This week the US Supreme Court heard oral arguments United States v. Skrmetti, A case challenging Tennessee’s ban gender affirming care for minors. Justices are examining whether these bans discriminate on the basis of sex under the Constitution’s Equality Clause.
the court appears ready To defend Tennessee law, SB1It was enacted in July 2023 and bans all medical care It seeks to allow a person under the age of 18 to “identify or live with an assumed identity that does not correspond to the minor’s sex” assigned at birth, citing the state’s interest in “encouraging minors to recognize their sex.”
“What is at stake is whether the Court will consider it or not transgender people Deserving some of the protections of the Equal Protection Clause or whether states allow discrimination against transgender people. And it’s a big question,” says Elana Redfield, an LGBTQ+ policy expert at the Williams Institute at the University of California, Los Angeles.
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Tennessee law, which mirrors similar recent bans 24 other statesprevents transgender youth from receiving treatments proven to alleviate symptoms of gender dysphoria (psychological distress resulting from incongruence between the sex assigned at birth and their gender identity). These treatments include puberty block drugs and hormonal therapy—Medicines that are also used by non-transgender teenagers and children to treat a variety of conditions. It is approved for use in the treatment of gender dysphoria American Medical Associationhas American Pediatric Associationhas American Psychological Association and other important medical organizations.
a number of studies be showing Teens who receive gender-affirming care have better mental health outcomes—including lower rates of suicidal ideation—than those who wanted treatment but couldn’t get it. And custody bans have increased suicide rates among transgender youth in affected states, recent research has shown As with any medication, treatments can have risks, and this is true even when prescribed to non-transgender people. Parents and doctors weigh these risks against those who have not received attention. Critics of gender-affirming care for minors often cite concerns that teens will later regret the treatment, but regret rates are relatively low.
Although Tennessee law prohibits these treatments when used to transition, non-transgender youth continue to have access to them. During oral arguments at the Supreme Court on Wednesday, US Attorney General Elizabeth Prelogar argued that this amounts to sex discrimination because the law uses the sex assigned at birth to determine which drugs someone can legally obtain. For example, a teenager would have access to testosterone if they were assigned male at birth, but not female.
“SB1 leaves the same medications and many others completely off-limits when used for any other purpose (outside of gender-affirming care), even if those uses carry similar risks,” Prelogar said in his opening statement. The federal government argues that the law’s sex-based classification should result in a greater level of judicial scrutiny under the Equal Protection Clauses of the 14th Amendment to the Constitution. If the Supreme Court approves, it can send the case back to lower courts. There Tennessee officials would have to demonstrate that the law serves an important government interest. At this stage, lower courts can weigh the evidence in favor of gender affirmation to assess the impact of the outright ban.
Before the court’s nine judges, Tennessee Attorney General Matthew Rice argued that the law does not discriminate on the basis of sex because it prevents those assigned male and female at birth from transitioning. That reasoning could also apply to laws that prevent or limit adults from receiving gender-affirming care, such as Florida’s SB 254. A decision isn’t expected until next spring, but at least five members of the Supreme Court’s conservative majority are widely supported. he is likely to favor Tennessee.
“If the court upholds this ban, it will validate all 24 states that have bans” protecting gender affirmation for minors, Redfield says. The decision, he added, could affect current and future legal challenges to other anti-trans legislation, such as gender expression care for adults or bathroom and sports bans based on gender identity.
The stakes of these challenges will continue to rise as President-elect Donald Trump returns to the White House in January. This election cycle, Republicans spent $215 million on network TV ads attacking and denigrating transgender people. less than 1 percent of the US population.
“On day one, I will sign an executive order to stop all federal agencies from promoting sexual or gender transition at any age,” Trump said in June 2023 at an event organized by the anti-LGBTQ+ group Moms for Liberty. he also said he would revoke federal funding for any hospital or health care provider that provides gender confirmation to minors.
That possibility is especially troubling to Daphna Stroumsa, an ob-gyn at Michigan State University who specializes in gender confirmation care. Being prevented from providing the best care to patients is “heartbreaking. It feels ethically and morally wrong,” says Stroumsa. “The consequences of not being able to provide that care to the individual can be devastating.”
Susan Lacy, one of the plaintiffs in the lawsuit against Tennessee’s ban and an ob-gyn based in Memphis, expressed similar dismay. confession in the initial case. “Being prohibited from treating my patients based on the available evidence and clinical guidelines is an appalling scenario that no medical provider should have to face,” he wrote.
Almost 40 percent Transgender youth between the ages of 13 and 17 currently live in states where laws prohibit gender-confirmation care. Members of the three families who challenged the Tennessee ban in a Tennessee court have described how devastating a ban would be to their lives and livelihoods. In three families, parents described how they experienced the debilitating mental and physical symptoms of gender dysphoria that caused their children to withdraw from the world. A child started having recurrent urinary tract infections because he was uncomfortable using the bathroom at school. said his parents. Another, named Ryan Roe, he threw up almost every morning before school and almost completely stopped talking.
“I was scared and didn’t want to move too quickly with medical treatment,” Roe’s mother wrote. confession. “But I was also worried that, in my fear, I had moved too slowly for what my child needed. As I watched my son suffer and deteriorate, I realized that we could not wait any longer.” The family consulted a doctor about gender confirmation, and Roe eventually started taking testosterone. Later, he “became the outgoing, talkative child we saw before puberty,” his mother said.
“No one makes this choice overnight,” says Stroumsa. “These are dedicated parents and doctors who have a very long process … before making decisions.”
All three families are considering traveling out of state on a regular basis for treatment; it’s an expensive endeavor, parents have to take days off from work and children have to miss school. And clinics in non-ban states already have limited capacity. “We’re in the state of Michigan, which is within traveling distance of several states that have bans,” says Stroumsa. “We’ve seen an uptick in patients coming in from out of state, and we’re already doing several months of consultations.”
But for the three families, going back to the way they were before is not an option.
“It may seem like a small problem to others, but it affects my whole world,” wrote John Doe, a transgender teenager, in one. confession filed in district court. “I’ve been through a lot to finally get to where I’m happy and healthy and I hope it doesn’t take away from me.”
