High court to weigh gender-affirming care
Tennessee's law banning hormone therapy for adolescents in question
By: Maureen Groppe
USA Today
WASHINGTON - The Supreme Court on Wednesday [12/04/2024] will consider states' ability to prevent transgender adolescents from using puberty blockers and hormone therapy, a major culture war flash-point that comes to the high court after President-elect Donald Trump campaigned on ending what the called "left-wing gender insanity."
.....
How the conservative court decides the transgender rights case out of Tennessee could affect access to specific medical treatment across much of the country, and it could impact ongoing legal challenges to other rules targeting transgender people. such as those restricting bathroom use and sports competition.
..... Enacted in 2022, Tennessee's law bans doctors form 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. Homone therapy triggers the development of physical traits that align with their gender identity, such as beasts or facial hair.
..... Tennessee's law also prohibits surgery for transgender adolescent,s but a lower court tossed out a challenge to that provision.
..... Since Arkansas first passed a ban in 2021, 26 states have enacted some from 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 ages 12-17 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 sue them.
..... A study of helaht insurance claims found that, between 2017 and 2021, 4,780 pa intents younger than 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 Incorporated.
DOJ part of challenge
..... Three families and a Tennessee doctor who treats adolescents 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.
..... After Trump takes office, the Justice Department could tell the Supreme Court that it want to drop the federal government's challenge to Tennessee's law. In reasons, the court could continue the case with the families as the remaining challenger, 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. The court is expected to issue its opinion by the end of June. [2025]
..... The Justice Department and the ACLU say the ban discriminates on the basis of sex and transgender status. A teenage whose sex assigned at birth is male may be given testosterone to treat delayed puberty. But a teenage assigned female at birth who wants testosterone to treat gender dysphhoria may not have it.
..... 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 suing 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.
What does the evidence show?
..... Leading medical organizations, including the American Academy of Pediatrics, says 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 arguing for the state were "minimally persuasive based on the current record."
..... 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 trails after a review concluded more data is needed to help doctors and their patients make informed decisions.
Ruling could affect other cases
.... 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 paned said the evolving issue of gender dysphoria may be left in the hands of state legislatures.
..... 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.
..... If the Supreme Court allows the ban to stand, access to puberty blockers and hormone therapy will depend on where a young persons lives.
..... A broad decisions 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.