Legal experts say the Supreme Court’s decision might impact access to transition-related treatment for adults and kids across the country for decades to come. The court will address a legislation that restricts transition-related health care for minors for the first time on Wednesday.
The court’s main consideration will be whether a Tennessee statute that prohibits trans children from receiving hormone therapy, puberty blockers, or surgery discriminates against them based on their sex.
Because it only forbids such care as treatment for gender dysphoria, the American Civil Liberties Union and Lambda Legal contend that it does. Minors who require the therapies for other reasons are exempt from the statute. For instance, children who undergo early puberty, or precocious puberty, can be treated with puberty blockers, and doctors can still operate on newborns whose sex traits do not fit the traditional male/female binary.
Days after the American Civil Liberties Union sued Tennessee’s law in April 2023, the Justice Department stepped in and filed a complaint against the law, claiming that it violates the Equal Protection Clause of the 14th Amendment by discriminating against trans youths based on their sex and transgender status. The Biden administration’s appeal of a 6th U.S. Circuit Court of Appeals ruling that upheld Tennessee legislation was granted by the Supreme Court. The portion of the legislation that prohibits surgery that was not addressed by the lower court’s injunction will not be taken into consideration by the court.
Tennessee Attorney General Jonathan Skrmetti contended in his reply brief to the Supreme Court that the law does not discriminate on the basis of sex but rather distinguishes between minors who are seeking drugs for gender transition and those who are seeking drugs for other medical reasons, with both boys and girls falling on either side of that line. The attorney general’s office also contends that the state has the authority to enact laws to try to safeguard kids because there is ambiguity surrounding the advantages and disadvantages of transition care for minors.
Harleigh Walker, a 17-year-old transgender girl from Auburn, Alabama, expressed concern about the potential impact of the court’s ruling on her future. Walker and her father, Jeff, have had to drive 200 miles to another state since Alabama banned transition-related care for juveniles in January. There, Walker will occasionally sit in a hotel room or in the car to complete a telehealth visit so she can continue receiving estrogen.
Walker intends to attend an out-of-state college because she will not be eligible for care in Alabama until her second year due to a law that applies to anybody under the state’s age of majority, which is 19.
“I knew that I was still safe under the general umbrella of the United States of America, and I could go to another state that has more of an open mind about trans people and access to health care,” Walker said. “But with Trump being elected and this Supreme Court decision, it’s horrifying that there’s a possibility that this could affect health care access for transgender adults.” The legislation’s introduction in Alabama and state legislatures across the nation was undoubtedly a huge shock, and it had a lot of unsafety and uncertainty.” The idea that I might not be safe in this nation for the rest of my life is unsettling, and I sincerely hope that is not the case.
Youths who are transgender, their families, and those who offer care connected to transitionhave told NBC News that many families are forced to travel outside of their home states for treatment because of the complicated patchwork of rules generated by state limits on this type of care. Because of some of President-elect Donald Trump’s proposed policies, legal experts fear that the court’s ruling could shape access to such treatment for both adults and adolescents in the years to come.
Shannon Minter, the legal director at the National Center for Lesbian Rights, an LGBTQ legal advocacy group, explained that the Affordable Care Act now protects the health care of transgender people because it is widely acknowledged that refusing them access would constitute illegal sex discrimination. Therefore, our coverage under the Affordable Care Act would be seriously jeopardized if the court rules that denying this care is not discriminatory.
The legal landscape leading up to the case
The U.S. Supreme Court was urged last year by three trans adolescents, their parents, and a physician to overturn Tennessee’s statute, which went into force in July 2023 but contains a clause allowing doctors to wean young people off the medication for nine months until March 31, 2024.
Last year, a 15-year-old trans girl named L.W., one of the plaintiffs in the case, stated that she is contesting the law because she understands how crucial this treatment is for tens of thousands of transgender youngsters like herself.
She added that she is unsure of her family’s options because so many states have approved legislation similar to hers. “It scares me to think about losing the medication that I need, and if this law continues, my family may have to leave Tennessee, the place I have lived and loved my entire life,” she said.
In its Supreme Court petition, the ACLU and Lambda Legal observed that circuit courts now disagree on the limitations. While the 6th and 11th circuits have let statutes in Tennessee, Kentucky, Alabama, and Florida to go into effect, the 8th U.S. Circuit Court of Appeals halted a law in Arkansas.
According to the LGBTQ think tank Movement Advancement Project, 23 states have banned hormone therapy, puberty blockers, or surgery for trans kids; 18 of those laws have been challenged in court.
According to the UCLA School of Law’s Williams Institute, as of April, an estimated 113,900 trans kids resided in states with limited access to transition-related care for minors.
In order to continue caring for their children, many families with transgender children have had to find ways around care regulations. Some families have completely departed their own states. To get care, some people, like the Walkers, must travel hundreds of miles.
Trans kids and adults around the country are served by Dr. Izzy Lowell, founder and head of the telehealth clinic QueerMed. Since the restrictions on transition care went into force, she added, her clinic has observed a rise in minor patients, especially in the South. Eighty to ninety percent of the 800 to 1,000 juvenile patients the clinic sees, according to her, are in states that limit access to care for minors.
According to Lowell, patients in states with restrictions who can afford to fly can schedule telehealth visits with the clinic in states without such limits. These appointments are subject to the legislation of the jurisdictions in which the patients are physically present.
“I work as a travel agent a lot right now,” Lowell remarked. Nearly all of her patients discuss their residences, states they can and cannot visit, potential vacation dates, and even layovers at airports in other states. According to her, the clinic once saw a patient who was at Boston Logan International Airport during a layover.
According to her, patients have found the consequences of the care limits to be quite challenging.
“This is stress times ten,” she remarked, adding that “I think in medicine in general we underestimate the really significant health risks of stress.” It is publicly discriminated against and disliked. People genuinely fear losing therapy, which is heartbreaking and potentially fatal, as well as for themselves.
She claimed that concern has grown since the election and Trump’s pledges to ban trans health care for minors nationwide and to stop Medicaid from paying for trans care. According to her, the clinic’s weekly average of 10 to 15 new patient registrations rose to 250 on November 6, the day following the election, and 150 on November 7. It averaged fifty new registrations per day the next week.
Lowell stated that, despite growing criticism, she intends to continue offering transition-related treatment to the fullest extent permitted by law, regardless of the Supreme Court’s decision.
According to her, the FBI is looking into the event as a hate crime after an arsonist damaged Lowell’s Georgia-based practice last year.
“There is no way to prepare for this, so we just need to keep going and help people as much as we can for as long as we can,” she said. Until we are forced to, we will not stop.
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