Understanding the Supreme Court’s Ruling on Gender-Affirming Care
The U.S. Supreme Court has upheld Tennessee’s ban on gender-affirming surgery for transgender youth in a ruling that’s likely to reverberate across the country.
Most Republican-controlled states already have similar bans. Since President Donald Trump returned to office this year, the federal government has been trying to restrict access.
In his majority opinion Wednesday, Chief Justice John Roberts wrote that Tennessee’s ban does not violate the Constitution’s equal protection clause, which requires the government to treat similarly situated people the same.
Here are some things to know about gender-affirming care and the court’s ruling:
Breaking News
What is Gender-Affirming Care?
Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, or their sense of feeling male, female, neither or some combination of both. Sometimes that’s different from the sex they were assigned at birth.
The services are offered to treat gender dysphoria, the unease a person may have because their assigned gender and gender identity don’t match. Studies, including one from 2023 by researchers at institutions including London Children’s Hospital and Children’s Hospital of Philadelphia, have found the condition is linked to depression and suicidal thoughts.
Related: What to know about Genecis, the Dallas clinic for transgender kids
Gender-affirming care encompasses counseling and treatment with medications that block puberty and hormone therapy to produce physical changes. Hormone therapy for transgender men causes periods to stop, increases facial and body hair and deepens voices. The hormones used by transgender women can have effects such as slowing growth of body and facial hair and increasing breast growth. Fewer than 1 in 1,000 U.S. adolescents receive gender-affirming medications, a study released this year found.
Gender-affirming care can also include surgery, including operations to transform genitals and chests. These surgeries are rarely offered to minors.
There are documented uses of genital surgery for adults dating back to the 1920s. But for youth, gender-affirming care has been more common since the 1990s.
What is the Controversy About Gender-Affirming Care?
As a medical consensus emerged in support of gender-affirming care for youth, the issue also became politically divisive in other ways. Some states approved measures to protect transgender people, who make up around 1% of the nation’s population.
Many critics dismiss the idea that gender is changeable and lies along a spectrum. About two-thirds of U.S. adults believe that whether a person is a man or woman is determined by biological characteristics at birth, an Associated Press-NORC Center for Public Affairs Research poll conducted in May found.
In the last five years, most GOP-controlled states have passed laws to block transgender girls from sports competitions for girls. About half the Republican-controlled states have now banned transgender people from using school bathrooms that align with their gender identity.
Opponents of gender-affirming care sometimes refer to it as “mutilation” and say people who transition when they’re young could later regret it.
What Could the Ruling Mean for Bans in States Besides Tennessee?
In addition to Tennessee, 26 other states have passed bans or restrictions on gender-affirming care for youth. Judges have struck down the bans in Arkansas and Montana, though the legal fights there aren’t over.
All of the laws have been adopted in the past five years and nearly all have been challenged in court.
The Supreme Court’s decision means that federal challenges to those laws aren’t likely to prevail. However, some of the lawsuits against them are based on arguments rooted in state constitutions, and it’s still possible that judges could find more protections in those state constitutions than are in the U.S. Constitution.
What Will the Ruling Mean for States Without Bans on Gender-Affirming Care?
It probably won’t make any difference immediately.
Several of those states have laws or executive orders intended to protect access to gender-affirming care for transgender minors.
But the question about whether the care will continue isn’t only about what’s legal. It’s also about funding.
That’s where Trump comes in.
Trump campaigned last year pledging to rein in rights of transgender people. He’s followed through on many fronts, though court challenges have resulted in some of his efforts being blocked, at least for now.
What Has Trump Done on Transgender Issues?
He has ordered that no federal taxpayer money be used to pay for the care for those under 19. Enforcement of that order is on hold.
Trump has also tried to block federal funding from institutions — including hospitals and the universities that run some of them — that provide gender-affirming care for youth. A judge has blocked that effort while challenges to it proceed.
His administration published recommendations that therapy alone — and not medication — be used to treat transgender youth. The position contradicts guidance from major medical organizations. But it could impact practices.
Other actions Trump has taken including initiating the removal of transgender troops from military service; ordering that transgender women and girls be kept out of sports competitions for females; erasing the word “transgender” from some government websites; and saying the government would recognize people only by their sex at conception.
That’s resulted in efforts to move transgender women inmates to men’s prisons and change how passports are issued to transgender and nonbinary people. A judge this week blocked the Trump administration from limiting passport sex markers for many transgender and nonbinary Americans.
Conclusion
The Supreme Court’s decision to uphold Tennessee’s ban on gender-affirming surgery for transgender youth has significant implications for the LGBTQ+ community and the medical professionals who provide care to them. As the controversy surrounding gender-affirming care continues, it’s essential to understand the complexities of the issue and the impact of the ruling on states with and without bans on gender-affirming care.
The future of gender-affirming care for transgender youth remains uncertain, with ongoing legal battles and efforts to restrict access to care. However, many medical organizations and advocacy groups continue to support the provision of gender-affirming care, citing its importance for the mental and physical health of transgender individuals.
Frequently Asked Questions
Q: What is gender-affirming care? Gender-affirming care refers to a range of medical and mental health services that support a person’s gender identity, including hormone therapy, surgery, and counseling.
Q: Why is gender-affirming care important for transgender youth? Gender-affirming care is essential for the mental and physical health of transgender individuals, as it helps to alleviate gender dysphoria and reduce the risk of depression and suicidal thoughts.
Q: What does the Supreme Court’s ruling mean for states with bans on gender-affirming care? The Supreme Court’s decision means that federal challenges to state bans on gender-affirming care are unlikely to prevail, but lawsuits based on state constitutions may still be successful.
Q: How has the Trump administration impacted access to gender-affirming care? The Trump administration has taken several actions to restrict access to gender-affirming care, including ordering that no federal taxpayer money be used to pay for care for those under 19 and blocking federal funding from institutions that provide gender-affirming care for youth.
Q: What can I do to support transgender individuals and advocate for their rights? You can support transgender individuals by educating yourself about the issues they face, advocating for policies that protect their rights, and providing a safe and inclusive environment for them to express themselves.
