The Supreme Court handed down a ruling today in a major case on transgender care for minors, and it’s not what trans advocates were hoping to see. The Court voted to uphold a Tennessee ban prohibiting some medical treatments for transgender minors, a ruling that also serves to protect similar bans in more than 20 other states. It’s the latest attack on trans rights under an administration that has made such attacks a cornerstone of its brand.
As part of the 6-3 majority vote, Chief Justice John G. Roberts Jr. noted “the fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments” in what he described as the “evolving field” of trans healthcare. “The voices in these debates raise sincere concerns; the implications for all are profound,” he wrote. Yet the justice and his five conservative colleagues came to the conclusion that these debates should be left to “the people, their elected representatives, and the democratic process,” rather than being decided by the Supreme Court.
In a concurring opinion, Justice Clarence Thomas was more direct. He questioned the authority of “alleged experts” on trans medical care, writing that “they have built their medical determinations on concededly weak evidence. And, they have surreptitiously compromised their medical recommendations to achieve political ends.” He concluded that “deference to legislatures not experts is particularly critical here.”
The plaintiffs on the case were a doctor and three families who challenged a 2023 Tennessee law banning medical providers from offering transgender healthcare treatments like puberty-delaying medication, hormone therapy, and surgery. Their case hinged on the Constitution’s equal protection clause, as they stated that the Tennessee law discriminated by sex and transgender status — particularly because the law specifically stated that the treatments were allowed when they weren’t being used for the purpose of gender transition.
In making their case, the plaintiffs noted that American medical associations support gender-affirming care as a way to prevent psychological distress among trans minors. That includes the American Academy of Pediatrics, which released a statement reaffirming that support following the ruling.
“To be clear — regardless of today’s legal ruling — the science still supports gender-affirming care, children will still need it,” Susan J. Kressly, MD, FAAP, president of the American Academy of Pediatrics, said in the statement. Dr. Kressly described gender-affirming care as “medically necessary for treating gender dysphoria” and noted that it “is backed by decades of peer-reviewed research, clinical experience, and scientific consensus.”
It’s important to stress this, because trans youth are at high risk of mental health issues. According to research by The Trevor Project, 71 percent of trans and nonbinary youth report symptoms of anxiety; 59 percent report symptoms of depression; and 46 percent had seriously considered suicide in the past year. Studies have found that gender-affirming care is “associated with lower odds of depression and suicidality” — making it crucial that they have access to this care.
“Too often mischaracterized as exclusively involving surgery and hormones, [gender-affirming] care is provided thoughtfully and with the involvement of multidisciplinary teams of physicians, mental health professionals, families, and most importantly, young people themselves,” Dr. Kressley continued. “Denying patients access to this care not only undermines their health and safety, it robs them of basic human dignity.” She also panned the ruling for setting “a dangerous precedent” that allows “legislative interference” to come between patient and physician.
In her dissenting opinion, Justice Sonia Sotomayor said that the Court’s ruling “abandons transgender children and their families to political whims.” She took issue, as well, with the majority opinion that questions of transgender care should be addressed by the people and their laws, stating that “judicial scrutiny has long played an essential role” in stopping lawmakers from imposing “the state’s views about how people of a particular sex (or race) should live or look or act.” To back up the argument, she pointed to past Supreme Court cases like Loving v. Virginia, which found state laws banning interracial marriage to be unconstitutional.
It goes without saying that the ruling today serves a massive blow to trans rights in the US, prohibiting trans children and their parents from making the healthcare decisions that are right for them. Yet, as Nancy Northrup, president and CEO of the Center for Reproductive Rights, said in a statement, this may be just the next domino to fall. “With this ruling, the Supreme Court has once again taken a wrecking ball to Americans’ rights to make decisions about their own bodies,” she said. “Today it’s the rights of transgender people, and next we expect politicians will come after birth control, IVF — anything that empowers us to make decisions about our own bodies and futures… This lawless assault on our fundamental rights must stop.”
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