Alabama Gov. Kay Ivey signed SB 184, nation's first felony ban on gender-affirming care for minors

On April 8, 2022, Alabama Gov. Kay Ivey signed SB 184, the "Alabama Vulnerable Child Compassion and Protection Act," into law as Act No. 2022-289, one day after the Alabama Legislature passed it in the final hours of its session. The law makes it a Class C felony — punishable by up to 10 years in prison and a $15,000 fine — to prescribe puberty blockers or cross-sex hormones, or to perform sterilizing or genital surgery, on a minor to treat gender dysphoria. It carves out only a narrow exception for minors with medically verifiable disorders of sex development, and separately requires school personnel to disclose a student's gender or sex incongruence to the student's parents.

In a signing statement, Ivey said she believed "if the Good Lord made you a boy, you are a boy, and if he made you a girl, you are a girl," and framed the measure as protecting children "from these radical, life-altering drugs and surgeries." The bill's sponsor, Sen. Shay Shelnutt, had characterized gender-affirming care as "child abuse." Alabama physicians and national medical associations, including the American Medical Association and American Academy of Pediatrics, said the law criminalized well-established, evidence-based care. The Act took effect May 8, 2022, 30 days after signing, making Alabama the first state to enact a criminally enforced ban on gender-affirming medical care for minors.

Updates

2022-05-13 — Federal court preliminarily enjoined the medication ban [6, 7]

U.S. District Judge Liles Burke issued a preliminary injunction in Eknes-Tucker v. Ivey (also captioned Boe v. Marshall) barring Alabama from enforcing SB 184's prohibition on prescribing puberty blockers and hormone therapy to transgender minors while the constitutional challenge proceeded. The suit was brought by four Alabama families, medical providers, and Rev. Paul Eknes-Tucker, with the U.S. Department of Justice joining as plaintiff-intervenor. Burke, a Trump appointee, found that "at least twenty-two major medical associations in the United States endorse transitioning medications as well-established, evidence-based treatments," and that the state's justifications were "not exceedingly persuasive." The Act's ban on surgeries and its school-disclosure requirement remained in effect.

2023-08-21 — Eleventh Circuit panel vacated the preliminary injunction [9]

A unanimous three-judge panel, in an opinion by Judge Barbara Lagoa, held the district court abused its discretion by applying heightened scrutiny to SB 184's medication ban and vacated the injunction, clearing the way for the state to enforce the ban while the underlying case continued.

2024-08-29 — Full Eleventh Circuit, sitting en banc, upheld the ban as constitutional [8, 10]

Ten of eleven judges on the full Eleventh Circuit, in a 173-page decision with five separate opinions, held that SB 184's ban on gender-affirming medication for minors does not violate the Constitution, rejecting claims under both the Due Process and Equal Protection Clauses. Judge Lagoa's majority opinion invoked the Supreme Court's Dobbs decision in reasoning that the asserted right was not "deeply rooted" in the nation's history. Judge Robin Rosenbaum dissented, writing that under the majority's reasoning "blistering, blood-letting, and leeches are in, but antibiotics, antivirals, and organ transplants are out." The ruling left the ban in continuous effect.

2025-06-06 — Supreme Court cert petitions dismissed by stipulation, ending the litigation [11, 12]

Two petitions asking the Supreme Court to review the Eleventh Circuit's en banc ruling — No. 24-582, filed by the U.S. Department of Justice, and No. 24-612, filed by the private plaintiffs — were both voluntarily dismissed by joint stipulation of the parties under Supreme Court Rule 46, without the Court ruling on the merits. The DOJ's petition was dismissed February 13, 2025; the private plaintiffs' petition was dismissed June 6, 2025, twelve days before the Supreme Court decided United States v. Skrmetti upholding Tennessee's similar ban. With both petitions withdrawn, the Eleventh Circuit's en banc ruling stands as the final word in the case, and Alabama's felony ban on gender-affirming medication for minors has remained in continuous effect since August 2024.