‘There are risks both ways’: Supreme Court Weighs Medical Care for Trans Youth
In the first case of its kind, the court’s conservative majority appeared willing to leave decisions up to the states.

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In the first case over medical treatments for trans youth to reach the U.S. Supreme Court, the conservative majority on Wednesday questioned the federal government’s argument that “overwhelming evidence” supports procedures like puberty blockers and hormone therapy.
They appeared to favor leaving such consequential matters up to lawmakers, but also wrestled with the possible implications of doing so.
“There are risks both ways in allowing the treatment or not allowing the treatment,” Justice Brett Kavanaugh said after hearing arguments over a Tennessee law that prohibits gender-affirming medication or surgery for trans minors. “There’s no kind of perfect way out … where everyone benefits and no one is harmed.”
In her comments, U.S. Solicitor General Elizabeth Prelogar argued that the ban discriminates on the basis of sex and violates the 14th Amendment guarantee of equal protection.
“There is a consensus that these treatments can be medically necessary for some adolescents,” she said, noting that they can reduce suicide attempts. The Tennessee legislature, she added, has “completely decided to override the views of the parents, the patients, the doctors who are grappling with these decisions.”
Justice Samuel Alito asked if she wanted to change her view that there’s a strong research basis for the procedures in light of moves by Britain, Sweden and other European countries to dial them back. Kavanaugh noted that these countries were “pumping the brakes on this kind of treatment.”
She replied that, unlike Tennessee, those countries haven’t banned the practice. The Biden administration is asking the justices to send the case back to the U.S. Court of Appeals for the Sixth Circuit to reconsider whether a blanket ban is appropriate.
But J. Matthew Rice, Tennessee’s Tennessee Solicitor General, argued that the state isn’t discriminating based on a patient’s birth sex, but holding that such treatments cannot be used for the purpose of transitioning.
“Just as using morphine to manage pain differs from using it to assist suicide, using hormones and puberty blockers to address a physical condition is far different from using it to address psychological distress associated with one’s body,” Rice said.
The liberal justices agreed with Prelogar that the state is treating youth differently based on sex because such treatments would be allowed, for example, in the case of a boy or girl who started puberty too early.
“I’m worried that we’re undermining the foundations of some of our bedrock equal protection cases,” Justice Ketanji Brown Jackson said.
The challenge to comes amid questions over what President-elect Donald Trump’s reelection means for both gender-related health care and, more broadly, the future of anti-discrimination protections for LGBTQ youth. During the campaign, in which the issue became highly politicized, Trump vowed to for schools that he says push “radical gender ideology.” He repeatedly warned, , that schools secretly arrange gender transition surgeries for students without their parents’ consent. And with Republicans taking control of both houses of Congress, it becomes more likely that anti-trans laws like those passed by many states could be enacted nationwide.
A showed that a majority of voters think activism over trans people’s rights in government and society has gone too far. That includes some , who have voiced new reservations about trans girls competing on teams that match their gender identity.
In Wednesday’s hearing — which included American Civil Liberties Union lawyer Chase Strangio, the first known openly trans lawyer to argue before the court — the conservative justices struggled with whether it’s the court’s place to rule in an area where the science is unsettled.
The court’s decision in this case is likely to have a broad impact: Tennessee is one of 26 GOP-led states with banning puberty blockers or hormones for trans youth.
Dr. Susan Lacy, a Memphis gynecologist, and three families, sued the state, claiming the ban violates the Constitution because it treats trans youth differently and violates parents’ rights to make medical decisions for their children. The Biden administration joined the case in support of their arguments.
In 2020, the Supreme Court decided in Bostock v. Clayton County that LGBTQ employees are a protected class in the workplace. Prelogar said the same standard should apply in this instance.
While the Tennessee case doesn’t directly pertain to schools, court documents detail the educational struggles of its teen litigants. One identified as John Doe “would have an incredibly difficult time wanting to be around other people and go to school” without gender-affirming medical care. Another trans boy using the pseudonym Ryan Roe would throw up before school because of anxiety over puberty and didn’t want to speak with a feminine-sounding voice. After receiving hormone therapy from Vanderbilt University, Ryan began participating more in class.
The American Academy of Pediatrics such care for transgender and “gender diverse” youth, restating its position as recently as last year in the face of widespread GOP to criminalize the practice. A of 220 trans youth found that the majority who received gender-affirming care were highly satisfied with the treatment at least three years later. Nine regretted taking puberty blockers or hormones, and four stopped taking the medication.

But call the treatments child abuse and reject the phrase “gender-affirming care.” They say the procedures cause irreversible physical harm and that most children would of gender dysphoria if they don’t transition. An from Britain’s National Health Service reinforced their view. Dr. Hilary Cass, the report’s author, concluded that there is insufficient research to determine if the treatments have positive or negative effects, and largely discouraged them. Based on her review, the NHS no longer prescribes puberty blockers or hormones outside of clinical trials.
“For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress,” the report said. “For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.”
In with The New York Times, she said she disagrees with the American Academy of Pediatrics over the issue and suggests the organization could be “misleading the public.”
Republican Sen. Bill Cassidy of Louisiana, incoming chair of the education committee, pointed to the Cass report when he for the Academy to explain why it continues to support the treatments for minors. A spokesman for Cassidy said they have not received a “substantive response.”
As legal challenges to the bans on those treatments reached the federal courts, the and circuits ruled that such practices don’t discriminate against trans youth, allowing the restrictions to stand. But the and circuits sided with opponents of the laws.
On such a divisive issue, Prelogar argued compromise is possible, pointing to a that stopped short of a ban and allows treatment when at least two doctors agree that a patient has gender dysphoria and is at risk of self harm.
“I do think that there is room here for states to enact tailored measures to try to guard against the kind of risk that you’re concerned about,” she told the justices.
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