## Facts

- Alabama enacted the Vulnerable Child Compassion and Protection Act (VCCPA), which criminalizes prescribing or administering puberty blockers or cross-sex hormones to minors when done to alter appearance or affirm gender identity inconsistent with the minor’s sex.
- Violations are felonies, and the Act also criminalizes participation in obtaining such medications for minors, exposing parents to prosecution.
- Plaintiffs included transgender minors, their parents, and medical providers seeking to provide or obtain the prohibited treatments.
- Plaintiffs challenged VCCPA § 4(a)(1)–(3) under substantive due process (parental rights) and equal protection (sex and transgender-status discrimination).
- The district court preliminarily enjoined enforcement, concluding plaintiffs were likely to succeed because the law burdened a fundamental parental right and constituted sex-based discrimination subject to heightened scrutiny.
- Alabama appealed, arguing the district court used incorrect constitutional standards in granting preliminary relief.

## Issues

1. Whether the Due Process Clause protects a fundamental parental right to obtain puberty blockers and cross-sex hormones for minors to treat gender discordance, triggering strict scrutiny.
2. Whether VCCPA § 4(a)(1)–(3) classifies on the basis of sex or another protected characteristic, triggering heightened scrutiny under the Equal Protection Clause.
3. Whether the district court abused its discretion by issuing a preliminary injunction based on those standards.

## Decision

- The Eleventh Circuit vacated the preliminary injunction and remanded.
- The court held the asserted parental right to obtain the specified medications for minors is not a fundamental right under substantive due process.
- The court held plaintiffs did not show the statute creates a sex-based (or other protected-class) classification; rational basis review applies.
- Because the district court applied heightened scrutiny on both claims, it abused its discretion in finding a substantial likelihood of success on the merits.

## Legal Principles

- Unenumerated fundamental rights are recognized only if carefully described and shown to be deeply rooted in the Nation’s history and tradition and implicit in ordered liberty.
- General parental rights in childrearing do not automatically create a fundamental right to access any specific medical treatment for a minor; states may reasonably regulate medical practice and minors’ welfare.
- A law does not trigger heightened equal protection scrutiny merely because it references sex-related concepts; the controlling question is whether it classifies based on sex (or another protected status) rather than regulating conduct or medical procedures.
- If no protected-class classification or fundamental right is implicated, the law is reviewed under rational basis, and legislative judgments receive substantial deference.
- A preliminary injunction is improper where the district court’s likelihood-of-success analysis rests on an incorrect constitutional scrutiny framework.

## Conclusion

The Eleventh Circuit vacated a preliminary injunction against Alabama’s criminal ban on providing specified gender-transition medications to minors, holding that the Due Process Clause does not recognize the asserted fundamental parental right and that the Equal Protection Clause requires only rational-basis review because the statute does not classify by sex or another protected characteristic.


Eknes-Tucker v. Governor of Alabama, 80 F.4th 1205 (11th Cir. 2023)