High Court Upholds Ban on 'Gender-Affirming' Care For Minors
The U.S. Supreme Court ruling curtails one of the most flagrant medical AND political scandals in modern history, the experimental use of drugs, hormones, and surgery for minors seeking to change sex.
A 6-3 majority of the U.S. Supreme Court ruled that scientific uncertainty justifies Tennessee’s ban on puberty blocking drugs, hormones, and surgeries for minors seeking to change their biological sex.
Chief Justice John Roberts, writing for the majority, said Tennessee’s law does not violate the Equal Protection Clause of the 14th Amendment by discriminating based on sex or transgender status. The Court found the Tennessee law was “rationally related” to state regulation of medical procedures, given the scientific debate about so-called gender-affirming care.
The Court’s decision in United States v. Skrmetti is expected to impact 26 other states that, in addition to Tennessee, have imposed limitations or outright bans on gender-affirming care for minors.
There is no reliable estimate of how many minors receive medications or surgery for gender transition today, but, especially in light of the state bans, it is thought to be a fraction of a percent of the U.S. population.
However, the promotion of the concept that children can change sex was a decisive factor in the 2024 election, and likely contributed to the Democratic Party’s loss of the presidency and both chambers of Congress.
On his first day in office in 2021, Democratic Pres. Joe Biden misinterpreted an earlier U.S. Supreme Court decision to justify signing Executive Order 13988, which stated, “[a]ll persons should receive equal treatment under the law, no matter their gender identity or sexual orientation.”
Biden appointed a transgender physician, Rachel Levine, as Assistant Secretary for Health at the U.S. Department of Health and Human Services, where s/he promoted puberty blockers and hormone treatments for minors.
A 2024 poll showed that 54% of Americans oppose allowing minors with gender dysphoria to access puberty blockers, while only 19% support the practice.
The Cass Review
The Skrmetti majority cited a 2024 independent review of gender identity services for minors in England, known as the Cass Review, that was ignored by the Biden, Levine and U.S. mainstream media. The Cass Review undertook a universal review of medical literature and found that evidence supporting medical treatments for minors was of “poor quality” and “remarkably weak.” Furthermore, its findings highlighted potential long-term consequences, including sexual dysfunction, infertility and decreased bone density.
In response, England severely restricted puberty blockers and cross-sex hormones for minors and adopted a holistic, evidence-based care model (e.g., therapy for co-occurring mental health issues). Sweden and Finland also restricted hormonal interventions for minors after systematic reviews found insufficient evidence that long-term benefits outweighed risks.
Roberts wrote: “We cite this report… to demonstrate the open questions regarding basic factual issues before medical authorities and the regulatory bodies. Such uncertainty ‘afford[s] little basis for judicial responses in absolute terms.”
Three of the four women on the Court, Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson, disagreed with the majority, arguing that the Tennessee law constitutes sex-based discrimination and should receive heightened scrutiny.
They argued the Court’s decision should align with its earlier (and, some believe, disastrous) ruling by Justice Neil Gorsuch in Bostock v. Clayton County, which held that the prohibition against “sex” discrimination in Title VII of the Civil Rights Act includes discrimination based on transgender status.
Chief Justice Roberts wrote that Bostock is not relevant because neither sex nor transgender status is the reason an individual cannot obtain hormones under the Tennessee law.
Rational Basis
Roberts wrote that there is a “rational basis” for Tennessee’s conclusion given the ongoing debate among medical experts about the “risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder and gender incongruence.”
He said the Court will not “second guess” the lines drawn by Tennessee on the issue. “We afford States ‘wide discretion to pass legislation in areas where there is medical and scientific uncertainty,” wrote Roberts.
Roberts pointed to “fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound.”
Misrepresentations?
In a concurrence, Justice Clarence Thomas said the Biden administration misrepresented that “overwhelming evidence” supports the use of puberty blockers and cross-sex hormones for treating pediatric gender dysphoria and that this view represents “the overwhelming consensus of the medical community.” Thomas said the treatments are “subject to a rapidly evolving debate that demonstrates a lack of medical consensus over their risks and benefits.”
Moreover, Thomas cited “unsealed documents” revealing that a “senior official in the Biden administration” (believed to be Levine) successfully pressed the World Professional Association for Transgender Health (WPATH) to remove age limits for adolescent surgeries from its guidelines for the care of transgender minors.
Thomas criticized medical experts for downplaying “grave problems, undercutting the assumption that young children can consent to irreversible treatments that may deprive them of their ability to eventually produce children of their own.”
Medical associations supporting medical interventions for transgender youth include the American Medical Association, American Academy of Pediatrics, Endocrine Society, and American Academy of Child and Adolescent Psychiatry.
The Women’s Declaration International USA, which submitted a brief in the case, described the Skrmetti decision as a “huge win for women’s rights,” arguing that Tennessee’s law safeguards minors from experimental treatments.
The plaintiffs in the Skrmetti case include three transgender minors, two families that requested anonymity, and Memphis “reproductive health” physician Dr. Susan Lacy. The lawsuit was brought and financed by the American Civil Liberties Union, Lambda Legal, and Akin Gump Strauss Hauer & Feld, a multinational law firm based in Washington, DC.
Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Project, was the first transgender to argue a case before the Court, A female to male transgender, Strangio said the ruling “is a devastating loss for transgender people, our families, and everyone who cares about the Constitution.”
Mainstream media in the U.S. generally failed to responsibly cover the transgender debate, and on Thursday was grasping at straws to salvage some hope from the Court’s decision. But, except for Kagan, Sotomayor and Jackson, most women hope the decision will help them salvage rights they lost as a result of trans ideology, including the right to private spaces and all-female sports teams, sororities and prisons.