill. Hiatt titled the letter Genesis 1:27 after the Bible verse that states, “God created mankind in his image; in the image of God he created them; male and female he created them.”

The Family Research Council, a different conservative organization, asked Burleigh to testify in favor of the bill before the Arkansas Legislature. He also testified for similar bills in Arizona, Idaho and Utah earlier this year. The Arizona bill is the only one of the three that was signed into law, and it specifically prohibits gender-affirming surgeries for minors.

Burleigh also told the Florida Medical Board earlier this year about his detransitioning “journey” and the role his faith played in it.

The state will call its final witness and rest its case Thursday.

CORRECTION: A previous version of this story mischaracterized Dr. Brian Hyatt’s role in the lawsuit. He is a psychiatrist and State Medical Board member who is a named defendant.