Supreme Court Will Decide on Law Barring Transgender Care for Minors

Key Points

• The state of Tennessee passed a law barring gender-affirming medical treatments for minors.
• The Biden administration and others are suing the state, arguing the ban violates the 14th Amendment of the U.S. Constitution.
• The Supreme Court agreed to hear the case and its decision will apply to several similar state laws nationwide.

When someone asks the question, "How do you identify?" a growing number of people around the world are answering "Transgender," because their gender identity doesn't match their biological sex assigned at birth.

But being transgender is nothing new, nor are the legal challenges transgender people can face. And although LGBTQIA+ folks have gained greater acceptance in society at large, the past few years have seen an increase in legislation seeking to curtail trans rights.

That includes transgender access to medical care.

What is the Tennessee law targeting gender-transition care?

The Supreme Court (SCOTUS) announced on June 24 that it will consider whether one such law violates the Constitution. The law, passed by Tennessee policymakers, bars gender-affirming medical care for minors.

The Tennessee law, SB 1, bars healthcare professionals from providing gender-affirming care, including puberty blockers, cross-sex hormones and gender-affirming surgery for trans minors.

The legislation, enacted in July 2023, does allow these treatments for cisgender young people with congenital conditions or early puberty. Providers who violate the law can face lawsuits, fines and professional discipline.

Questions about gender have increasingly become the subject of legal disputes.

As of June, 25 states have passed similar bans, affecting roughly 117,600 trans youth ages 13 to 17, according to the Human Rights Campaign (HRC). In the past few years, several states have also enacted restrictions on trans people regarding school sports participation and bathroom usage.

The justices are expected to hear the 2024 Tennessee case, U.S. vs. Skrmetti, during the next session, which begins in October.

The plaintiffs, including three transgender youths and their parents, sued the state of Tennessee, contending that the ban violates the equal protection clause of the Constitution's 14th Amendment by discriminating against trans teens based on their sex and gender and undermining parents' rights to access and make decisions regarding their children's healthcare.

The law prohibits the specified treatments in "explicitly sex-based terms," Solicitor General Elizabeth Prelogar wrote in her petition to the Supreme Court after the Biden Administration intervened to support the plaintiffs.

The same medical treatments remain unrestricted if prescribed for any purposes other than gender affirmation, she wrote.

The challengers say gender-affirming care is crucial for people who experience gender dysphoria–a diagnosis indicating significant distress caused by a mismatch between a person's gender identity and sex assigned at birth, per the American Society of Clinical Pathology.

Transgender patients seeking gender-affirming medical care have to undergo thorough assessments and extensive counseling before receiving treatment. Parental consent is also required for minors.

State laws like this inflict "profound harms" on trans teens and their families by denying medical treatments families and doctors have deemed appropriate and necessary to treat a serious health condition, Prelogar wrote.

In 2023, a federal judge sided with the plaintiffs, deciding that the law probably violates the Constitution. He blocked the ban on puberty blockers and gender-affirming hormones but didn't touch the ban on gender-affirming surgery, stating the plaintiffs didn't have the legal standing to challenge it.

These operations usually entail top surgery—or breast removal—but can also involve other procedures, including the creation of artificial vaginas or penises.

When the Cincinnati-based Sixth Circuit Court of Appeals upheld the law and reversed the judge's preliminary injunctions, the Biden Administration asked the Supreme Court to step in.

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Why does the law ban treatment for transgender minors?

The law's supporters, including Tennessee Attorney General Jonathan Skrmetti, argue that gender-affirming medical treatments are experimental, have "uncertain benefits" and carry serious, potentially irreversible side effects, including infertility, sexual dysfunction, diminished bone density, cardiovascular disease and cancer.

The number of trans patients seeking such care has risen significantly, Skrmetti wrote, prompting states to intervene to protect teens who may not fully recognize the lifelong consequences of such medications and procedures.

All major medical organizations in the U.S., including the Endocrine Society and American Academy of Pediatrics(AAP), endorse the treatments.

Gender dysphoria is a significant risk factor for suicide, indicated a 2019 report and, proponents say, gender-affirming care, which is evidence-based, can be lifesaving.

Other research indicates few trans teens receive gender-affirming medical treatments, and the vast majority who do receive puberty blockers, which delay–but don't prevent–puberty. The number of surgeries has rapidly increased since states began implementing bans but remains exceedingly rare in minors, suggested a 2023 report.

The current Supreme Court case won't affect state laws banning gender-affirming surgery for minors.

Although HRT obstacles exist and transitioning at all can be challenging, a 2021 long-term study suggests fewer than one percent of people regret their decision.

In April, SCOTUS granted an emergency application allowing Idaho to enforce its ban on gender-affirming medical care for almost all minors statewide. However, the justices did not express an opinion on whether such bans are constitutional.

Until recently, the Supreme Court has mostly declined to weigh in on the national debate about transgender rights. In 2021 and January, the justices turned away two separate cases regarding whether trans students could use school bathrooms corresponding to their gender identities.

However, in 2023, SCOTUS expressed an opinion to allow a transgender girl to participate in girls' sports and decided in 2020 that federal law bars discrimination based on sexual orientation or gender identity, including trans identities.

The upcoming ruling on the Tennessee ban will affect other state laws, including those in Texas and Kentucky, barring gender-affirming medical care for minors.

Why are more youth identifying as gender diverse?

More than 1.6 million people ages 13 and up in the U.S. identify as transgender, according to the Williams Institute at the University of California Los Angeles (UCLA). Nearly one in five transgender people nationwide are teens ages 13-17.

The number has almost doubled in the past few years, indicated a 2022 report.

The rise may be attributable to younger generations' willingness to explore and express their distinct identities, according to the Hartford Healthcare Institute of Living.

The openness of transgender celebrities may also be a factor.

"Adolescence is naturally a period of change and exploration, and more and more, younger generations are more openly exploring aspects of their gender identity," said Derek Fenwick, Psy.D., in a news release. Fenwick is a clinical psychologist with The Right Track/LGBTQ Specialty at the Institute of Living, based in Hartford, Connecticut.

An increasing number of people are making an effort to support trans men and women and nonbinary folks by respecting gender pronouns and adopting more inclusive language. Still, there's a long way to go before nonbinary and transgender people feel wholly accepted in society.

"We must move away from a gender binary that has never existed," Fenwick said. "Throughout history, we have always had gender diversity, and as a society, we need to openly embrace this so individuals can feel comfortable exploring various aspects of their identity without fear of repercussions or stigma, which sadly we know still occurs."

The bottom line

Research indicates that, for most trans patients, the benefits of gender-affirming hormones and surgeries outweigh the risks.

The Supreme Court will likely issue its ruling in the Tennessee case sometime in 2025. Until then, state laws barring gender-affirming medical care for minors will remain in effect.