Outside of the Supreme Court on Dec. 4, banners, flags and picket signs were raised into the air, representing both sides of a culture war that has in recent years consumed our nation. “Protect trans youth,” read one sign. “Stop transing gay kids,” said another. Beyond the fence surrounding the building, members of the Court heard arguments regarding a very important—and controversial—case.
The lawsuit, United States v. Skrmetti, was brought against the state of Tennessee in response to the state’s recent ban on gender-affirming care for minors. The plaintiffs include Nashville residents Samantha and Brian Williams and their 15-year-old transgender daughter and Dr. Susan Lacy, who practices medicine in Memphis. Two additional plaintiffs filed anonymously.
Gender-affirming care, which includes puberty blockers, hormone replacement therapy and surgery, is a part of gender transition for many trans people, including youth. These forms of treatment help alleviate gender dysphoria, a condition defined by the Mayo Clinic as “a feeling of distress that can happen when a person’s gender identity differs from the sex assigned at birth.”
A decrease in gender dysphoria is often correlated with improved mental health and general happiness. According to a study performed by the University of Washington, gender-affirming care can decrease depression among trans youth by 60% and suicidal ideation by a shocking 73%.
“You may have heard folks describe it as life-saving care, and that might sound dramatic…but it really is true for a lot of folks,” said Erin Rook, program manager of GenderHive, a Central Oregon nonprofit working to support trans youth.
While these statistics are difficult to argue with, gender-affirming care has become yet another point of contention in the culture war regarding transgender rights. Critics question whether these interventions are necessary, especially for those below the age of 18. To supporters of gender-affirming care, the answer seems quite obvious.
“Why wait for something that you know could be helpful now?” asked Rook. This philosophy applies particularly well to puberty blockers, which can temporarily suppress the development of secondary sex characteristics, such as breasts and facial hair, if started before the onset of puberty.
If the Court rules to uphold Tennessee’s law, trans youth in the 24 states with full or partial bans on gender-affirming care for minors will have no hope of seeking treatment in their home states. A decision in this vein would be devastating, likely leading to a continued exodus of trans teens from red states to places like Oregon, in which legislation has been passed to protect gender-affirming care access.
“If I never had the hope of transitioning to where I’m happy, I wouldn’t want to continue living to be unhappy forever with something that I can’t change,” said Grey, a transgender teen who is currently receiving hormone-replacement therapy in Bend. “Now, I know I will be able to change it, so I have hope.”
However, this case stands to decide far more than gender-affirming care access for teens like Grey—it will set a precedent for all future cases regarding transgender rights. In order to reach their decision, the Court must consider whether or not the 14th Amendment’s Equal Protection Clause applies to trans people.
The clause, which asserts that no state must “deny to any person within its jurisdiction the equal protection of the laws,” has been applied to numerous landmark Supreme Court cases regarding race or sex-based discrimination, including Brown v. Board of Education and Obergefell v. Hodges, which established same-sex marriage as a constitutional right.
The plaintiffs argue that, as the Tennessee law places no restrictions on the same forms of care for cisgender youth, the law violates the Equal Protection Clause based on a person’s gender. However, the state of Tennessee claims that the clause does not apply to this case, or rather, to trans people in general. After all, they claim that their law does not make distinctions based on sex.
If the Court rules that the Equal Protection Clause does not apply to transgender youth, the future ramifications could be devastating. If trans people are not guaranteed equal protection under the law, it will become much easier for state governments to restrict their rights. A decision to uphold Tennessee’s ban will not only embolden opponents of gender-affirming care, but allow for restrictions to bathroom access and the ability to compete on athletic teams matching their gender identity.
This last point is particularly relevant following the passage of a bill in the House of Representatives which will prevent transgender girls and women from competing in women’s sports at the high school level. If the bill succeeds in the Senate, any future challenges will likely mirror the Court’s ruling in this case.
The Court is expected to announce their decision on United States v. Skrmetti this June. Although many analysts suspect that the ban will be upheld, there is little to do but wait. In the meantime, trans people and their allies have a message for those who have politicized their existence and fought to restrict their rights:
“Trans people are just normal people,” Grey emphasized.
