Pinned. The Supreme Court is hearing arguments on Wednesday over whether a Tennessee law blocking some kinds of medical care for transgender youth runs afoul of the Constitution. More than 20 other states have similar laws that could be affected.. The court’s decision, expected by June, will almost certainly yield a major statement on transgender rights. Arguments are unfolding against the backdrop of a fierce public debate over the role that gender identity should play in matters as varied as sports, bathrooms and pronouns.. The Tennessee law, which is being challenged by three families and a doctor, prohibits medical providers from prescribing puberty-delaying medication, providing hormone therapy, or performing surgery to treat what the law calls “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”. The law allows those same treatments for “a congenital defect, precocious puberty, disease or physical injury,” leading the plaintiffs, backed by the Biden administration, to argue that the law violates the Constitution by denying equal protection to transgender people, primarily by discriminating against them based on sex.. Here’s what we’re covering:. Level of scrutiny: The Supreme Court has said that laws that discriminate based on sex are subject to “heightened scrutiny,” a demanding form of review that requires states to demonstrate that the laws are substantially related to achieving an important objective. Here’s what that means and why it’s key to the case.. A major precedent: The Supreme Court has only once before heard arguments in a case on transgender rights. In Bostock v. Clayton County, which was decided in 2020, the justices ruled that a federal civil rights law protected transgender people from employment discrimination. That case turned on the language of a federal law, while the new case concerns the equal protection clause of the 14th Amendment. Here’s more about the 2020 decision and what it means for the case before the justices today.. Lower court decisions: The case came to the Supreme Court after a divided three-judge appeals court panel in Cincinnati upheld Tennessee’s law, saying it was a reasonable legislative response to contested medical evidence. Judge Jeffrey S. Sutton, writing for the majority, said the law did not draw distinctions based on sex, so was not subject to heightened review. Here’s the background on the Tennessee case.. The parental rights question: The families suing over the Tennessee law argued that it had both violated the 14th Amendment and ran afoul of “the fundamental right of parents to make decisions concerning the medical care of their children.” The Biden administration pressed only the constitutional claim, and the court agreed to consider its petition, meaning parental rights are not directly before the justices. Read more about the families affected by the case.. A new White House: The government will almost certainly switch sides in the case after President-elect Donald J. Trump takes office in January. To continue considering the constitutionality of the law, the justices would have to make adjustments, perhaps by belatedly granting the families’ petition for review.. Dec. 4, 2024, 12:24 p.m. ET. Demand for puberty-blocking medication and hormone therapy among transgender youth has not been studied extensively.Credit…Hannah Beier/Reuters. About a third of the teenagers in the United States who identify as transgender live in states that have limited access to puberty-blocking medication and hormone therapies, according to an estimate by the Williams Institute at the U.C.L.A. School of Law, which conducts demographic research about the L.G.B.T.Q. population.. About 110,000 transgender adolescents between the ages of 13 and 17 live in the 24 states where the treatments are limited, and about a thousand 18-year-olds are also subject to bans on hormone therapies in Alabama and Nebraska, the researchers wrote. As the Supreme Court considers a challenge to a Tennessee law that prohibits some medical treatments for transgender minors, the estimates were included in court documents, offering a sense of how many people might ultimately be affected by a decision in the case.. Demand for puberty-blocking medication and hormone therapy among transgender youth has not been studied extensively, but only a small fraction of minors who identify as transgender currently receive gender-transition treatments. The institute researchers wrote that thousands of young people living in states where bans have been enacted “have received these treatments in the past, are receiving them currently, or may need to receive them in the future.’’. The Supreme Court case revolves around a ban on gender-transition treatments for minors in Tennessee, which is home to about 3,100 transgender teenagers, the researchers say. Nationally, about 1.4 percent of Americans between 13 and 17 identify as transgender, according to a 2022 report by the Williams Institute, which applied statistical modeling to data from several government sources.. A recent study by the Centers for Disease Control and Prevention, based on a 2023 survey of teenagers in 20,000 high schools across the United States, found that 3.3 percent of high school students identified as transgender with an additional 2.2 percent of students saying that they were unsure if they were transgender. .. One review of health insurance claims by Reuters found that about 122,000 patients between 6 and 17 in the United States were diagnosed with gender dysphoria — a condition marked by a distressing sense of disconnection between a person’s physical appearance and gender identity — from 2017 to 2021. In the same period, about 5,000 in the group began puberty-blocking medication, and 15,000 began hormone therapy.. About 190,000 young people who identify as transgender live in the rest of the states where access to puberty-blocking medication and hormone therapy is protected by law, or is neither protected nor prohibited.. SUPREME COURT JUSTICES. Clarence Thomas. Appointed by George H. W. Bush in 1991. John Roberts. Appointed by George W. Bush in 2005. Samuel Alito. Appointed by George W. Bush in 2006. Sonia Sotomayor. Appointed by Barack Obama in 2009. Elena Kagan. Appointed by Barack Obama in 2010. Neil Gorsuch. Appointed by Donald Trump in 2017. Brett Kavanaugh. Appointed by Donald Trump in 2018. Amy Coney Barrett. Appointed by Donald Trump in 2020. Ketanji Brown Jackson. Appointed by Joe Biden in 2022. Dec. 4, 2024, 12:23 p.m. ET. Justice Kavanaugh asks: Why not trust parents rather than the state to decide, especially since there’s no direct harm to third parties? Rice, the Tennessee attorney, points out that the question of parental rights is not before the court.. Dec. 4, 2024, 12:18 p.m. ET. Justice Kagan characterizes the Tennessee law as: “We want boys to be boys and girls to be girls.” The law says the state has an interest in preventing minors from becoming “disdainful of their sex.”. Dec. 4, 2024, 12:23 p.m. ET. Matthew Rice, Tennessee’s lawyer, says that Kagan is suggesting that the law has an improper purpose. But actually, he says, what the state cares about is preventing regret and detransitioning, by making sure minors have time to appreciate their sex before making a life-altering change.. Dec. 4, 2024, 12:14 p.m. ET. In sparring with liberal justices, Matthew Rice repeatedly rejects a framework outlined by Chase Strangio, the ACLU lawyer arguing for Tennessee families. Strangio said that a birth-sex male who hits puberty too early and a birth-sex female who is trans have the same purpose in receiving puberty blockers: to be in a position to go through puberty like typical boys. Rice argues that this reasoning relies on “conflating different medical purposes.”. Dec. 4, 2024, 12:18 p.m. ET. He compares the two examples to using morphine to manage pain versus using it to assist in suicide. The effects on the body are different, he says, allowing it to be regulated differently.. Dec. 4, 2024, 12:13 p.m. ET. This is Matthew Rice’s first case before the Supreme Court as the Tennessee solicitor general, after being appointed to the position earlier this year.. Dec. 4, 2024, 12:06 p.m. ET. The liberal justices are jumping in quickly to grill Rice, the Tennessee lawyer, moving away from the questioning in order of seniority we saw during the arguments by the law’s opponents.. In Case You Missed It. Dec. 4, 2024, 12:05 p.m. ET. Pulling back from the weeds, we spent nearly two hours hearing arguments from opponents of Tennessee’s ban on some medical treatments for trans minors. The Biden administration’s solicitor general, Elizabeth Prelogar, and an ACLU lawyer representing Tennessee families, Chase Strangio, both argued that the state’s ban discriminates based on sex. Therefore, they said, the Sixth Circuit used the wrong standard of legal review when considering the law. We are now starting to hear arguments from Tennessee’s top lawyer, Matthew Rice, in favor of affirming the appeals court’s ruling and upholding the ban.. Credit…Maansi Srivastava for The New York Times. Dec. 4, 2024, 11:59 a.m. ET. Matthew Rice, arguing for Tennessee, says that the state ban on some medical treatments for transgender youth turns entirely on medical purposes, not the patient’s sex, which is a key question to arguments over its constitutionality. Some of the justices have suggested both are at issue. Rice is not giving ground.. Dec. 4, 2024, 11:56 a.m. ET. J. Matthew Rice, Tennessee’s solicitor general, is arguing before the Supreme Court in defense of the law banning gender-affirming care in the state, his firstappearance before the nation’s highest court.. Mr. Rice, 35, initially pursued a baseball career: He joined the Tampa Bay Rays organization, playing in the minor leagues. But he soon left the sport to attend law school at the University of California, Berkeley, and later became a clerk for Justice Clarence Thomas on the Supreme Court.. He then worked at Williams & Connolly, a prestigious law firm based in Washington, D.C. A native of Johnson City, Tenn., Mr. Rice returned to his home state to work in the state attorney general’s office in 2022.. J. Matthew Rice is Tennessee’s solicitor general.. He started work there shortly before Attorney General Jonathan Skrmetti was appointed to an eight-year term. Under Mr. Skrmetti, the office has defended Tennessee’s efforts to limit access to gender-affirming care and public drag shows and has successfully challenged the Biden administration’s efforts to expand Title IX protections to L.G.B.T.Q. students.. As solicitor general, Mr. Rice and his office are tasked with all litigation before a higher court, ranging from the Tennessee Court of Appeals to the Supreme Court.. Mr. Rice, who was named to his position in March, is expected to argue that limiting access to gender-affirming care is not discriminatory because the state is obligated to protect children. In legal documents, Tennessee lawyers have argued there is a distinction between using hormones and puberty blockers to help transgender children transition, and using the same sorts of medications to treat young people for other issues.. “Tennessee, like many other states, acted to ensure that minors do not receive these treatments until they can fully understand the lifelong consequences or until the science is developed to the point that Tennessee might take a different view of their efficacy,” the state wrote in one brief to the court.. Dec. 4, 2024, 11:55 a.m. ET. Under questioning from Justice Kavanaugh, Strangio agrees that it is possible to say that the Tennessee law banning some medical treatments for trans minors is unconstitutional, but also say that laws excluding transgender athletes from participating in female sports (a question not before the court today) are constitutional. The reason, Strangio says, is that the purported state interest in imposing each of those types of bans is “wholly different.”. Dec. 4, 2024, 11:48 a.m. ET. Justice Gorsuch, the conservative author of the Supreme Court’s previous opinion supporting trans rights, has for a second time declined to ask any questions. He is keeping his thinking on this new trans rights case very close to the vest today.. Dec. 4, 2024, 11:43 a.m. ET. Justice Thomas presses Chase Strangio to explain why the Tennessee law means that one group of people can receive something that another group cannot, based on sex. That’s the key equal protection question on which this case hinges.. Video. Dec. 4, 2024, 11:43 a.m. ET. Strangio explains it like this: A birth-sex male who hits puberty too early can receive puberty blockers in order to later develop like other boys. A birth-sex female may also want to to receive puberty blockers in order to undergo puberty as a typical boy. So it is the same purpose, Strangio says, and what makes the treatment prohibited for the latter person is sex.. Dec. 4, 2024, 11:32 a.m. ET. Justice Alito says it is “a bit distressing” that opponents of the Tennessee ban keep making “categorical statements” about medical questions, both in oral arguments and briefs, that, he says, “seem to me to be hotly disputed.” He questions, for example, whether it is clearly established that the procedures and medications in question reduce the risk of suicide for trans youth.. Video. Dec. 4, 2024, 11:38 a.m. ET. Evidence shows that transgender people are at higher risk of thinking about suicide and attempting it, as well as actual suicides. Whether medical treatment for minors reduces that risk is contested. You can read more about the research on the topic here and here.. In Case You Missed It. Dec. 4, 2024, 11:26 a.m. ET. We are now into the second hour of arguments, and the solicitor general for the state of Tennessee has not yet had an opportunity to start defending the state’s ban on some medical treatments for transgender minors. The Biden administration’s solicitor general, Elizabeth Prelogar, sparred with the justices for a little more than an hour. Her position is that the Supreme Court should send the case back to the Sixth Circuit to reconsider its earlier decision to uphold the law, this time holding it to a tougher test. Chase Strangio, an ACLU lawyer representing Tennessee families that sued to block the law, is now making similar arguments.. Dec. 4, 2024, 11:19 a.m. ET. Chase Strangio, the ACLU lawyer, agrees with everything that the Biden administration’s solicitor general said over the past hour. But he goes further, arguing that the Tennessee ban on some trans medical care for minors should be struck down because the law goes beyond the legitimate power of the government.. Dec. 4, 2024, 11:14 a.m. ET. Chase Strangio is the first openly transgender lawyer to argue before the Supreme Court. He has tried to make his case to the public in recent months through social media posts and interviews. “In some sense, I am speaking not only to the nine justices who will decide this case, but also to a country confused, skeptical and unnecessarily fearful of trans health care,” he wrote here.. Dec. 4, 2024, 11:17 a.m. ET. Asked at a news conference yesterday about the plaintiffs’ chances given the conservative makeup of the Supreme Court, Strangio acknowledged that it might be an uphill battle, referencing the 1986 case in which the court held that there was no constitutional protection for sodomy. “It was a bleak moment.” But he noted that 17 years later, the justices found the Texas statute criminalizing sodomy unconstitutional.. Dec. 4, 2024, 11:14 a.m. ET. Justice Clarence Thomas has not given much of his own reasoning in his votes against transgender rights, typically joining dissents written by Justice Samuel A. Alito Jr. or noting dissents without offering reasoning.Credit…Allison V. Smith for The New York Times. Justice Clarence Thomas has frequently voted against transgender rights, typically by joining dissents written by Justice Samuel A. Alito Jr. or noting dissents without offering reasoning.. In the Supreme Court’s only other major transgender rights case, Bostock v. Clayton County, which ruled that a federal civil rights law protected gay and transgender workers from employment discrimination, Justice Thomas signed Justice Alito’s slashing dissent.. Last year, when the court ruled that a transgender girl could compete on the girls’ cross country and track teams at her middle school in West Virginia while her appeal moved forward, Justice Thomas joined a dissent by Justice Alito indicating that states are entitled to enact laws “restricting participation in women’s or girls’ sports based on genes or physiological or anatomical characteristics.”. The court’s brief order, which let stand an appeals court’s temporary injunction, gave no reasons, which is not unusual when the justices rule on emergency applications filed on what critics call the court’s shadow docket.. In 2020, when the Supreme Court turned down an emergency request from Idaho prison officials to block court-ordered sex reassignment surgery for a transgender prisoner, Justices Thomas and Alito said they would have granted the request but did not say why.. On one occasion, though, Justice Thomas did file an extended dissent in a case involving gender identity.. Last December, the court announced that it would not hear a First Amendment challenge to a Washington State law banning professional counseling services intended to change a minor’s gender identity or sexual orientation.. The law forbids licensed therapists there from performing conversion therapy, which it defined to include “efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.” The law permits counseling that promotes “acceptance, support and understanding.”. Justice Thomas wrote that the court should have agreed to hear the case.. “This petition asks us to consider whether Washington can censor counselors who help minors accept their biological sex,” he wrote. “Because this question has divided the courts of appeals and strikes at the heart of the First Amendment, I would grant review.”. Justice Thomas said the state had violated the Constitution by choosing sides in the “fierce public debate over how best to help minors with gender dysphoria,” the psychological distress caused by incongruence between experienced gender and that assigned at birth.. Dec. 4, 2024, 11:13 a.m. ET. Chase Strangio represents two transgender boys, a transgender girl, their parents and a Tennessee doctor.Credit…Rob Kim/Getty Images. Chase Strangio, an attorney for the A.C.L.U., is the first openly transgender lawyer to argue before the U.S. Supreme Court, making the case against a ban on gender-transition treatments for minors in Tennessee.. Mr. Strangio, 42, grew up outside of Boston and came out as trans in his early 20s. He has said that he regrets how long it took for him to receive medical treatment to align his body with his gender identity. In social media posts and interviews with reporters in the months before his Supreme Court appearance, he has invoked his own story to make a public appeal as well as a legal one.. “As all parents know, when your child is suffering, you are suffering,” Mr. Strangio, the father of a 12-year-old, said in a news conference earlier this week. “My heart especially aches for the parents who spent years watching their children in distress and eventually found relief in the medical care that Tennessee now overrides their judgment to ban.”. Supporters of the Tennessee law and similar restrictions in other states argue that doctors mislead parents into thinking that gender transition treatment is necessary for their children without informing them of potential risks.. The arguments in the case come as national political figures, including some Democrats, have pushed back on transgender athletes participating in sports. Republicans in Congress have also moved to bar transgender people from using bathrooms on Capitol Hill that align with their gender identity.. In the case, Mr. Strangio represents two transgender boys, a transgender girl, their parents and a Tennessee doctor who provided gender-transition treatments to minors before such treatment became illegal. The minors say the treatments have improved their happiness and sense of well-being. The Justice Department also intervened in the suit to challenge the law.. Dec. 4, 2024, 11:09 a.m. ET. Justice Amy Coney Barrett is now asking questions for the first time. She was not on the court in 2020, when the justices decided an employment case upholding trans rights. Justice Neil Gorsuch, the conservative who wrote that decision, asked no questions of the solicitor general when it was his turn, not tipping his hand in the current case.. Dec. 4, 2024, 11:06 a.m. ET. The other conservative justice who joined Gorsuch on that majority opinion was Chief Justice Roberts. Justices Alito, Thomas and Kavanaugh dissented.. Dec. 4, 2024, 11:07 a.m. ET. Under a barrage of questions from the justices, Solicitor General Prelogar’s argument, scheduled for 15 minutes, is approaching an hour. Two other lawyers are scheduled to argue. At this rate, the whole hearing could last four hours.. Dec. 4, 2024, 11:01 a.m. ET. Justice Kavanaugh asks about trans athletes in women’s and girls’ sports, which has become a major national cultural issue in recent years. Could laws that ban transgender girls and women from competing on female teams be constitutional? Prelogar says that situation is different from gender-transition medical treatment, because sports affect other people.. Video. Dec. 4, 2024, 10:56 a.m. ET. Under questioning from Justice Kavanaugh, Prelogar acknowledges that some people who receive medical treatment for gender dysphoria later de-transition, or wish they had made a different decision. “We are certainly not denying that some people might regret this care, but all of the available evidence shows that it’s a very small number,” she says.. Video. Dec. 4, 2024, 10:52 a.m. ET. Elizabeth Prelogar, the solicitor general for the Biden administration, says the court can give states a lot of room to regulate medical treatments for minors, while foreclosing an outright ban on gender care.. In Case You Missed It. Dec. 4, 2024, 10:48 a.m. ET. To take a step back, we are about 40 minutes into the arguments. The Biden administration’s solicitor general, Elizabeth Prelogar, has been arguing that the Tennessee law banning some medical treatments for transgender minors is categorizing people differently on the basis of their sex, and so under the Constitution it should be scrutinized under a tougher test than the one the Sixth Circuit used in upholding the ban. Some conservative justices have questioned that reasoning.. Dec. 4, 2024, 10:46 a.m. ET. Prelogar points to West Virginia’s law regulating gender-transition for minors as a potential model — it contains exceptions and departs from most of the 23 other state laws that have implemented more sweeping bans on puberty blockers and hormone therapies.. Dec. 4, 2024, 10:43 a.m. ET. Justice Kagan asks whether the basis of Tennessee’s ban is discrimination and disregard for young people who are trans, as opposed to another form of a sex-based classification.. Dec. 4, 2024, 10:25 a.m. ET. A Supreme Court ruling from 2020 protects gay and transgender workers from workplace discrimination.Credit…Anna Moneymaker for The New York Times. The Supreme Court has rendered only one major decision on transgender rights: Bostock v. Clayton County.. That ruling, issued in 2020, said that a landmark civil rights law protects gay and transgender workers from workplace discrimination.. “An employer who fires an individual merely for being gay or transgender defies the law,” Justice Neil M. Gorsuch, President Donald J. Trump’s first appointee to the court, wrote for the majority in the 6-to-3 ruling. He was joined by another conservative, Chief Justice John G. Roberts Jr., and what was then the court’s four-member liberal wing.. That majority opinion and two dissents spanned 168 pages. In remarks to reporters, President Donald J. Trump said he accepted the ruling. “I’ve read the decision,” he said, “and some people were surprised, but they’ve ruled and we live with their decision.” He added that it was a “very powerful decision, actually.”. The question for the justices was the meaning of a statute, Title VII of the Civil Rights Act of 1964, which bars employment discrimination based on race, religion, national origin and sex. They had to decide whether that last prohibition — discrimination “because of sex” — applied to many millions of gay and transgender workers.. Justice Gorsuch wrote that it did.. “An employer who fires an individual for being homosexual or transgender fires that person for traits or actions it would not have questioned in members of a different sex,” he wrote.. In dissent, Justice Samuel A. Alito Jr. wrote that “the arrogance of this argument is breathtaking,” adding that “there is not a shred of evidence that any member of Congress interpreted the statutory text that way” when the law was adopted in 1964.. That law prohibited workplace discrimination “because of sex.” The case argued on Wednesday, by contrast, concerns the equal protection clause of the 14th Amendment, which is written in general terms and has been interpreted to establish an analytical framework rather than categorical rules. Still, Justice Alito wrote in 2020, “the court’s decision may exert a gravitational pull in constitutional cases.”. Dec. 4, 2024, 10:19 a.m. ET. In one dissent, Justice Samuel A. Alito Jr. wrote that the court had opened a Pandora’s box.Credit…Erin Schaff/The New York Times. When the Supreme Court sided with transgender workers in a landmark employment discrimination case in 2020, Justice Samuel A. Alito Jr. wrote an extraordinarily cutting dissent that accused the majority of arrogance and bad faith. It was 54 pages, not counting a 53-page appendix.. He said the majority had created dangers in restrooms and locker rooms. “For women who have been victimized by sexual assault or abuse,” he wrote, “the experience of seeing an unclothed person with the anatomy of a male in a confined and sensitive location such as a bathroom or locker room can cause serious psychological harm.”. He added that the ruling would have pernicious consequences for sports, college housing, religious employers or health care.. “The effect of the court’s reasoning may be to force young women to compete against students who have a very significant biological advantage,” he wrote, “including students who have the size and strength of a male but identify as female and students who are taking male hormones in order to transition from female to male.”. Free speech was at risk, too, he wrote.. “After today’s decision,” Justice Alito wrote, “plaintiffs may claim that the failure to use their preferred pronoun violates one of the federal laws prohibiting sex discrimination.”. In all, he wrote, the court had opened a Pandora’s box.. “Although the court does not want to think about the consequences of its decision, we will not be able to avoid those issues for long,” he wrote. “The entire federal judiciary will be mired for years in disputes about the reach of the court’s reasoning.”. In 2023, Justice Alito also dissented from a ruling on an emergency application that sided with a transgender girl who sought to compete on the girls’ cross-country and track teams at her middle school in West Virginia.. The court will soon have to address, he wrote, whether a federal law or the Constitution “prohibits a state from restricting participation in women’s or girls’ sports based on genes or physiological or anatomical characteristics.”. Dec. 4, 2024, 10:11 a.m. ET. The court has sided with gay and transgender people in recent cases, but there have been dissents.Credit…Eric Lee/The New York Times. At a pair of arguments in 2019 about employment discrimination against gay and transgender workers, the justices could not stop talking about bathrooms. In all, five justices explored questions related to who may use which facilities, though bathrooms did not figure in the cases before them.. “Let’s not avoid the difficult issue,” said Justice Sonia Sotomayor, a member of the court’s liberal wing, posing a hypothetical question: “You have a transgender person who rightly is identifying as a woman and wants to use the women’s bathroom.”. She added: “There are other women who are made uncomfortable, and not merely uncomfortable, but who would feel intruded upon if someone who still had male characteristics walked into their bathroom. That’s why we have different bathrooms. So the hard question is: How do we deal with that?”. David D. Cole, a lawyer with the American Civil Liberties Union representing a transgender woman, seemed puzzled.. “That is a question, Justice Sotomayor,” he said. “It is not the question in this case.”. The argument also touched on sports, religion and dress codes, and it suggested that many justices found it hard to disentangle the legal question before them from related ones.. Justice Neil M. Gorsuch, for instance, asked whether a ruling in favor of Mr. Cole’s client would do away with sex-specific dress codes. Mr. Cole said no.. “There are transgender male lawyers in this courtroom following the male dress code and going to the men’s room,” he said, “and the court’s dress code and sex-segregated restrooms have not fallen.”. When the court issued its decision, which sided with gay and transgender workers, Justice Gorsuch’s majority opinion said it was tightly focused on employment discrimination.. “We do not purport to address bathrooms, locker rooms or anything else of the kind,” he wrote, adding that those “are questions for future cases, not these.”. In dissent, Justice Samuel A. Alito Jr. chastised the majority for kicking the can down the road.. “The court may wish to avoid this subject,” he wrote, “but it is a matter of concern to many people who are reticent about disrobing or using toilet facilities in the presence of individuals whom they regard as members of the opposite sex.”. In cases that reached the court on what critics call its shadow docket, the justices have ruled for a transgender prisoner seeking surgery and a transgender girl who sought to compete on the girls’ cross-country and track teams at her middle school in West Virginia. Justice Alito and Clarence Thomas dissented in both cases.. Those two justices also dissented in 2021 when the court turned down an appeal from a ruling in favor of a transgender boy in Virginia who wanted to use the boys’ bathroom at his high school.. Dec. 4, 2024, 9:52 a.m. ET. Puberty blockers are prescribed to prevent the permanent physical changes of puberty.Credit…Jamie Kelter Davis for The New York Times. Most doctors in the United States support gender treatments for adolescents based on guidelines written by professional medical groups, making these standards central to today’s Supreme Court case.. Standards published by the World Professional Association for Transgender Health, or WPATH, in 2022 say that children and teenagers with gender distress should have a thorough psychological assessment before starting on drugs that block puberty or hormones like testosterone and estrogen. The Endocrine Society, a group of endocrinologists, has similar standards.. These guidelines draw upon a small study from a clinic in the Netherlands in the 1990s, which found that teenagers who medically transitioned experienced long-term mental health benefits. The Dutch clinicians carried out psychological assessments over months, screening out teenagers whose distress about their gender had only recently emerged, as well as those with serious mental health conditions, like depression, eating disorders and autism. (Those young people, they reasoned, would be better served by therapy or other treatments.). Today, the guidelines from WPATH and the Endocrine Society don’t specify a protocol for psychological assessments. The groups also don’t keep track of how closely gender clinics have followed the guidelines as they try to meet a great rise in demand. In 2022, Reuters surveyed 18 American gender clinics and found that none of them conducted “anything like the monthslong assessments” in the Dutch studies. Some reported prescribing puberty blockers or hormones after one visit.. More recent studies in the U.S. have shown improvements in life and body satisfaction for teenagers after one or two years of treatment, though long-term data has not been published.. In Tennessee’s brief defending its ban on gender transition for minors, the state attacked WPATH’s guidelines “for prioritizing politics over science.” That accusation was referring to the role that Adm. Rachel Levine, an assistant secretary at the Department of Health and Human Services, played in urging WPATH to drop age recommendations from its 2022 standards. The group had initially proposed a minimum age of 14 for hormone treatments, which can permanently affect voice tone, body hair and other features like breast development.. But as the Tennessee brief pointed out, Dr. Levine argued that including the age recommendations would prompt “devastating legislation for trans care,” according to emails released last summer in a case challenging an Alabama ban on gender care. In the emails, WPATH members questioned allowing politics to influence their decisions, but in the end, the group dropped the age recommendations as Dr. Levine requested.. Tennessee’s brief also noted that in some countries — including Sweden, Finland, Norway and Britain — medical authorities have departed from the WPATH guidelines. These countries have limited gender-related medical treatments for teenagers after scientific reviews that found weak evidence of long-term benefits.. But no European country has categorically banned gender medications for minors as Tennessee has. In its brief asking the Supreme Court to strike down Tennessee’s law, the Biden administration suggested that the state could have followed the European approach of setting waiting periods and other guardrails on prescribing the drugs, rather than banning them outright.. Dec. 4, 2024, 9:49 a.m. ET. Matt Walsh, a conservative political commentator at The Daily Wire in Nashville, spoke at rally in opposition to gender-affirming care for children in 2022.Credit…Elijah Barrett for The New York Times. Vanderbilt University Medical Center’s announcement of a new transgender clinic in 2018 did little to draw attention to its practice. The four-paragraph news release amounted to a location, hours and the names of two senior staff members.. The spotlight came four years later, when Matt Walsh, a conservative political commentator at The Daily Wire in Nashville, published a series of posts and videos about the clinic. Those posts said that a staff member there had privately characterized gender-affirming medication and surgery as “moneymakers,” and used caustic terms to describe the center’s treatments.. The medical center, which is separate from Vanderbilt University, pushed back. In a statement at the time, the center said that the clinic’s mission was to serve a “high-risk population for mental and physical health issues” who “have been consistently underserved by the U.S. health system.”. The medical center said that it had not provided care to children younger than 18 without the consent of a parent, and that it would not force any employee who disagreed with the care because of personal or religious beliefs to provide it.. Conservatives called for an investigation into the clinic, and Republican leaders spoke at a rally Mr. Walsh organized in Nashville in October 2022 in opposition to gender-affirming care for children. When Tennessee legislators convened in January 2023, lawmakers designated a proposed ban on gender-affirming care as Senate Bill 1. The bill passed over objections from transgender people and most Democrats.
