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12/03/2024 | News release | Distributed by Public on 12/03/2024 14:15

Supreme Court to Hear Case about Bans on Gender-Affirming Care for Transgender Youth on Wednesday

Supreme Court to Hear Case about Bans on Gender-Affirming Care for Transgender Youth on Wednesday

One of the term's highest profile cases, U.S. v. Skrmetti could have broad implications nationwide, say BU LAW professors

In a case before the Supreme Court on December 4, three transgender teenagers and their families-along with the Biden Administration and a host of civil rights legal organizations, including the ACLU and Lambda Legal-argue that a 2023 Tennessee law violates the equal protection clause of the 14th Amendment, because it allows similar treatments for young people wishing to conform to the sex they were assigned at birth. Photo via AP/Lily Ride/Sipa USA

Supreme Court

Supreme Court to Hear Case about Bans on Gender-Affirming Care for Transgender Youth on Wednesday

One of the term's highest profile cases, U.S. v. Skrmetti could have broad implications nationwide, say BU LAW professors

December 3, 2024
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The Supreme Court justices will hear arguments about gender-affirming care for transgender youth on Wednesday in what is so far one of the highest profile cases of the term. At the heart of the case, United States v. Skrmetti, is a question about whether discrimination against transgender people qualifies as sex discrimination, and therefore violates the Constitution.

This case began as a challenge to a Tennessee law enacted in 2023 that bans gender-affirming care for patients under 18. The bill, passed in March of that year, prohibits all medical treatments intended to allow "a minor to identify with, or live as, a purported identity inconsistent with the minor's sex" or to treat "purported discomfort or distress from a discordance between the minor's sex and asserted identity."

Three transgender teenagers and their families-along with the Biden Administration and a host of civil rights legal organizations, including the ACLU and Lambda Legal-argue that the Tennessee law violates the equal protection clause of the 14th Amendment, because it allows similar treatments for young people wishing to conform to the sex they were assigned at birth.

"This case is part of a larger trend of states acting to ban gender-affirming care and anything looking like it for minors specifically," says Nicole Huberfeld, the Edward R. Utley Professor of Health Law at Boston University's School of Law and School of Public Health.

The Tennessee law prohibits the prescribed use of hormone therapies, such as puberty-blockers and hormone-replacement therapy, as well as surgical care for minors. However, genital surgery is almost never performed on minors, and the focus for the plaintiffs is the therapeutic use of hormones to provide gender-affirming care.

Since 25 other U.S. states have similar bans in place, the court's ruling in Skrmetti could have ramifications across half the country.

Chase Strangio, codirector for transgender justice at the ACLU's LGBTQ and HIV Project, will argue the case before the Supreme Court, making him the first openly transgender person to argue at the high court. In a statement by the ACLU, Strangio laid out the stakes of this case, as he sees it: "The future of countless transgender youth in this and future generations rests on this Court adhering to the facts, the Constitution, and its own modern precedent."

Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions "designed to support and affirm an individual's gender identity" when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives-emotional, interpersonal, and biological-with their gender identity.

According to the U.S. Department of Health and Human Services: "For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system."

This sort of gender-affirming care is also widely accepted by medical groups. Organizations including the American Academy of Pediatrics and the American Psychological Association, among others, have filed briefs in support of the plaintiffs.

"The thing that I have been curious about going into Wednesday's argument is how much of the research and data the justices are going to look into, because a lot of the state's claims rest on undermining the science and medical aspect of this medical care," says Michael Ulrich, an assistant professor of health law, ethics, and human rights at BU's School of Public Health and School of Law.

Ulrich says he'll be listening for if, or when, the justices push back on medically inaccurate or misleading claims by Tennessee's lawyers. "Even the simplest look into all of the state's explanations and justifications-they really start to fall apart fairly easily," says Ulrich, whose work has included this issue since at least 2021.

Another line of argument Ulrich will be listening for is how the court distinguishes this type of medical care from other types of care, if it does at all. "We've seen this with abortion, where it's treated as separate from healthcare," he says.

Huberfeld, too, sees parallels in the battle over reproductive freedom.

"There are similar patterns to the way that-for lack of a better way of putting it-more controversial kinds of care are being treated by these states," Huberfeld says of gender-affirming care and reproductive care. "But the politicization of healthcare, while it's not new, has intensified, and the willingness of state regulators to make decisions about what healthcare providers can do does not bode well for the practice of medicine nationwide."

This sort of political interference in medicine "has become easier for states to do after the Dobbs decision," Huberfeld says, referring to the 2022 Supreme Court decision that overturned Roe v. Wade and Planned Parenthood v. Casey.

Both Huberfeld and Ulrich say that pinpointing certain types of medical care as acceptable or not acceptable opens up a dangerous precedent.

"It's hard to see, then, why that would not apply to other areas of medicine that states could just say, 'We don't like this,' or 'We don't like the intent that you have behind this type of treatment,' and that really opens the door to legislating healthcare and medicine and what treatments are available and who they're available to," Ulrich says. "It becomes really, really dangerous."

The Supreme Court is expected to hand down a decision on United States v. Skrmetti by the end of June 2025.

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Supreme Court to Hear Case about Bans on Gender-Affirming Care for Transgender Youth on Wednesday

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  • Molly Callahan

    Senior Writer

    Molly Callahan began her career at a small, family-owned newspaper where the newsroom housed computers that used floppy disks. Since then, her work has been picked up by the Associated Press and recognized by the Connecticut chapter of the Society of Professional Journalists. In 2016, she moved into a communications role at Northeastern University as part of its News@Northeastern reporting team. When she's not writing, Molly can be found rock climbing, biking around the city, or hanging out with her fiancée, Morgan, and their cat, Junie B. Jones. Profile

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