The Supreme Court wants to uphold the Tennessee law on transgender care

An Attorney General’s Report on the “Doogie Howser” Case in Tennessee: Gender-affirming Children’s Health Care

That fear was reinforced as I entered the legal profession. In Boston in 2007, one of my law school professors at Northeastern told our class that we needed to abide by traditional gender norms in court. She instructed that women should wear skirts to appear before juries, and after a presentation in class she told me that I was too “soft-spoken” to be seen as an effective male advocate. Outside class, I found my appearance was regularly the subject of mockery. When I was working at a public defender’s office in New York City, some court officers and judges called me “Doogie Howser” and inquired if my kid would go to school the following day. I was perceived as too boyish to be either a woman or an adult man. I was questioned by staff members about whether I would be taken seriously in court. Fearing my gender would be a distraction and that my future clients would pay the price, I stayed away from the courtroom for years after graduation.

The questions before the court is only a small one and the stakes are high because of Donald Trump’s election. This case gives a critical vehicle for a judicial review of the incoming president’s efforts to ban health care for children of trans parents and restrictions on it for people of other genders.

NPR put the question to Vanderbilt University Medical Center, which until the law was passed was the major center in Tennessee for providing gender-affirming care for minors. The center didn’t make a comment after pondering the question for three days.

“The government of Tennessee is displacing the decision-making of loving parents,” who follow the “recommendations of doctors,” Strangio told NPR. The law is tailored to one thing, and that’s Tennessee’s preference that adolescents conform to their birth sex.

Strangio says that the language of the statute telegraphs the real purpose of the ban. Specifically, the statute encourages minors to “appreciate their sex” and bans treatments that “might encourage minors to be disdainful of their sex.”

Gender-affirming care: from birth to death, doctors and their relationship with their patients, their bodies, and their families, and what we’ve learned from Dr. Bursch

“There are countries in Western Europe that were ahead of us in terms of these types of medications,” says Sen. Johnson. They are pulling back because of the adverse effects of some of the medications that they have been taking, and this is because they have had a longer runway.

Western Europe and Nordic countries have national healthcare systems that cover everyone, said John Bursch of the conservative Christian legal advocacy group Alliance Defending Freedom.

From birth until death, they can have a picture of a patient. And so if someone gets cross-sex hormones for the purpose of a gender change at age 15, they can look at how they’re doing at age 20,25, 45 65 and see what the outcomes were,” Bursch notes.

The drugs are still available in a research setting despite the fact that they are highly controversial.

In Britain, restrictions on access to medical treatments for minors followed a yearslong review of the medical evidence by Dr. Hilary Cass, one of the country’s leading pediatricians. Her final report concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.”

Over the past decade, as the number of adolescents identifying as transgender has risen sharply, doctors around the world have weighed the risks and benefits of what is called gender-affirming care, or treatments like puberty blockers, hormones and surgeries that align their bodies with their gender identities.

People make assumptions. They say it’s just a phase, because they don’t know what it’s like,” LW says of her experience. “It can certainly feel pretty hopeless,” especially given “how slow” the process is.

A Tennessee law that bans gender-affirming medical treatments for minor children in the early post-Bostock era, and why it’s important to the courts

Tennessee doesn’t allow you to get a tattoo unless you’re 18. You can’t be a smoker. You can’t drink,” he observed to NPR. Tennessee regulates “a number of different types of medical procedures,” Johnson said, adding that “it felt like this was the best public policy to prevent kids form suffering from irreversible consequences, things that cannot be undone.”

The law is just another example of the state exercising its regulatory power, according to Tennessee State Sen. Jack Johnson.

ACLU lawyer Chase Strangio, the first openly trans lawyer to argue in front of the Supreme Court, represented the kids and their parents. He argued that “these are very commonly used medications,” and Tennessee “bans them for one and only one purpose.”

Prelogar said she acknowledged that there was a debate on the issue both in the United States and elsewhere, but she said she “stand[s] by that there is a consensus that these treatments can be medically necessary for some adolescents — and that’s true no matter what source you look at.”

Roberts queried why the courts should get involved after he cited scientific uncertainty about longer-term implications of gender-affirming medical treatments for minor children. That view was echoed by Justice Alito, who cited Swedish data, and said that “these treatments have benefits that greatly outweigh the risks and the dangers.”

The Supreme Court has only once before heard arguments in a case on transgender rights. The question in that case, Bostock v. Clayton County, decided in 2020, was whether a federal civil rights law protected transgender people from employment discrimination.

The U.S. Supreme Court’s conservative majority appeared skeptical Wednesday of a challenge to a Tennessee law that bans gender-affirming care for transgender children.

The Constitution leaves that to the people’s representatives, and it does not have a doctor on it, according to John G. Roberts Jr.

Justice Jackson believed that leaving the question to the states was abdication of responsibility. She said she was suddenly quite worried.

More than 20 other states have similar laws. The court’s decision, expected by June, will almost certainly yield a major statement on transgender rights against the backdrop of a fierce public debate over the role gender identity should play in areas as varied as sports, bathrooms and pronouns.

The wide-ranging argument, which lasted two and a half hours, touched on the approaches of other nations, the relevance of a previous ruling protecting transgender workers from workplace discrimination and the rights of parents.

But the core question the justices focused on was whether the Tennessee law made distinctions based on sex, which would subject it to a demanding form of judicial scrutiny and make it harder for the law to survive.

The families and the Biden administration filed separate petitions seeking Supreme Court review. The families’ petition posed two questions: whether the law violated the equal protection clause and whether it ran afoul of “the fundamental right of parents to make decisions concerning the medical care of their children.” The administration only cared about the equal protection claim.

The solicitor general for Tennessee argued that the law was passed for medical reasons, and several of the conservative justices agreed with him.

“The burdens of the law fall equally on boys and girls, because neither can transition,” Justice Amy Coney Barrett said, repeating and seeming to endorse a point made by Justice Brett M. Kavanaugh.

Conservative justices seemed to be inclined to overturn the court’s approach in the case of Wade. In that case, the majority said regulating abortion was a matter for the states.

Providing healthcare for transsexuals is a heavy yellow light for Europe and the U.S. courts to take into account contested medical evidence

Most doctors in the United States support gender treatments for adolescents, based on guidelines written by professional medical groups. But in Europe, countries including Sweden, Finland, Norway and Britain have limited gender-related medical treatments for teenagers after scientific reviews that found weak evidence of long-term benefits.

Treatments for body dysphoria help relieve the symptoms, said advocates backing gender-affirming care. More recent studies in the United States show improved life satisfaction for teenagers after one or two years of treatment, but long-term data has not been published.

“England’s pulling back and Sweden’s pulling back,” Justice Kavanaugh said. “It strikes me as a pretty heavy yellow light if not red light for this court to come in, the nine of us, and constitutionalize the whole area when the rest of the world, or at least the countries that have been at the forefront of this, are pumping the brakes.”

The European responses are different to theTennessee law, claimed Elizabeth B. Prelogar, the U.S. solicitor general. She said that it is a sweeping categorical ban.

The court considers a variety of factors when deciding whether or not to give protected status to groups. Some of the topics that the court considers include whether a group has political power or not, if it’s the same as a group with no political power or not.

He said that there are individuals that are assigned a male at birth, but later come to identify as male.

It is not possible to strike down Tennessee Law but to upholdlaws that limit women’s and girls sports to exclude trans athletes, as suggested by Justice Kavanaugh.

“There’s nothing like this here,” she added. Allowing the use of medications that carry health benefits recognized here and abroad for the purposes of providing healthcare for transexuals should not affect the rights of other people.

The Bostock case looked at the language of a federal law, while the new case deals with the Equal Protection Clause of the 14th Amendment. Last year, a divided three-judge panel of the U.S. Court of Appeals for the Sixth Circuit, in Cincinnati, ruled that Tennessee’s law had a rational basis as a reasonable legislative response to contested medical evidence.

“The unsettled, developing, in truth still experimental, nature of treatments in this area surely permits more than one policy approach,” Judge Sutton wrote, “and the Constitution does not favor one over the other.”

General Prelogar said that there was not direct harm to third parties when it came to sports, so why not trust parents?

Mr. Rice, representing Tennessee, said “the parental rights question is not before this court” and added that there are times when “the states, in their traditional role as regulators, have had to intervene” to protect children.