Topline
The Supreme Court will hear oral arguments Wednesday over Tennessee’s ban on gender-affirming care for minors, a landmark case that will have implications nationwide as Republicans have increasingly targeted transgender rights and enacted bans on healthcare for minors across the country.
A transgender rights supporter takes part in a rally outside of the U.S. Supreme Court as the … [+]
Key Facts
Justices will hear oral arguments in United States v. Skrmetti, centered on Tennessee’s ban on medication treatments that enable “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”
The federal government and transgender youth have challenged the law, arguing it violates the Constitution’s Equal Protection Clause by discriminating on the basis of sex and gender identity—particularly as Tennessee’s law does allow the same medical treatments that are provided for transgender youth when they are instead “to treat a minor’s congenital defect, precocious puberty, disease, or physical injury.”
Tennessee has argued the policy is constitutional, claiming the state is using its lawful power to regulate medications “to protect minors from the life-altering risks of uncertain gender-transition interventions.”
The state is not discriminating on the basis of sex, it argues, but is rather just “draw[ing] age- and use-based distinctions for drugs” as it already does “all the time.”
The case came to the Supreme Court after a federal district court previously blocked the law, but an appeals court then reversed that, allowing the ban to take effect.
What To Watch For
Justices will hear oral arguments Wednesday morning. It’s unclear when a ruling will come out, but it will be at some point before the court’s term ends in June. While justices could rule one way or the other on whether Tennessee’s law is constitutional, the court could also send the case back to the appeals court that previously upheld it to reconsider it based on however the court thinks the law should be interpreted. The government has asked the Supreme Court to order the case be sent back to the lower courts—though it’s unlikely the Justice Department would continue to oppose the law in court if the litigation keeps continuing, given it will soon be taken over by Donald Trump’s administration.
Big Number
25. That’s the number of states besides Tennessee that have passed some form of ban on gender-affirming care for minors, as compiled by the pro-LGBTQ rights Human Rights Campaign, though courts have blocked some of them from being in effect. The states that have passed laws that could be affected by the Supreme Court’s case are Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia and Wyoming.
What Is Gender Affirming Care?
The term “gender-affirming care” refers to a range of treatments—whether “social, psychological, behavioural or medical”—that are “designed to support and affirm an individual’s gender identity,” according to the World Health Organization. That could include steps that range anywhere from counseling and speech therapy to surgery, the Association of American Medical Colleges notes, though the Tennessee case specifically involves the use of prescribing puberty blockers or hormones. While hormones help people physically transition genders, puberty blockers are designed to delay the physical changes of puberty for transgender or gender non-conforming youth, and the Mayo Clinic notes they are not permanent and puberty changes would resume whenever a person stops taking them. The Tennessee ban also prohibits surgical procedures aimed at confirming a person’s gender identity, but the federal government told the court that aspect of the law is not being debated in this case, as studies have found such surgeries are extremely rare among transgender youth.
What Does The Medical Community Say?
Leading medical organizations are broadly in favor of gender-affirming care remaining accessible for minors, with the American Medical Association arguing “trans and non-binary gender identities are normal variations of human identity and expression, and … forgoing gender-affirming care can have tragic health consequences, both mental and physical.” Medical groups led by the American Academy of Pediatrics argued in a brief to the court that hormone therapy and puberty blockers “can alleviate clinically significant distress and lead to significant improvements” in patients’ mental health and “overall well being,” and argued that lawmakers enacting bans are “disregard[ing]” medical evidence and “precluding healthcare providers from providing adolescent patients with treatments” that are “in accordance with the well-accepted protocol.” The evidence that Tennessee has cited as part of its argument against providing the treatments has also been challenged, with an investigation by left-leaning watchdog group Accountable.US finding four of the six doctors the state references have been “repeatedly rebuked by courts for their inexperience, bias, and reliance on pseudoscience.”
Key Background
The Supreme Court taking up the Tennessee case comes as transgender rights has become a major political issue in recent years, with the Tennessee law making up one of a number of laws aimed at transgender Americans that conservative-leaning states have adopted. Nearly 50 anti-transgender laws have passed state legislatures in 2024 alone, according to the independent Trans Legislation Tracker, with approximately 139 bills still pending. Studies have shown such legislation is harmful to transgender youth, with a September study in Nature Human Behavior finding anti-transgender laws have led to statistically significant increases in suicide attempts among transgender teens. The Supreme Court is also taking up the case on gender-affirming care as lower courts have been divided on how to address the laws, with the federal government telling the Supreme Court that seven of eight district courts have opposed bans on minors receiving gender-affirming care. Multiple federal appeals courts also have cases pending that concern the bans.
