Dr. Josephson argued that children are not mature enough to make such major, permanent decisions and that 80-95 percent of children claiming gender dysphoria eventually accept their biological sex over time without such treatment.

Those views are widely shared by others and have been cited as the basis for states adopting bans on conversion treatments for young children.

His commentary triggered a backlash at the school, which led to a decision not to renew his contract. When sued, the school invoked the Eleventh Amendment and claimed qualified immunity. The district court correctly rejected that claim and the Sixth Circuit just affirmed that denial.

The university was seeking protection that would have insulated anti-free speech practices from liability, a dangerous prospect that could have dramatically accelerated the growing intolerance on campuses. The University of Louisville was arguing that they could punish faculty for public statements without fear of liability as state officers.