The U.S. Supreme Court heard oral arguments Dec. 4 against Tennessee’s ban on gender-affirming care for minors, which prohibits minors from accessing puberty blockers and hormone treatments. Tennessee’s ban was enacted in 2023 and also penalizes doctors who violate the ban.
The appeal against Tennesse’s ban was brought forward by three transgender teenagers and their families, a physician from Memphis and President Joe Biden’s administration, who all claim the law violates the 14th Amendment of the Constitution, which guarantees equal protection for all American citizens.
The appeal challenged the ban on the constitutional principles that prohibit discrimination based on sex. Republican lawmakers in Tennessee argued gender-affirming care decisions should not be made until the individual is an adult and the ban regulates the medical rights of all youth, not just those of a certain sex.
This is the first time the Supreme Court has heard an appeal arguing the constitutionality of the restriction of transgender people’s medical rights. Steve Sanders, a professor at the IU Maurer School of Law, said the court agreed to hear the case because of the Biden administration’s involvement. Chase Strangio also made history when he became the first known transgender attorney to present an argument before the Supreme Court when speaking against the ban.
The decision in the landmark case will not only affect Tennessee youth’s access to gender-affirming care but also how freely other states can implement laws concerning the rights of transgender people.
“Depending on what happens with this case, it will have an impact on all the other bans because if they uphold and say that the ban in Tennessee is not unconstitutional, then that will mean, basically, that any hope to challenge bans in other states will pretty much evaporate as well,” Sanders said.
The Supreme Court is expected to decide on the ban by the end of June 2025, but according to CNN, the Court seemed ready to uphold Tennessee's ban after hearing the appeal.
If Tennessee’s ban is upheld, it would be considered federally constitutional to create such bans, though individual states would still have the power to choose whether to have such restrictions. Sanders said this means state bans could not be challenged on these grounds, and challenging these bans would become much more difficult. Currently, 26 U.S. states have implemented bans or restrictions on gender-affirming care for minors.
Both surgical and medicinal gender-affirming care are banned in Indiana, and doctors are prohibited from aiding minors seeking out-of-state treatment. Sanders said he does not think it is likely for Indiana’s ban to dissipate anytime soon.
Nalini Krishnan, an IU senior and an office services assistant at the IU LGBTQ+ Culture Center, is transfeminine, queer and currently receiving gender-affirming care. Krishnan said she came out when she was around 17. Living in Indiana, she said she did not see gender-affirming care as an option until she was legally an adult.
“I have heard testimonials from friends, friends of friends, who are minors, who are genuinely scared about what this ruling could mean for them, what this new presidential administration is going to mean for them,” Krishnan said.
She added she knows multiple families who have moved out or are looking to move out of Indiana since the state began “attacking” and implementing laws restricting the rights of transgender youth and incarcerated people. Indiana implemented a law in 2023 that prohibited state or federal funds from being used for gender-affirming care treatments for incarcerated individuals. The law was suspended in September.
In Tennessee, families of transgender children have expressed similar sentiments, planning to move states if the ban is upheld to receive legal and safe gender-affirming care for their children.
Krishnan said she worries implementing a gender-affirming care ban for minors is just the beginning of an attack on transgender people in Indiana.
“It's only a matter of time before they turn their attention to the rest of the community, so this concerns all of us, really,” she said.
Effects of gender-affirming care
Transgender youth often experience mental health issues, and gender-affirming care has been shown to better their mental states in many cases. As gender-affirming care bans began to be implemented throughout the U.S., medical organizations spoke out against them in support of this healthcare for transgender youth. These organizations include the American Medical Association, American Psychological Association, American Academy of Pediatrics. In Indiana, Riley Hospital for Children provides the only gender health clinic in the state. It too spoke out against the bans, telling legislators it was unable to continue its regular gender-affirming care practices.
Krishnan said she has seen firsthand the mental health struggles transgender youth face and how gender-affirming care “saves lives.”
“Especially when families are supportive of their child's transition too, and they're together making the decision to go through with gender-affirming care, there is truly no reason for the government to be involved in what is truly a family and healthcare decision,” Krishnan said.
Richard Brandon-Friedman, an associate professor of social work at IU Indianapolis, said most of the youth seeking gender-affirming treatments suffer significant health concerns due to their gender dysphoria. Gender dysphoria is condition in which an individual experiences inconsistency between their sex assigned at birth and their gender identity.
“Receiving gender-affirming care for that is really the only way to assist them,” Brandon-Friedman said.
He said transgender youth being able to express their gender identity to society is extremely critical to their social integration and mental health.
“Our (IU Indianapolis School of Social Work’s) research has shown that this (transgender youths’ social engagement) is decreasing with the care ban,” Brandon-Friedman said. “Some of the youth have told us, ‘Now that I’m not able to receive those hormones, I know how my body is going to change and I’m not going to be able to go out as much anymore.’”
Brandon-Friedman also said there is a misconception these services are done on a whim or without prior discussion.
“There is a lengthy process of discussion of ‘this is what it is, these are the outcomes we think will happen, these are the possible side effects that could happen, this is the benefit and this is the risk,’” he said.
However, the Tennessee attorney general argued medical evidence for gender-affirming treatments is not sufficient and they need to be studied more before the state can allow minors to access them.
Some also argue choosing to undergo gender-affirming care as an underage individual could lead to regret and dissatisfaction with the decision, possibly leading individuals to stop or reverse treatments. Multiple Supreme Court justices similarly focused on this concept of “detransitioners” during the hearing. A 2021 study shows that about 13.1% of people who transition using gender-affirming care pursue a detransition at some point in their lives.
Krishnan offered a different point of view.
“The vast majority of those stories are due to the fact that these individuals face pressure from society, from the people around them, to the point where they don't feel safe or accepted as a trans person going through gender-affirming care,” Krishnan said. “And as such, it's that pressure that kind of pushes them to either detransition or stop treatment.”
Additionally, Riley Hospital for Children spoke out when Indiana’s gender-affirming care ban was passed, saying it was not performing surgeries on anyone under 18 to begin with and that hormone therapy and other forms of gender-affirming care were only done with parental consent.
