In a federal trial considering a lawsuit challenging Arkansas’ state law banning gender-affirming care for minors, the state called two additional witnesses Tuesday who spoke against providing treatment for transgender people under the age of 18.

The suit was brought by the ACLU on behalf of the families of four transgender young people. They are seeking to prevent Act 626, or the Save Adolescents from Experimentation (SAFE) Act, from going into effect. Arkansas was the first state in the nation to pass such a law.

The state called Mark Regnerus, a professor of sociology at the University of Texas at Austin, to testify remotely. He was forced to stop speaking several times to accommodate for technical difficulties.

ACLU attorney Daniel Richardson asked Regnerus several questions about his qualifications before Regnerus began giving his testimony. Richardson pointed out that Regnerus is not a medical doctor and has no mental health training. Regnerus explained that he does not conduct research outside his jurisdiction. He said his expertise was in the science of social structures.

During his testimony, Regnerus reiterated statements made the day before by Dr. Stephen Barrett Levin of Case Western Reserve University School of Medicine in Ohio. Regnerus claimed he was concerned about the growing number of underaged patients who identify as transgender and suggested there was a lack of medical gatekeeping to receive treatment.

Regnerus talked in detail about research conducted by other academics, claiming some researchers, like psychologist Ken Zucker and Dr. Lisa Lippman, faced criticism for their work condemning transgender health care.

U.S. District Judge James M. Moody Jr. interrupted him.

“All I’m hearing is that people are forming opinions that are causing debate,” Moody said. “He can’t testify if the criticism was appropriate or not.”

Moody went on to ask Dylan Cooper, a lawyer for the attorney general’s office, “What does this have to do with the decision I have to make today?”

On cross-examination, Regnerus acknowledged he has received funding from a think tank called the Witherspoon Institute. He also had given testimony opposing same-sex adoption in the Michigan case DeBoer v. Snyder.

Richardson read to him from the judge’s decision which said his testimony was, “entirely unbelievable and not worthy of serious consideration.” Regnerus also said he had attended the Alliance Defending Freedom Conference in Arizona.

Regnerus’ testimony was followed by Dr. Patrick Lappert, a surgeon in Alabama who specializes in plastic and reconstructive surgery. In his career, Lappert said he had only treated one transgender patient. That person had requested a de-transition.

An attorney for the ACLU, Laura Oswell, pointed out that Lappert is not a psychologist and had almost no training in transgender care. Lappert said he had never diagnosed anyone with gender dysphoria.

Lappert talked about body dysmorphia in general. He said a red flag when treating patients is when they describe “a defect I can’t see.” He gave an example of a female patient requesting breast augmentation to keep her partner from leaving her.

“A patient will describe the level of emotional harm, a level of sorrow,” he said, professing his belief that surgery can only temporarily alleviate these feelings.

Lappert said there is a difference between reconstructive and aesthetic surgery. Ascetic surgery focuses on form and appearance, while reconstructive surgery focuses on bodily function. He said when consulting with patients, he tries to “ferret out” people who want an emotional result not achievable through cosmetic surgery

Lappert spoke very little about transgender health care specifically, only saying had provided breast augmentation on non-transgender people, but would provide such treatment on a transgender person. He said a minor child seeking this surgery cannot give informed consent.

On cross-examination, Lappert agreed that his opinions were out of alignment among most plastic surgeons. He also said he attended the same Alliance Defense Freedom Conference in Arizona as Regnerus. During the event, he said he went to a meeting about the difficulty of finding transgender experts to testify in cases.

Attorneys have said they will conclude calling witnesses on Thursday.