CNN
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When Tennessee banned gender-affirming care for transgender youth last year, Sarah took several days off work and drove hundreds of miles from her home in Nashville to a clinic in North Carolina that could treat her transgender son. started to move.
But just a month later, a similar ban went into effect in North Carolina, and Sara panicked when she realized the closest state she could take her son to was Ohio, more than 400 miles away. To her relief, North Carolina law made an exception for children already receiving treatment.
Sarah, using a pseudonym out of concern for her family's safety, said: “If I could just go five minutes away and get my child cared for and easily get my medication, I wouldn't have to travel 12 hours.'' It should be fine,” he told CNN. .
Parents like Sarah and the nation's transgender community will be paying close attention Wednesday as the U.S. Supreme Court hears arguments in United States v. Scrumetti. The case could determine whether states can ban certain forms of gender-affirming care for transgender children and teens. .
The lawsuit was brought by the Biden administration on behalf of the families of transgender youth, and the lawsuit is filed by the Biden administration in Tennessee, which restricts puberty blockers and hormone therapy for transgender minors and imposes civil penalties on doctors who violate the law. The case challenges the constitutionality of the state's ban on gender-affirming medical care.
Tennessee Attorney General Jonathan Scumetti said in court documents that “minors will not be able to fully understand the lifelong effects or until science develops and Tennessee takes a different view of its effectiveness.” He argued that the law guarantees that “minors will not receive these treatments until the But plaintiffs' lawyers point to major medical institutions that say the treatment is safe and may be medically necessary.
Since the state law was enacted last year, parents like Sarah have gone to extraordinary lengths to seek out-of-state treatment for their transgender children. He told CNN that some people are dipping into their savings and going into debt to pay for expensive trips.
The direction and scope of the court's decision is critical to both parties, and will be felt by transgender communities across the country. A victory for the plaintiffs would demonstrate that transgender people are protected from discrimination under the Constitution's Equal Protection Clause and could strengthen efforts to combat anti-trans laws that have swept the nation in recent years.
But if the state wins, Republicans, including President-elect Donald Trump, have pledged to restrict transgender people's ability to access health care and engage in daily activities such as play in ways consistent with their gender identity. Efforts by other conservative groups could move forward. such as playing sports or using the toilet.
As the parties hold oral arguments Wednesday and await the court's decision next year, here's how the ruling could impact the trans community.
If the court rules Tennessee's ban unconstitutional, it would be a major victory for transgender rights groups. Similar state laws would effectively be invalidated, legal experts say, and would give transgender youth greater protections when receiving gender-affirming care.
“It would be a monumental achievement for the trans legal movement, and its potential remains clear,” said Kate Redburn, co-director of the Center on Gender and Sexuality Law at Columbia Law School.
For children and teens who have not had access to care to treat gender dysphoria (the emotional distress a person feels when they feel that their gender assigned at birth does not match their gender identity), this Access to medical care can have a transformative effect, said Dr. Maurice Garcia, director of the Cedars-Sinai Transgender Surgery and Health Program.
“Gender dysphoria is a huge impediment to life. It's a barrier to living a normal, fulfilling life, enjoying the day, going out with friends, and being in public,” Garcia says. said.
Gender-affirming care for young people, such as puberty suppression and hormone therapy, can help transgender people live according to their gender identity. Garcia said these treatments can help alleviate the high rates of anxiety and depression among transgender youth, primarily due to stigma and social isolation.
Currently, 26 U.S. states have passed laws restricting gender-affirming care for transgender youth, but bans have been temporarily blocked in Montana and Arkansas, according to CNN. This was revealed through the project's data analysis. The Williams Institute, a public policy think tank at the University of California, Los Angeles, estimates that more than 110,000 teens live in states with bans in place.
The court's decision would only invalidate a ban similar in structure to Tennessee's, which would partially invalidate the ban in a way that transgender rights advocates say discriminates against transgender and cisgender children. The state's ban may remain in effect, Redburn said.
It's also possible that the Supreme Court will send the case back to the Court of Appeals, which will examine Tennessee's law under “severe scrutiny.” That's a higher legal standard than the one the appeals court used when upholding the ban last year. To apply strict oversight to gender-affirming treatment restrictions, states would need to show that there is an important government interest “substantially related” to the treatment ban.
Lawyers for the Biden administration have argued that the Tennessee ban does not pass this stricter standard of review, and the justices will rule on whether the law is constitutional under greater scrutiny rather than defer to lower courts. He indicated that he may consider whether to pass the bill at a rally.
Sarah, a Tennessee mother, said the risks of undergoing hormone therapy could not be greater for her child. Before treatment, she said, her son became withdrawn and increasingly irritable as puberty changed his body in ways he didn't like. He reportedly attempted suicide three times by the time he was 15. But since receiving testosterone therapy, her son has become more confident, sociable and feels more at peace with himself.
“Our friends came over and told us how much they could see the difference and the sparkle in his eyes,” Sarah said. “Within a few months[of taking hormone therapy]I saw a huge change. It was amazing.”
But a ruling in favor of the plaintiffs won't end the battle over health care access for the trans community, said Elana Redfield, director of federal policy at the Williams Institute.
“I think we look forward to seeing states continue to innovate in how they prohibit access to gender-affirming care,” said Redfield, who co-authored a brief to the court assisting the plaintiffs. .
Redfield pointed to Arkansas, where a judge has blocked the state's ban on gender-affirming care. Still, Republican lawmakers passed another law last year that would allow patients who received gender-affirming treatment as minors to file medical malpractice lawsuits against doctors for up to 20 years after they turn 18. . This is typically a much longer period of time than is allowed for medical injuries. claims. The law, which she called a “backdoor ban,” makes it extremely difficult for doctors to obtain malpractice insurance coverage, effectively discouraging them from practicing medicine.
The court's ruling upholding Tennessee's law would strengthen a nationwide patchwork of transgender medical bans, making access to gender-affirming care even more difficult for minors in half the country. That could open the door to broader restrictions on transgender people, Redburn said.
Transgender advocates say a lack of access to health care can exacerbate mental illness among trans minors and, in extreme cases, force some families to leave the state altogether. I'm concerned.
Research shows that transgender youth commonly deal with significant mental health issues. A 2018 study found that transgender youth are seven times more likely than cisgender youth to report mental health problems. A 2024 study found that nearly half of transgender and nonbinary youth in the United States reported considering suicide, and 14% had attempted suicide.
“Untreated gender dysphoria can be all-consuming,” said Sean Meerkamper, chief attorney at the Transgender Law Center.
Meerkamper and other LGBTQ advocates wrote in a brief to the court that the lack of access to gender-affirming care has led to some transgender youth experiencing “severe anxiety, depression, substance problems, and self-harm.” , causing extreme distress, including suicidal tendencies.” ”
As families in states with transgender health care bans grow increasingly desperate, Meerkamper splits up the family, sends one parent to another state with a transgender child, and decides not to give up. One parent and sibling said they have seen people stay home due to work or school obligations. .
Almost half, or 45%, of transgender and nonbinary people surveyed by LGBTQ advocacy group The Trevor Project would consider moving themselves or a family member to another state because of “LGBTQ+-related politics and laws.” I answered that I had done so before.
Sarah is already trying to figure out what it will take to move her family to a place where her transgender son can receive treatment. “We're going to do whatever it takes to keep us safe and to make him happy,” she said.
Redburn said the court's ruling that Tennessee does not discriminate against transgender youth on the basis of gender and therefore are not protected by the Equal Protection Clause will force conservative lawmakers to impose medical restrictions on trans adults. It is said that there is a possibility that the company will be given the green light to expand.
Plaintiffs' lawyers also argue that the decision could affect the entire American population and could serve as a “stepping stone to further restrict access to abortion, in vitro fertilization, and contraception.” .
They point out that the court could apply parts of the Dobbs v. Jackson decision that allowed states to ban abortions. In a brief aside from the Dobbs decision, Justice Samuel Alito argued that abortion regulations do not discriminate on the basis of sex and are more stringent than those used to determine the constitutionality of laws that classify individuals based on certain characteristics. He wrote that there is no need to strengthen inspections.
Tennessee has relied heavily on this argument while defending its ban on gender-affirming care. The state argues that its law applies equally to both trans girls and trans boys and should be considered a medical regulation.
The state argues that such medical regulations for minors are a matter that should be left to elected officials.
“Nothing in the Constitution authorizes petitioners to overturn Congress' decisions and demand policies they deem more favorable,” Tennessee officials said in court briefs.
But plaintiffs' lawyers argue that the law clearly discriminates on the basis of gender because it does not apply to cisgender children. For example, a doctor may prescribe puberty blockers for a cisgender child who hits puberty prematurely, but a doctor may prescribe puberty blockers for a transgender child to prevent the onset of puberty, which would worsen gender dysphoria. I can't prescribe medicine.
Regardless of the outcome of the Scumetti case, the transgender community has other legal options to fight laws that limit transgender rights, as several district courts consider challenging anti-trans laws. Meerkamper said there would still be means left.
“We're here to stay and we've always fought and survived because we always had to, and that's going to be true no matter what happens at the Supreme Court,” he said.
