Transgender youths, their parents and a doctor who provides transition care to adolescents say the Supreme Court’s decision upholding Tennessee’s ban on such care for minors could have devastating, widespread effects for trans Americans.
The court ruled 6-3 on Wednesday that Tennessee’s prohibition on puberty blockers and hormone therapy for minors does not discriminate based on sex and, as a result, does not violate the Constitution’s 14th Amendment.
It means that Tennessee’s law will stand and that similar measures in 26 other states will also be likelier to survive legal challenges. Lawsuits have permanently blocked bans from taking effect in two states — Arkansas and Montana. Otherwise, restrictions have taken effect in all the remaining states except West Virginia.
As a result, the court’s decision could affect an estimated 112,400 trans youths who live in states that have laws banning access to transition-related care, according to the Williams Institute at UCLA’s School of Law.
Trans young people like Violeta Acuna, 19, are afraid of the ruling’s impact on trans youths and their mental health.
Acuna, who lives in Pomona, California, started hormone replacement therapy when she was 17 after she experienced anxiety and depression due to gender dysphoria, which is the distress caused by a misalignment between one’s birth sex and gender identity. Within two months of starting the treatment, she said, her mental health improved.
“If I had not had that opportunity, I probably wouldn’t be here speaking,” Acuna said.
She said the Supreme Court’s decision is dangerous for trans youths, even though proponents of restrictions on gender-affirming care often argue that it is “mutilating” children.
That is “completely false,” she said, adding, “It only puts them more at risk of the dangers that come from it not being accessible.”
She added that the move could be harmful and have deadly mental health effects for trans minors who have already started receiving care and are abruptly forced to stop receiving it because of state bans.
Tennessee Attorney General Jonathan Skrmetti said in a statement Wednesday that “the common sense of Tennessee voters prevailed over judicial activism” in the Supreme Court win.
“A bipartisan supermajority of Tennessee’s elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand,” Skrmetti said in a statement. “I commend the Tennessee legislature and Governor [Bill] Lee for their courage in passing this legislation and supporting our litigation despite withering opposition from the Biden administration, LGBT special interest groups, social justice activists, the American Medical Association, the American Bar Association, and even Hollywood.”
As Skrmetti pointed out, restrictions on gender-affirming care for minors have faced widespread backlash from the medical, scientific and legal communities.
All major medical associations in the United States, such as the American Medical Association, the American Academy of Pediatrics and the American Psychological Association, support access to transition-related care for minors and oppose restrictions on it.
Some European countries have restricted access to such care, but only one, the United Kingdom, has indefinitely banned new prescriptions of puberty blockers to treat minors for gender dysphoria.
Dr. Morissa Ladinsky, a clinical professor of pediatrics at Stanford University’s medical school, said the Supreme Court’s decision “is not based in science and not based in evidence, but based in a political stance to harm kids.”
She pointed to Utah, which enacted a ban on transition care for minors in 2023 that required Utah’s Department of Health and Human Services and other health experts in the state to conduct a review of all existing evidence on the safety of such care.
The reviewers concluded in a 1,000-page report published in May that policies to prevent access to gender-affirming hormone therapy for treatment of gender dysphoria in pediatric patients “cannot be justified based on the quantity or quality of medical science findings or concerns about potential regret in the future, and that high-quality guidelines are available to guide qualified providers in treating pediatric patients who meet diagnostic criteria.”
Ladinsky said that transition-related care, like all medical care, is evidence-based and guideline-driven and that it is continually studied and improved.
“That’s science, and that is how medical decision-making happens and should happen — by those who are trained to understand the science, not by those who are not,” she said.
Ladinsky previously practiced for 10 years as a pediatrician in Birmingham, Alabama, where she treated hundreds of trans adolescents until the state passed a ban on transition care for minors that took effect in January 2024. She said she had a patient whose family pawned a valuable personal item to get the money to drive their son to a state where their son’s care could be continued.
“The lengths that people are going through are unfathomable,” she said. “Having been on those front lines now in Alabama, I will tell you that these laws, these bills, these executive orders have not made transgender young people no longer transgender.”
In his statement Wednesday, Skrmetti said the court’s decision “recognizes that the Constitution lets us fulfill society’s highest calling — protecting our kids.”
However, many parents with trans kids feel that it does the opposite and that it robs them of that right. Keisha Bell, whose trans daughter just finished her second year of college, called the decision “sanctioned discrimination.”
“No parent takes any of this discussion lightly,” Bell said, adding that parents “understand the full ramifications of some side effects of medications if they decide to take that path, but they also understand the weight of the decision when children are not supported.”
Skylar Bret, the mom of a trans girl in Seattle, said Wednesday at a news conference hosted by Rep. Pramila Jayapal, D-Wash., that her daughter has “amazing doctors” and that “it scares me that there might be people other than myself and her doctors making decisions about whether she’s able to get the care that she needs.”
Acuna, the trans teen living in California, who is also a drag artist and an organizer with Advocates for Youth, a sexual health nonprofit organization, said her message to trans young people is that things are “going to get harder.”
“They won’t stop,” Acuna said, “But that doesn’t mean that we have to allow ourselves to give in.”
