In the heated national debate over the gender medicalization of minors who are confused about their sex, one state has emerged as a decisive player: Alabama.
A new episode of the popular “Generation Indoctrination” podcast weighs in on how the state’s tough law and aggressive litigation strategy reshaped the legal and political landscape surrounding so-called gender-affirming care.
“When the history of the gender wars is written, particularly the medical scandal of so-called gender affirming care, it will be revealed that one state played an outsized role in forcing the issue into the public consciousness and helped bring about the political reckoning that halted the madness,” says host Brandon Showalter.
Alabama became the second state, after Arkansas, to prohibit puberty blockers, cross-sex hormones and body-mutilating surgeries for minors with the 2022 passage of the Vulnerable Child Compassion and Protection Act. Unlike many other states, Alabama’s law imposed criminal penalties on providers who performed such illicit procedures.
That move drew a lawsuit from the Biden administration and LGBT activist groups, Boe v. Marshall, which accused the state of unconstitutional overreach. But earlier this year, the Department of Justice under President Donald Trump dismissed the case.
By then, Alabama’s discovery process had uncovered internal government communications and documents from the World Professional Association for Transgender Health (WPATH) that Attorney General Steve Marshall later described as “jaw-dropping.”
Secretary of State Wes Allen, then a freshman legislator, recalled being approached in late 2019 about sponsoring the bill.
“About 2020, early 2020 or late 2019, the Eagle Forum and some other groups approached me about sponsoring this legislation in the Alabama House of Representatives about the mutilation of these children and all the puberty blockers, cross sex hormones, and then, of course, potential surgeries,” Allen said. “I thought it was horrendous. I said, ‘Yeah, let’s dig into this. Let’s look into it.’”
Allen described years of delays, including during the ongoing COVID-19 pandemic shutdowns, before the measure finally passed in 2022. “It was a lot of heavy lifting, a lot of adversity, a lot of opposition, but there were so many good people that came together to lock arms to get this across the finish line, to become the second state to get it done, to be the tip of the spear in this fight,” he said.
Attorney General Marshall noted that, early on, even Republicans resisted.
“The political reality was that when the effort first started, there was significant pushback, not just from the Democratic side of the aisle, but also many Republicans,” he said. “They, number one, felt like this is really not an issue. Why are we talking about it? They were hearing from a small subset of parents who, frankly, were given false information about suicide risk. … And then finally, there was the sense that somehow, if Alabama engaged in the protection of kids, that we were a backward state.”
Marshall credited lawmakers for ultimately passing “one of the strongest laws in the country” and said criminal penalties were crucial to deterrence.
The state also focused on undermining WPATH, whose standards of care were being cited in courts and medical associations nationwide. Marshall said the discovery process revealed internal communications showing federal officials, including then-Assistant Secretary for Health Rachel (Richard) Levine, who himself identifies as trans, pressed the group not to include age restrictions for said body-disfiguring “interventions.”
“It was like Exhibit A to why this is so insane,” Marshall said, describing the material uncovered. “We’re using fantasy chatrooms to define standards of care for kids.”
One revelation included WPATH citing content from the Eunuch Archive, an internet forum laced with fetishistic material, including child sexual abuse themes. Marshall later incorporated those findings into a U.S. Supreme Court amicus brief defending Tennessee’s ban.
Dr. Patrick Lappert, a cosmetic surgeon from Decatur, testified in support of Alabama’s law and has criticized the harms of trans surgeries. He said the profit motive fueled the booming industry.
“All of Sunday morning was devoted to that topic,” Lappert recalled of a California conference. “It was essentially four solid hours of plastic surgeons teaching one another about how to bring this into your practice. The technology you’ll be looking for, how to work the insurance companies, how to bully the insurance companies [by] using the threat of litigation. … Meanwhile, plastic surgeons are making bookoo bucks doing gender affirmation surgery.”
Lappert said he was “sorely embarrassed” by his professional society’s refusal to take a stand.
On Jan. 28, President Trump signed an executive order directing agencies to reject WPATH guidelines and called youth gender transitions “a stain on our nation’s history.” In May, the Department of Health and Human Services issued a 400-page report declaring insufficient evidence for the irreversible procedures.
Allen said he hopes history remembers Alabama’s stand. “I just hope that in the end, we recognized an issue. We were not afraid to get in the fight, not afraid to expose what was going on with this child mutilation, gender ideology that was sweeping the country, and to plant our flag … to protect children,” he said.
