The Supreme Court's upcoming consideration of a law restricting transition-related health care for minors on Wednesday holds significant implications. This decision could shape the access to such care not only for minors but also for adults across the nation for decades. The key legal question at hand is whether a Tennessee law, which bars puberty blockers, hormone therapy, and surgery for trans minors, discriminates based on sex.

The Supreme Court's Ruling and Its Impact on Trans Health Care

Understanding the Tennessee Law

The Tennessee law in question specifically prohibits certain transition-related care only when it is used as treatment for gender dysphoria. However, it makes exceptions for minors needing the treatments for other reasons. For instance, puberty blockers can be used to address precocious puberty, and surgeries can still be performed on infants with non-standard sex characteristics. This distinction has sparked intense legal debates.

Just days after the ACLU filed suit against the law in April 2023, the Justice Department intervened and filed its own complaint. They argued that the law discriminates against trans youths based on sex and transgender status, violating the 14th Amendment's Equal Protection Clause. The Supreme Court granted the Biden administration's appeal of a 6th U.S. Circuit Court of Appeals decision upholding the Tennessee law. But the court won't consider the part that bans surgery, which wasn't covered by the lower court's injunction.

The Attorney General's Argument

In his reply brief to the Supreme Court, Tennessee Attorney General Jonathan Skrmetti claimed that the law doesn't discriminate based on sex but rather distinguishes between minors seeking drugs for gender transition and those for other medical purposes. He argued that boys and girls fall on both sides of this line. The attorney general's office also emphasizes the uncertainty around the risks and benefits of transition care for minors and the state's right to pass legislation to protect them.

Harleigh Walker, a 17-year-old trans girl from Auburn, Alabama, is deeply concerned about the court's decision. Since Alabama's ban on transition-related care took effect in January, she and her father have had to travel 200 miles to another state for her estrogen treatment. She plans to attend college out of state as Alabama's law applies to those under 19. The thought of losing access to care in the future is terrifying for her.

The Impact on Trans Youth and Their Families

Trans youths, their families, and providers of transition-related care have faced a confusing patchwork of laws across the country. State restrictions have led many families to travel out of their home states for care. Dr. Izzy Lowell, founder of the telehealth clinic QueerMed, has seen an increase in minor patients since the restrictions took effect, especially in the South. Her clinic serves 800 to 1,000 minor patients, and 80% to 90% of them live in states with care restrictions.

Patients with the resources to travel can go to states without such laws for telehealth appointments. But the effects of these care restrictions have been extremely difficult. Dr. Lowell emphasizes the significant health risks of stress caused by discrimination and fear. The election and Trump's promises to bar trans health care have only increased this fear. Her clinic's new patient registrations saw a significant spike after the election.

The Legal Landscape Leading Up to the Case

Last year, three trans youths, their parents, and a doctor asked the Supreme Court to block Tennessee's law. One of the plaintiffs, a 15-year-old trans girl referred to as L.W., fought the law because she knows how important it is for thousands of trans youth. Circuit courts have become divided on these restrictions, with the 8th U.S. Circuit Court blocking a law in Arkansas while the 6th and 11th circuits allowed laws in other states to take effect.

Twenty-three states currently restrict puberty blockers, hormone therapy, or surgery for trans minors, and 18 of these measures have been challenged in court. As of April, an estimated 113,900 trans youths lived in states with such restrictions. Many families have had to work around these restrictions to continue care for their children, with some leaving their home states entirely.

Regardless of the Supreme Court's decision, Dr. Lowell plans to continue providing transition-related care as long as it is legal. An arsonist destroyed her practice in Georgia last year, and she considers it a hate crime. Her determination to help trans patients remains unwavering.