Judge, attorneys scrutinize witness expertise in trial on Arkansas transgender law

A federal judge and plaintiffs’ attorneys expressed frustration at testimony Tuesday from defense witnesses in the ongoing trial challenging Arkansas’ ban on gender-affirming care for transgender minors.

A sociologist and a plastic surgeon, called by lawyers for Attorney General Leslie Rutledge’s office in defense of the 2021 law, expressed doubts about the safety and effectiveness of gender-affirming care but said they have little experience with transgender patients.

The law in question is 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 American Medical Association, American Psychiatric Association and Endocrine Society have all said gender-affirming care is safe for minors. The state has claimed otherwise.

U.S. District Court Judge James Moody said multiple times Tuesday that he did not fully understand “who is at war” with multiple national medical groups during the testimony of Dr. Mark Regnerus, a sociology professor at the University of Texas at Austin.

Moody blocked implementation of the SAFE Act in July 2021 with a preliminary injunction that was upheld in August by a three-judge panel of the 8th U.S. Circuit Court of Appeals. The state requested a rehearing on the panel’s ruling in October, 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.

Tuesday was the sixth day of proceedings in the trial that began last month and recessed until Monday due to scheduling issues with defense witnesses. The plaintiffs’ attorneys, who work for or with the American Civil Liberties Union, rested their case after the first three days of the trial in October.

Monday’s sole witness was Dr. Stephen Levine, an Ohio-based psychiatrist who said psychotherapy should be the primary treatment for gender dysphoria and claimed doctors are too quick to prescribe hormones to minors. Much of his testimony was in contrast to opinions offered by six medical professionals, two of whom have treated transgender youth in Arkansas and testified for the plaintiffs last month.

Tuesday’s second witness was Dr. Patrick Lappert, an Alabama-based plastic surgeon who said his work is primarily “restoration of form and function” of body parts after physical illness or trauma.

Lappert said he is not an expert on gender dysphoria, pediatric health care, endocrinology, medical ethics or mental health in response to questions from the plaintiffs’ attorneys. His only gender dysphoria education or training was “one weekend class at the California Society for Plastic Surgery,” he confirmed to ACLU co-counsel Laura Oswell.

Tuesday’s testimony

Regnerus testified via videoconference from Europe. He reiterated some of Levine’s statements from Monday, including the idea that medical professionals with doubts or trepidation about allowing transgender people to medically transition are afraid to share those opinions because they might face backlash.

Regnarus and Levine also said they see credibility in the theory of “rapid-onset gender dysphoria,” or the idea that adolescents can experience gender dysphoria suddenly as a result of peer pressure or “social contagion.”

The idea of “rapid-onset gender dysphoria” came from a 2018 research paper by Dr. Lisa Littman, a physician and Brown University faculty member. Brown University removed the article from its website later that year due to “concerns about research design and methods,” and the article received a “post-publication reassessment” and was revised and republished in 2019.

Dr. Jack Turban, a psychiatrist from San Francisco who has treated transgender minors, testified for the plaintiffs in October that “rapid-onset gender dysphoria” is an inaccurate term because parents might be surprised when their child comes out as transgender, but the child is often secretly aware of their identity for years.

Dr. Dan Karasic, another San Francisco psychiatrist, also testified in October that gender dysphoria as a “social contagion” is a misunderstanding. Instead, young transgender people “seek out peers that might share their experiences and seek out media to gain more information and social support,” Karasic said.

Regnerus said he believed Littman’s study was “just describing” her observations and did not deserve “blowback” from the public or the university, although she did not lose her job.

“[University administrators] were concerned about appearing uncaring toward people with gender dysphoria,” Regnerus said. “It just looked like they were critical of Dr. Littman when they should have been supportive of her academic freedom.”

Regnarus also said he has seen debates about gender-affirming health care in print and audiovisual news outlets, but Moody said this was not sufficient testimony to help him make a decision about Act 626.

“What investigation or something did he do to find out about the reception as opposed to, ‘I just looked at these things and saw a reaction in the newspaper,’?” Moody asked defense attorney Dylan Jacobs. “For him to give me meaningful testimony, he has to have done something to give me more than a lay opinion about how he reads the tea leaves.”

Witness background

Regnarus is the author of a controversial 2012 study asserting that children of same-sex parents were more likely to have adverse experiences as adults, including unemployment and receiving public financial assistance, than children of opposite-sex couples.

Both Regnarus and Lappert attended a 2017 Alliance Defending Freedom conference that included a discussion about gender identity, they said in response to questions from the plaintiffs’ attorneys. ADF is a conservative religious freedom advocacy group that has opposed LGBTQ rights efforts.

Lappert said his only experience treating a transgender patient was conducting breast implant removal surgery for someone who “detransitioned” and no longer wanted to present as female, he said. He has never conducted gender-affirming surgery on the breasts or genitals of any patient, he said.

He described these surgeries as “a disservice to the patient,” and said he would not recommend or perform them because the patient would develop “false hope” that surgery would cure all their self-image issues.

“There’s a period of happiness after the surgery, there’s a time of excitement, but then the excitement has worn away,” Lappert said. “They’re no longer hearing compliments from friends, [or] feeling the emotional support or satisfaction because they’ve essentially sought a physical remedy for a subjective problem, and of course that’s an impossibility.”

The Gender Spectrum Clinic at Arkansas Children’s Hospital in Little Rock does not recommend or provide surgeries to transgender youth, the clinic’s current and former directors testified in October.

The trial will continue Wednesday and Thursday.