In a landmark victory for academic freedom, the University of Louisville will pay nearly $1.6 million in damages and attorneys’ fees to settle a lawsuit brought by a respected psychiatrist fired for questioning the use of puberty blockers and cross-sex hormones on gender-distressed children.
The payout ends the long-running case of Dr Allan Josephson, a nationally renowned child and adolescent psychiatrist, who was targeted by colleagues and administrators after speaking in a personal capacity at a 2017 Heritage Foundation panel on treatment approaches for gender dysphoria.
Represented by Alliance Defending Freedom (ADF), Dr Josephson sued the university in 2019, alleging a campaign of harassment and retaliation for voicing mainstream clinical concerns about the increasingly dominant ‘affirmative’ model of transgender care, which urges clinicians to unquestioningly validate a child’s stated gender identity and, where requested, support medical transition.
Last September, the US Court of Appeals for the Sixth Circuit ruled that Josephson’s case could proceed to trial, rejecting the university’s claims to qualified immunity and confirming that his comments were protected under the First Amendment.
Dr Josephson, who was hired in 2003 to lead a struggling division he later transformed into a nationally respected programme, had warned during the panel that the evidence for puberty blockers and cross-sex hormones was weak.
Anticipating key findings from the UK’s Cass Review (2024), he pointed to growing evidence that such interventions can cause serious harms, including long-term bone density loss and infertility.
Given “the tendency for gender dysphoria to subside by late adolescence”, he argued that the affirmative model “did not serve [children’s] long-term health interests”.
Instead, he advocated a ‘watchful waiting’ approach – a developmentally grounded strategy that closely monitors children without initiating medical or social transition until their identity stabilises with age.
After learning of his remarks, several university faculty and staff members – including individuals from the institution’s LGBT Centre – objected to his views. Their indignation deepened when they discovered he had expressed similar opinions as an expert witness in earlier state and federal lawsuits involving public school children seeking access to facilities inconsistent with their biological sex.
Court documents reveal one colleague complaining to another that Dr Josephson was “literally going against the scientific and ethical position of the profession… and getting paid to do it”, receiving the reply: “Definately [sic] agree.” Yet in later depositions, both interlocutors disclaimed any expertise in gender dysphoria and were unable to identify a single ethical guideline he had violated.
Remarkably, senior administrators moved swiftly to placate critics, demoting Dr Josephson to the role of junior faculty just seven weeks after the Heritage Foundation panel event.
For good measure, they also reduced his salary, retirement benefits and academic travel funds. Shortly after the demotion, the Chief of Staff to the Dean of School reassured one irate employee: “We’ve taken care of that,” in reference to Dr Josephson’s presentation.
Over the ensuing months, colleagues continued to belittle and berate him, causing irreparable damage to his professional career and reputation. He was barred from treating LGBTQ patients. He was illegally mandated to use transgender terminology – i.e., language inconsistent with biological sex. He was prevented from discussing gender dysphoria with students, stripped of his teaching duties and even temporarily banned from faculty meetings.
University officials also conspired to remove him entirely. Their efforts included keeping a bizarre “Allan tracking document”, soliciting complaints from alumni who were coached on what to say and discussing the need to generate “strong documentation” to ensure he would not be reappointed.
In an op-ed for the Daily Signal, Josephson recalled being “ostracised” and “subjected to other forms of hostility”, as faculty members demanded he apologise for his views on transgender issues, though without specifying to whom.
“Others remained silent, knowing which way the cultural winds were blowing,” he says. “I was stunned to realise I was actually being punished for doing what I was paid to do; namely, think and speak.”
The environment grew increasingly hostile until the university informed him of its highly unusual decision not to renew his contract when it expired on June 30th 2019, bringing a nearly 40-year academic career to an end.
Following his dismissal, he sued, and in March 2023 a federal district court ruled that a jury should hear his claims that university officials retaliated against him for his constitutionally protected speech.
The officials in question then appealed, arguing they were entitled to qualified immunity, which would have shielded them from trial. It was not clearly established, they claimed, that each defendant’s conduct, in isolation, showed retaliation against the professor because of his protected First Amendment speech. They further argued that it was “unclear” whether the First Amendment protected Dr Josephson’s off-campus, off-the-clock remarks.
In response, his counsel pointed out that this was effectively to ask the Court to ignore “decades of established precedent – from this Court and the Supreme Court – that protects professors’ right to express their views on public issues off campus, prohibits public universities from retaliating against professors who exercise this right, and allows wrongly terminated professors to seek reinstatement”.
Last year, the Sixth Circuit Court of Appeals rejected the defendants’ argument and sent the case back to the district court for jury trial.
Facing the prospect of a public trial, the university opted to settle before proceedings began.
“I’m glad to finally receive vindication for voicing what I know is true,” said Dr Josephson following news of the settlement. “Children deserve better than life-altering procedures that mutilate their bodies and destroy their ability to lead fulfilling lives.”
Despite the ordeal, he said he is “overwhelmed” to know that his case may help other medical professionals speak more freely: “Acceptance of one’s sex leads to flourishing.”
“After several years, free speech and common sense have scored a major victory on college campuses,” said ADF Senior Counsel Travis Barham. “Dr Josephson’s case illustrates why – because the latest and best science confirms what he stated all along. Hopefully, other public universities will learn that if they violate the First Amendment, they can be held accountable – and it can be very expensive.”
Dr Frederick Attenborough is the Executive Director of Communications and Research at the Free Speech Union.
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