Nearly two dozen states are urging a federal appeals court to uphold Florida’s ban on child sex change operations, warning that history may not look kindly on the sterilization of children for gender distress.

In a brief filed Wednesday and obtained by the Daily Caller News Foundation, Alabama Attorney General Steve Marshall and 22 other state attorneys general urged the eleventh circuit court of appeals to reverse a lower court ruling that overturned Florida’s pediatric sex-change ban. The amici noted that until recently, “providing sex-change treatments to minors was practically unthinkable,” and recognized that many states and European countries have already created age-based restrictions on sex-change medical interventions.

“Maybe history is repeating itself in grim fashion, and we’ll one day wonder how this medical scandal spread so far before being reined in,” the brief states. “In any event, because ‘nothing rules out th[e] possibility’ that Florida acted to protect kids from sterilizing treatments, the district court grievously erred.”

The brief argues the court made a critical miscalculation by assuming the actions of the Florida State legislature were not motivated in good faith, while presuming the good faith of the World Professional Association of Transgender Health (WPATH).

WPATH is an influential transgender medical organization that recommends children receive sex-change interventions such as puberty blockers, cross sex hormones, and sex change surgery.

In June Federal District Court Judge Robert L. Hinkle ruled against Florida law SB 254 which prohibits minors from receiving irreversible transgender treatments such as puberty blockers, cross sex hormones, and sex-change surgeries. The decision is currently under appeal and the 11th Circuit Court of Appeals has issued a stay on Hinkle’s ruling, allowing Florida’s ban on pediatric sex change to be implemented during the court proceedings.

In his opinion, Hinkle argued that “Gender identity is real” and suggested legislators in Florida who banned pediatric sex-change were motivated by bigotry.

“There has long been, and still is, substantial bigotry directed at transgender individuals,” Hinkle wrote. “Common experience confirms this, as do some of the comments of legislators recounted above. And even when not based on bigotry, there are those who incorrectly but sincerely believe that gender identity is not real but instead just a choice.”

The term “gender identity” was popularized by controversial sexologist John Money, and is used by transgender activists to describe a person’s internal sense of being male or female, distinct from their natural sex.

The Alabama-led brief states that claims of bigotry were made erroneously and without the “presumption of legislative good faith,” noting pediatric sex-change interventions are a “booming business, with devastating consequences for many.”

“When a legislature has admittedly ‘legitimate concerns’ about ‘substantial harm’ that sterilizing treatments are having on children, there is no ground for assuming that bigotry is the real reason the State acted,” the brief states.

The brief also rejects Hinkle’s claim that a Florida state House member’s quotation of a biblical passage which says God created people “male and female” was “evidence” that “animus” motivated the passage of Florida’s sex-change ban.

Hinkle references the WPATH Standards of care throughout his ruling, calling them “well-established standards of care” that underpin much of his argument for overturning Florida’s child sex change ban.

NEW: More #WPATH court documents have been unsealed, and the evidence is incontrovertible: @SecretaryLevine applied political pressure throughout the drafting of the WPATH guidelines in order to remove age restrictions for gender surgeries on minors. #FireLevine pic.twitter.com/49VnxquvH5

— Do No Harm (@donoharm) June 28, 2024

The amicus brief challenges the credibility of WPATH, referencing recently unsealed court documents showing top officials in the Biden-Harris administration, concerned about the political implications of minimum age requirements, pressured WPATH to remove lower age limits for sex change surgeries from their clinical guidance.

“Senior government officials influenced the guidelines they now hold up as ‘evidence-based.’ Admiral Rachel Levine, the Assistant Secretary for Health at HHS, met regularly with WPATH leaders, ‘eager to learn when SOC 8 might be published’ because ‘[t]he failure of WPATH to be ready with SOC 8 [was] proving to be a barrier to optimal policy progress’ for the Biden Administration,” the brief states.

“After WPATH provided Levine exclusive access to the near-final draft of SOC8, Levine asked WPATH to remove the recommended age minimums for transitioning treatments. According to officials within Levine’s office, the Admiral was concerned that the listing of “specific minimum ages for treatment … will result in devastating legislation for trans care.”

It also points out that a pattern of prioritizing politics and ideology over science was again seen in documents showing WPATH breaking international standards of guideline creation by allowing clinicians with a financial conflict of interest to help craft the Standards of Care and suppressed the publication of their own research.

“While the standards suggest ways for guideline committees to benefit from those clinicians’ expertise, they understandably recommend not putting clinicians who are financially dependent on the services under review in charge of evaluating the safety or efficacy of those exact services. WPATH did the opposite, expressly limiting SOC-8 authorship to existing WPATH members—who already practiced or espoused “gender-affirming care,” the brief states.

WPATH did not respond to a request for comment.