This week, the U.S. Supreme Court heard oral arguments. United States vs. Scumetti, The lawsuit challenges Tennessee’s ban on gender-affirming care for minors. The justices are considering whether these bans constitute sex-based discrimination under the Constitution’s Equal Protection Clause.
The court appears poised to uphold Tennessee law SB1, enacted in July 2023. The law bans all medical care intended to allow a person under 18 to “identify with or live as an identity that does not correspond to the minor’s gender.” It is something to do. It cited the state’s interest in “encouraging minors to understand their gender” at birth.
“The question is whether courts think transgender people deserve some of the protections of the Equal Protection Clause, or whether states are allowed to discriminate against transgender people. questionable,” says Elana Redfield, an LGBTQ+ policy expert at the Williams Institute, part of the University of California, Los Angeles.
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Tennessee’s law mirrors similar recent bans in 24 other states, and allows transgender youth to suffer from gender dysphoria (the emotional distress that results from a mismatch between their sex assigned at birth and their gender identity). ) are prohibited from receiving treatments that have been shown to reduce symptoms. These treatments include puberty blocking drugs and hormone therapy. These drugs are also used by non-transgender youth and children to treat a variety of conditions. Their use to treat gender dysphoria is supported by the American Medical Association, American Pediatric Association, American Psychological Association, and other important medical organizations.
Numerous studies have shown that adolescents who receive gender-affirming care have improved mental health, including lower rates of suicidal ideation, than adolescents who seek treatment but do not receive it. . Recent studies have also shown that care bans have increased suicide rates among transgender youth in affected states. Like any drug, the therapy can have risks, even when prescribed to non-transgender people. Parents and doctors weigh these risks against the risks of not receiving care. Critics of gender-affirming care for minors often cite concerns that the youth will later regret the treatment, but regret rates are relatively low.
Tennessee law prohibits these treatments for gender reassignment, but non-transgender youth can still receive treatment. In oral arguments before the Supreme Court on Wednesday, U.S. Attorney General Elizabeth Preloger argued that this amounted to sex discrimination. That’s because the law uses birth gender to determine which drugs someone can legally access. For example, adolescents assigned male at birth have access to testosterone, but those assigned female do not have access to testosterone.
“SB1 leaves the same drug and many other drugs completely unrestricted when used for other purposes (other than gender-affirming care), even if those uses pose similar risks.” Mr. Preloger said in his opening statement. The federal government argues that the law’s gender-based classification should trigger an increased level of judicial oversight under the Fourteenth Amendment’s Equal Protection Clause. If the Supreme Court agrees, it can send the case back to a lower court. There, Tennessee officials would have to prove that the law serves an important government interest. At this stage, lower courts may weigh evidence supporting gender-affirming care when assessing the impact of a blanket ban.
Tennessee Attorney General Matthew Rice told the court’s nine-judge panel that discrimination on the basis of sex does not apply because the law prevents both people assigned male and female at birth from changing gender. claimed not to have done so. This reasoning could also apply to laws that prevent or limit adults’ access to gender-affirming care, such as Florida’s SB 254. A ruling is not expected until next spring, but at least five members of the Supreme Court’s conservative majority are widely seen as banning or restricting access to gender-affirming care. He is likely to side with Tennessee.
“If the court upholds this ban, it could end up recognizing all 24 states that ban gender-affirming care for minors,” Redfield said. The decision could impact current and future legal challenges to other anti-transgender laws, such as bans on adult gender-affirming care and bans on bathrooms and sports based on gender identity, she said. added.
The risks of these challenges will continue to increase as President-elect Donald Trump returns to the White House in January. During this election cycle, Republicans spent an estimated $215 million on network television ads attacking and denigrating transgender people, who make up less than 1 percent of the U.S. population.
At an event hosted by the anti-LGBTQ+ group Moms for Liberty in June 2023, President Trump announced, “On day one, I will require all federal agencies to stop promoting gender and gender transition at any age.” I will sign an executive order directing this.” It also said it would cancel federal funding for hospitals and health care providers that provide gender-affirming care to minors.
This possibility is deeply worrying to Daphna Strumsa, an obstetrician-gynecologist at the University of Michigan Health who specializes in gender-affirming care. It’s “heartbreaking” to not be able to provide the best care to patients. I feel that is ethically and morally wrong,” Strumsa says. “The impact on individuals of not being able to provide this care can be devastating.”
Susan Lacey, a Memphis-based obstetrician-gynecologist and one of the plaintiffs in the lawsuit against Tennessee’s ban, expressed similar anguish in her initial lawsuit statement. “Being prohibited from treating patients according to existing evidence and clinical guidelines is a terrible scenario that health care providers are forced to face,” she wrote.
Currently, nearly 40 percent of transgender youth ages 13 to 17 live in states with laws prohibiting gender-affirming care. In the case, which began in Tennessee District Court, members of the three families that challenged Tennessee’s ban told how devastating the ban was to their lives and livelihoods. In all three families, parents described how they experienced debilitating mental and physical symptoms of gender dysphoria that caused their children to withdraw from the outside world. Parents say one child started suffering from repeated urinary tract infections because he was uncomfortable going to the bathroom at school. Another boy, called Ryan Roe, vomited almost every morning before going to school and had almost stopped talking.
“I was scared and didn’t want to rush into treatment,” Lo’s mother wrote in a statement. “But I also worried that I had been too slow to act on what my child needed. As I watched my son suffer and deteriorate, I realized that this I realized I couldn’t wait any longer.” The family consulted a doctor about gender-affirming care, and Lo eventually started taking testosterone. After that, he “returned to the vocal, outgoing child he had been seen as a preadolescent,” his mother said.
“No one makes this choice overnight,” Strumsa said. “They are dedicated parents, they are dedicated doctors, and they go through a very long process before their decision is made.”
All three families consider regularly traveling out of state for treatment, which requires parents to take days off from work and children from school, which can be expensive. . And clinics in non-ban states already have limited capacity. “We’re in Michigan, and we’re within travel distance of several states that have bans,” Stromsa said. “We are seeing more patients coming from out of state and are already booked months in advance.”
But for all three families, going back to how things were before is not an option.
“This may seem like a small issue to others, but it affects my entire world,” transgender adolescent John Doe wrote in a statement filed in district court. I wrote it inside. “I’ve been through a lot to get to the happy, healthy place I’m in, and I really hope none of that is taken away from me.”
