Amicus Brief: Hudacko v. Regents of the University of California

When Ted Hudacko divorced, a family court order required both parents’ approval before his minor son could undergo any gender-related surgery. A University of California hospital nonetheless implanted a puberty-blocking device in the boy without Hudacko’s knowledge or consent. The Ninth Circuit held that the doctors and other state defendants were entitled to qualified immunity because Hudacko could cite no clearly established law under similar facts. Hudacko has asked the Supreme Court to grant review.

Manhattan Institute senior fellow Leor Sapir has filed a brief in support of Hudacko. Sapir, a coauthor of the U.S. Department of Health and Human Services' review of pediatric gender medicine, explains what the best available evidence shows about the treatments at the heart of this case. (Last month, MI also filed a separate brief supporting Hudacko, together with the Independent Women’s Law Center.)

The HHS review, published in November 2025, examined 17 systematic reviews of pediatric medical transition (PMT). It found that the evidence of benefit is very uncertain, while the evidence of harm is less so. PMT's side effects often include serious and irreversible harms, including infertility, sexual dysfunction, and impaired bone development. Systematic reviews tend to understate harms, given that most minors who received these treatments did so only in the last decade, long-term follow-up is scarce, and researchers have been reluctant to publish unfavorable results. 

Sapir also explains why these interventions are unlike other pediatric care. Pediatric medical transition is unusual in offering minors with no physical pathology interventions with an unfavorable risk-benefit profile, based on a subjective diagnosis with poor predictive validity.

Patients are also too young to grasp the lifelong consequences of PMT, so they cannot meaningfully consent. More fundamentally, consent matters only when a treatment’s benefits outweigh its risks, which has not been established for PMT. Patient autonomy is a right to refuse treatment, not a right to demand interventions of unproven benefit.

Leor Sapir is a senior fellow at the Manhattan Institute.

Ilya Shapiro is a senior fellow and director of Constitutional Studies at the Manhattan Institute. Follow him on Twitter here.

John Ketcham is a legal policy fellow and director of Cities at the Manhattan Institute.