Transgender people under the age of 18 face laws in 25 states that bar them from receiving gender-affirming medical care. Until just a few years ago, no states had such laws.
The Supreme Court has agreed to hear a case challenging Tennessee’s ban on gender-affirming care for young people in its next session.
“There was growing pressure for the Supreme Court to step in on this case,” said Lindsay Dawson, director of LGBTQ health policy at the health research organization KFF.
Dawson noted that most state bans have been challenged in court, with 20 states currently having bans in place. “There have been mixed decisions in the appeals courts, but this is always an indication that the issue could end up at the Supreme Court.”
While the details of each state’s bans vary, the laws generally prohibit transgender minors from taking puberty-suppressing drugs, hormones, or surgery (which is extremely rare for minors).
be on the agenda
Oral arguments in the Supreme Court case are scheduled to take place in the fall. US Attorney General Elizabeth Preloger will argue on behalf of transgender Tennesseans before the Supreme Court. Tennessee’s Republican Attorney General Jonathan Scurmetti will defend the law.
In her written request to the justices to consider the case, Preloger wrote that nationwide bans on gender-affirming care “have caused serious anxiety to transgender young people and their families across the country, and has caused particular harm in Tennessee and other states where such laws are permitted.”
“We fought hard to defend Tennessee’s law protecting children from irreversible gender-based labeling, and we look forward to ending this fight at the U.S. Supreme Court. This case will bring much-needed clarity about whether the Constitution includes special protections for gender identity,” Scurmetti said in a statement.
What was the catalyst for these new laws restricting gender-affirming care? “You can’t point to any specific external event,” Dawson says. “But these policies spread like wildfire. Once a handful of states enacted them, other states followed suit.”
Conservative groups, including the Alliance Defending Freedom and the Heritage Foundation, are urging state lawmakers to take up the issue. “Experimental sex-reassignment surgeries forced upon children are often irreversible,” ADF’s Matt Sharp wrote last year. “And these drugs and surgeries are not only dangerous, they are experimental and unproven.” ADF did not respond to NPR’s request for comment on the story.
For the American Principles Project, the ban is “an effort to curb the predatory transgender industry,” president Terry Schilling said in a statement this week. The American Principles Project did not respond to multiple requests for comment from NPR on this story.
‘Nothing has changed’
These allegations, and the speed with which lawmakers have acted on them, have troubled Dr. Cade Gephardt, chief education officer and medical director of the Gender Health Program at Children’s Health Minnesota, who has provided similar care to gender-variant children for 20 years.
“Our approach to this treatment is not new. We are not using new medications. No groundbreaking new research has been published. Nothing has changed,” they say. “If anything, treatment has become more standardized and more guideline-based.”
All major U.S. medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association, support gender-affirming care as safe and necessary.
Erin Reid, a transgender journalist and activist, has been closely tracking these laws as they make their way through state legislatures.
“I’ve watched thousands of hours of legislative discussion on this issue, and I don’t think there’s another topic that’s currently devoting so much legislative time to state legislatures across the country,” she said. “Laws targeting queer and transgender people seem to be coming in waves throughout American history. This isn’t just an isolated incident.”
And she argues that this isn’t driven by any growing public concern: “Regardless of what people personally think about transgender care, they just don’t want lawmakers to spend their time on it.”
She points to a NORC-LA Times poll released in June that found 77% of Americans agreed that “elected officials often use debate about transgender and non-binary people to distract from more pressing priorities.”
The push for such legislation also has a religious component. “When God created us, he created us male and female, and that’s it. There’s no other choice,” South Carolina House Majority Leader Davey Hiott, a Republican, told reporters in January. “We have to oppose anybody who wants to change that from birth or throughout their life.”
In May, South Carolina became the 25th state to enact a ban on gender-affirming care for young people.
Travel for care
Dawson points out that these laws cover the use of a range of medical interventions, not the medical interventions themselves, and he questions the assertion that drugs and hormone treatments are unsafe.
“There are exceptions for young people who need to receive the same prohibited services for care purposes other than gender reassignment,” Dawson noted. Nearly all of the regulations include penalties for health care workers, and some target parents, teachers, and counselors.
Gephardt’s Minnesota clinic has seen a roughly 30% increase in calls from patients since the bans in surrounding states.
“We’ve increased our medical and mental health staff to handle the demand, but the waiting list is still over a year,” they say — a long time for adolescents.
Having patients travel to Minnesota from other states every three months would be a logistical nightmare and complicate insurance coverage, Goepferd added. “We’re set up to take care of Minnesotans, not the entire Midwest.”
Kellan Baker, executive director of the Whitman Walker Institute, an LGBTQ research and advocacy group, points out that it’s not just health care laws that have been passed: “Every day new restrictions are proposed and enacted, not just on transgender people’s access to health care but also on their ability to move through the world, for example, to attend school or play on a sports team,” Baker says.
In Baker’s view, state legislators who pass these laws are “attacking kids to score political points and taking advantage of the fact that many people may not know someone who is transgender,” he said. “There aren’t that many transgender people. The best estimates we have are that about 0.6 percent of the U.S. population self-identifies as transgender.”
