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Supreme Court to weigh key transgender care case: What’s at stake for minors
WASHINGTON ? The Supreme Court on Wednesday will consider states’ ability to prevent transgender adolescents from using puberty blockers and hormone therapy, a major culture war flashpoint that comes to the high court after President-elect Donald Trump campaigned on ending what he called “left-wing gender insanity.”
How the conservative court decides the transgender rights case out of Tennessee could affect not just access to specific medical treatments across much of the country, but could also impact ongoing legal challenges to other rules targeting transgender people, such as those restricting bathroom use and sports competition.
Here’s what you need to know about the most high-profile case the court has taken up this term.
What are the medical treatments at issue?
Enacted in 2023, Tennessee’s law bans doctors from giving puberty blockers or hormone therapy to a minor seeking treatment for gender dysphoria, the psychological distress a person may experience when their assigned sex and gender identity don’t match.
Puberty blockers stop the body from making testosterone and estrogen to delay the changes of puberty, giving the adolescent more decision-making time. Hormone therapy triggers the development of physical traits that align with their gender identity, such as breasts or facial hair.
Tennessee’s law also prohibits surgery for transgender adolescents, but a lower court tossed out a challenge to that provision.
The state says it has a “compelling interest in encouraging minors to appreciate their sex" and in prohibiting procedures “that might encourage minors to become disdainful of their sex.”
How many states ban gender-affirming care?
Since Arkansas first passed a ban in 2021, 26 states have enacted some form of limitation on gender-affirming care.
The Williams Institute at the UCLA School of Law, a think tank that researches sexual orientation and gender identity demographics, estimates that 113,900 people aged 13 to 17 who identify as transgender live in states restricting access to puberty blockers and hormone therapy.
While there’s no comprehensive data on how common the treatments are, the institute says a “substantial number” of transgender youth have used them.
A study of health insurance claims found that, between 2017 and 2021, 4,780 patients under 18 had started puberty blocking medication for gender dysphoria. Nearly 15,000 began gender-affirming hormone therapy, according to the study conducted by Reuters and Komodo Health Inc.
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Who is challenging the ban?
Three families and a Tennessee doctor who treats adolescent with gender dysphoria originally challenged the law. They are represented by the American Civil Liberties Union.
The Biden administration joined the case.
Lawyers for both the ACLU and the Justice Department will be squaring off against Tennessee’s lawyers before the Supreme Court.
What is the argument for why Tennessee's ban is unconstitutional?
The Justice Department and the ACLU say the ban discriminates on the basis of sex and on transgender status. A teenager whose sex assigned at birth is male may be given testosterone to treat delayed puberty. But a teenager assigned female at birth who wants testosterone to treat gender dysphoria may not have it.
“Stripped of its illusory justifications, SB1 is a naked attempt to enforce Tennessee’s stereotypes as to how a person should `identify’ and `live’ based on their sex assigned at birth, imposing tremendous harm on transgender minors and their families in the process,” lawyers for the families wrote in a filing.
How does Tennessee defend the law?
The state says it is restricting treatments based on what they are being used for and the patient’s age, not because of the patient’s sex or transgender status.
Using puberty blockers or hormone therapy to transition to another sex is not the same as using it to address delayed or early puberty, the state argues. And the banned use is justified because it carries too many risks without enough proven benefits, Tennessee contends.
“The legislature determined that the cost-benefit calculus warranted permitting the surgeries and drugs subject to SB1 for some reasons and not others,” the state’s lawyers told the Supreme Court in a filing. “That is not discrimination.”
What does the evidence show?
Leading medical organizations, including the American Academy of Pediatrics, say the evidence shows puberty blockers and hormone therapy can reduce depression, anxiety and the risk of suicide for adolescents with gender dysphoria.
The federal district court judge who first heard the case found the doctors the state relied on to argue the treatments are too risky were “minimally persuasive based on the current record.”
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In its briefs to the Supreme Court, Tennessee emphasized that some European countries have tightened restrictions on the treatments. England’s National Health Service, for example, stopped prescribing the drugs outside of clinical trials after a review concluded more data is needed to help doctors and their patients make informed decisions.
The Biden administration responded that the “more nuanced regulatory approaches” of the European countries are different from the categorical bans imposed by Tennessee and other states which, they contend, ignore the benefits and overstate risks of the care.
What outside groups have weighed in?
Reflecting the case’s high profile, more than 80 groups have filed briefs urging the court to rule one way or another.
Those opposed to Tennessee’s law include the American Academy of Pediatrics, the American Psychological Association, the American Bar Association, the NAACP, dozens of transgender adults who have benefited from gender-affirming healthcare including the actor Elliot Page, and Democratic attorneys general and leaders of Congress.
Those supporting Tennessee’s law include the Family Research Council and other conservative groups, Republican governors and attorneys general of multiple states, tennis legend Martina Navratilova, the U.S. Conference of Catholic Bishops, and several adults who said social and medical gender transition did not resolve their gender dysphoria they experienced when young and left them worse off.
How have lower courts ruled?
District courts have largely sided with families challenging the bans in various states. But three appeals courts have upheld the laws, including the Cincinnati-based 6th U.S. Circuit Court of Appeals. A divided 3-judge panel said the evolving issue of gender dysphoria may be left in the hands of state legislatures.
"This is a relatively new diagnosis with ever-shifting approaches to care over the last decade or two," U.S. Circuit Judge Jeffrey Sutton, appointed by President George W. Bush, wrote for a 2-1 majority last year. "Under these circumstances, it is difficult for anyone to be sure about predicting the long-term consequences of abandoning age limits of any sort for these treatments."
How could the Supreme Court decide the case?
The court could uphold the 6th Circuit’s decision, or it could rule that Tennessee’s ban is unconstitutional, or the justices could direct the appeals court to reconsider the law using a tougher standard.
When is a decision expected?
The court is expected to issue its opinion by the end of June.
What are the potential impacts of the decision?
If the Supreme Court allows the ban to stand, access to puberty blockers and hormone therapy will depend on where a young person lives.
A broad decision siding with Tennessee could also make it easier for states or the federal government to restrict gender-affirming care for adults.
Conversely, a ruling that the ban discriminates against transgender people would both preserve access to the treatments and could help transgender rights advocates fight other laws.
How could the case be affected by Donald Trump's return to the White House?
After Trump takes office, the Justice Department could tell the Supreme Court that it wants to drop the federal government’s challenge to Tennessee’s law. In response, the court could continue the case with the families as the remaining challengers, dismiss the case or call for new arguments.
Both sides, however, say this is an issue that the court needs to weigh in on sooner rather than later ? so it would be better to deliver a clear ruling without substantial delays.
What other transgender issues are pending before the court?
The justices have been asked to weigh in on several other transgender-related issues including:
Whether states can ban transgender athletes from joining female sports teams.
Whether states can exclude gender-affirming care from health plans for employees or for low-income residents.
Whether a middle school student can be prohibited from wearing a t-shirt that reads “There Are Only Two Genders.”
Whether parents can challenge a school’s gender identity support plan before it’s been applied to their child.
Appeals in those cases are pending before the court.
What do the polls show?
More than six in ten adults surveyed by Gallup in May opposed laws banning gender-affirming care for minors. Opposition was slightly lower, but still a majority, in a March NPR/PBS NewsHour/Marist Poll.
Polls have found more support for restricting transgender athletes to sports teams that conform with their birth gender: 69% of adults backed that in a 2023 Gallup survey.
But 64% of those surveyed in 2022 by the Pew Research Center supported protections for transgender people on the job, in housing and public spaces. The poll was conducted two years after the Supreme Court’s landmark decision barring workplace discrimination against LGBTQ employees under a federal civil rights law.
This article originally appeared on USA TODAY: What to know about the transgender care case at the Supreme Court