Editor’s note: This article was updated after a judge blocked Alabama's ban.

A federal judge last week blocked Alabama’s felony ban on the prescription of puberty-blocking medication or hormone treatment for transgender youth under 19, through a preliminary injunction issued as the state’s law faces an ongoing court battle. 

The state’s law, which had gone into effect this month, still requires school counselors and teachers to inform parents if their children come out as transgender or gender-nonconforming — which has some students in the state worried. That part of the law was not challenged by GLBTQ Legal Advocates & Defenders (GLAD) and other LGBTQ+ and civil rights groups in the current lawsuit. 

Dina Marble, a counselor for middle and high schoolers in Birmingham, told The 19th prior to the judge’s order that one 15-year-old student was so anxious about the law that he got only three hours of sleep the previous night.

“His mind was racing through all the scenarios and options. He was considering going back into the closet at school,” Marble said over text message. The student is also coming up with ways to explain himself to his parents if a teacher calls home to tell his parents that he is transgender. 

“The bottom line is he feels threatened and unsafe,” she said. “He feels like he can’t be himself at home and fears he won’t be accepted at home or at church if they find out.” 

The ban on gender-affirming care was met with legal challenges last month on behalf of medical providers and families within the state, cases that were both voluntarily dropped. A new lawsuit, brought again by GLBTQ Legal Advocates & Defenders (GLAD) and others, argued  the law violates the 14th and 1st amendments. 

“We didn’t challenge the ban on surgical care as no minors undergo any surgical care in Alabama,” said Shannon Minter, legal director of the National Center for Lesbian Rights (NCLR), tweeted in response to the U.S. District Judge Liles Burke’s order. “Our plaintiffs obtained all the relief they sought, which is terrific.”

Any individual who prescribes or administers puberty-blocking medication or hormone treatment to a minor to treat gender dysphoria or as part of a gender-affirming care regimen — which is backed by the American Medical Association and American Academy of Pediatrics —would  commit  a Class C felony under Alabama’s now-blocked law,  potentially exposing violators to a prison sentence of at least one year or up to ten years.

Arkansas is the only other state that has successfully passed a ban on trans youth receiving gender-affirming care, but its law was blocked in federal court before it could take effect. Arkansas appealed that ruling to the U.S. Court of Appeals for the 8th Circuit earlier this year. Arkansas’ law also did not declare providing the care a felony. While other states have attempted to pass felony bans within the past few years, those bills stalled in committee or died altogether. 

Dr. Morissa Ladinsky, an associate professor of pediatrics at the University of Alabama at Birmingham who provides gender-affirming care to trans youth in Alabama and surrounding states, said her clinic prescribed drugs needed for existing patients before the 30-day mark when the law, signed by Gov. Kay Ivey last month, briefly went into effect. 

“For many youth currently receiving these medications, it would be medically contraindicated to abruptly stop them. It would also be wholly unethical to do so,” she said. “So we’ve made sure that refills are already at the pharmacy before the law went into effect. However, while it is in effect, we cannot and will not issue new prescriptions.” Ladinsky is serving as a material witness for the lawsuit against Alabama’s ban and testified on behalf of the plaintiffs last week, and was named as a plaintiff in a prior lawsuit against the ban

The lawsuit was brought by GLBTQ Legal Advocates & Defenders (GLAD), plus the Southern Poverty Law Center (SPLC), National Center for Lesbian Rights (NCLR) and the Human Rights Campaign. 

Scott McCoy, LGBTQ rights & special litigation interim deputy legal director at the Southern Poverty Law Center who is representing plaintiffs in the case, said prior to Burke’s order that 

the plaintiffs are waiting to see “whether or not the judge hits the pause button” on enforcement of the law, which various LGBTQ+ civil rights groups have argued violates the 14th and First Amendments, as the case goes to trial.

Alabama Attorney General Steve Marshall, representing the state in the case, criticized the Biden administration’s stance in support of gender-affirming care, specifically calling out the Justice Department after the agency warned states last month that blocking trans youth from accessing the care may violate federal law. 

“The Biden Administration has chosen to prioritize leftist politics at the expense of Alabama’s children,” he said in an emailed statement. 

The lawsuit was brought by GLBTQ Legal Advocates & Defenders (GLAD), plus the Southern Poverty Law Center (SPLC), National Center for Lesbian Rights (NCLR) and the Human Rights Campaign. 

Scott McCoy, LGBTQ rights & special litigation interim deputy legal director at the Southern Poverty Law Center who is representing plaintiffs in the case, believes that Burke allowing the law to go into effect Sunday does not necessarily mean that an injunction is off the table. 

“It just told me that he needed more time,” McCoy said. 

There are different forms a potential injunction could take, he said, including narrowing the scope of who could be prosecuted under Alabama law to apply to only physicians or finding the entire ban to be unconstitutional.

The plaintiffs are waiting to see “whether or not the judge hits the pause button” on enforcement of the law, which various LGBTQ+ civil rights groups have argued violates the 14th and First Amendments, as the case goes to trial, McCoy said. 

Alabama Attorney General Steve Marshall, representing the state in the case, criticized the Biden administration’s stance in support of gender-affirming care, specifically calling out the Justice Department after the agency warned states last month that blocking trans youth from accessing the care may violate federal law. 

“The Biden Administration has chosen to prioritize leftist politics at the expense of Alabama’s children,” he said in an emailed statement.