Should state-run healthcare plans be required to cover transgender procedures? The 4th U.S. Circuit Court of Appeals recently ruled that they should, while the states of West Virginia and North Carolina argued their decision not to cover these procedures was rooted in “legitimate government interests.” If the ruling stands, then West Virginia and North Carolina taxpayers will be made to foot the bill for transgender procedures.

The court’s decision was based in part on the premise that gender transition procedures are medically necessary. If that’s true, then it really is in the government’s best interest to cover these procedures. But it isn’t, and taxpayers should not be on the hook for funding them.

For a procedure to be medically necessary, it must be “needed to diagnose or treat an illness, injury, condition, disease or its symptoms,” and it must “meet accepted standards of medicine.” While there are loads of studies claiming gender-affirming care is associated with better mental health outcomes, a groundbreaking report out of the UK suggests these studies are flawed.

Last month, Dr. Hilary Cass, a British doctor and former President of the Royal College of Pediatrics, released a report uncovering how previous research supporting the gender transition procedures was of low quality and was built on “shaky” foundations. Simply put, if Cass is right, then there’s no good evidence to support the claim that gender surgeries are needed to treat gender dysphoria.

And Cass is not alone in the medical community. Last summer, physicians from nine European countries signed a letter stating that the emerging medical opinion that “gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide” isn’t backed by good evidence. In fact, many people who have undergone gender transition surgeries have done so because they had autism or bipolar disorder, felt uncomfortable with being gay or lesbian, or experienced severe sexual abuse or assault and wanted to escape the body they were in.

Instead of alleviating these underlying factors through traditional medicine or therapy, doctors and therapists allowed their patients to transition, which does not permanently heal their wounds. Tragically, 10 to 15 years after gender transition surgeries, the suicide rate of those who had undergone the surgery “rose to 20 times that of comparable peers.”

Aside from a lack of good evidence that transgender procedures like hormone therapy and gender reassignment surgery are necessary to treat conditions, there are also documented risks of harm and irreversible consequences.

Puberty blockers and hormones carry a significant risk of decreased bone densitystunted growth and infertility, especially when given to children. Those who undergo gender transition surgeries permanently lose certain organs, as well as face risks associated with silicone injections, and a higher risk of certain cancers. Those pushing for gender transition surgeries also leave out the devastating stories of people who underwent these procedures as children, only to profoundly regret them later.

West Virginia and North Carolina were right in arguing that not covering these procedures is in the government’s best interest. It is not in the government’s best interest to fund costly, experimental procedures that have a shaky success rate at best, and worse, a well-documented track record of causing immense harm.

What’s more, taxpayers across the country should not be on the hook to pay for these procedures. There’s strong legal precedent for protecting entities from covering or performing certain controversial procedures, including abortions, sterilizations, or assisted suicide. Gender reassignment surgery should be no different. The court should not have the authority to compel these states to do so.

People struggling with their gender identity deserve medical care that makes them whole. Pushing them toward ineffective, permanent procedures they may regret later is uncaring and immoral. Given the complete lack of legitimate government interest and medical necessity of these transition surgeries, West Virginia and North Carolina should appeal the case and protect both taxpayers and patients from the medical and financial consequences of these treatments.