Parents of gender-distressed children are on tenterhooks as they closely follow the Supreme Court case US vs. Skrmetti. This case poses a crucial question regarding the constitutionality of a Tennessee law that prohibits the use of puberty blockers and cross-sex hormones for altering a minor's sex characteristics. Oral arguments are scheduled for Wednesday, with a decision not expected until summer 2025. The incoming Trump administration will take over the case from Team Biden, which strongly advocated for pediatric sex “changes” and the associated industry.

Why Letting the Case Persist Matters

With a 6-3 conservative majority on the court and a compelling legal ruling from the Sixth Circuit where the case originated, along with an evidentiary record that is deeply disturbing, a victory for Tennessee seems highly likely. This would be a significant triumph for child welfare. It would not only effectively put an end to constitutional challenges against relevant child-protection laws in two dozen states but also have far-reaching impacts on the lives of millions of American families.Gender ideology has permeated not only medicine but also K-12 education and child protective services. Parents in blue states who refuse to “affirm” their children's gender confusions live in constant fear of child protective services. Erin Friday, one of the authors, has firsthand experience. CPS showed up at her doorstep after a dispute with her daughter's school, which insisted on using a male name despite her instructions. Doctors pressured Erin to accept her daughter's desire to be a boy. However, Erin resisted, and two years later, her daughter returned to identifying as a girl without undergoing medical intervention. Yet, schools across the country are readily socially transitioning children as needed, even behind their parents' backs. If the court were to examine the “gender-affirming care” closely, it would uncover a medical scandal. Numerous briefs, including those by Erin Friday and Leon Sapir, detail how the medical profession has gone astray in this area.

The Role of WPATH

The leading organization promoting hormones and surgeries is the World Professional Association for Transgender Health (WPATH), which is far from professional and shows no genuine concern for health. As court documents have shown, WPATH commissioned evidence reviews but suppressed them when the findings did not align with its preferred medicalized approach. It consulted “social-justice lawyers” who were concerned that the disappointing findings could put WPATH in a difficult position regarding policy and lawsuits. The lead author of WPATH's most recent “standards of care” admitted that he was aware that “most” of the authors had conflicts of interest due to their personal involvement in and advocacy for these procedures.For example, WPATH's former president, Marci Bowers, admitted in a deposition that she made over $1 million from performing gender surgeries in 2023. WPATH also did not include more cautious and evidence-based perspectives on its guideline committee. Bowers admitted that it was essential for an advocate for [gender transition] treatments to be involved in the guideline's development. In a private conversation with colleagues, Bowers confessed that the “standards of care” reflect “a balancing act between what I feel to be true and what we need to say.” Within days of publishing the “standards of care” in 2022, WPATH issued a correction removing age minimums for hormones and surgeries. It did so under pressure from Rachel Levine, the Biden administration's assistant secretary for health and a transgender pediatrician, and the American Academy of Pediatrics. WPATH's own leaders privately complained that politics were taking precedence over science. This is a compelling record, especially considering that at least 14,000 children underwent gender interventions between 2019 and 2023, according to Do No Harm. A Manhattan Institute analysis of “top surgery” (double mastectomy) found evidence of at least 5,200 such procedures on minors between 2017 and 2023, including 50 to 179 surgeries on girls as young as 12½.Americans are growing increasingly frustrated with “gender identity” extremism. According to a recent YouGov poll, 54% of American voters believe minors should not have access to puberty blockers, while only 19% think they should. A reckoning has already begun within the Democratic Party. The coming years present a unique opportunity to challenge the gender industry with its pseudoscience and perverse incentives and put it on the defensive.Leon Sapir is a fellow at the Manhattan Institute, and Erin Friday is an attorney and a leader at Our Duty USA.