Transgender people under 18 face laws that bar them from accessing gender-affirming health care in 25 states — just a few years ago, none had such laws.
The Supreme Court agreed. Consider a case from Tennessee. in his next term, challenge the state’s ban on health care for young people.
“The pressure has been mounting on the Supreme Court to weigh in here,” he said. Lindsey DawsonDirector of LGBTQ Health Policy at medical research organization KFF.
Dawson noted that most state bans have been challenged in court, with 20 state bans currently in effect. “We’ve seen split decisions in the appeals courts, which is always a sign that an issue could be ripe for the Supreme Court.”
The Details of different state bansBut the law generally prohibits transgender minors from accessing puberty blockers, hormones, and surgery (which is rare for minors).
On schedule
Oral arguments in the Supreme Court case will take place in the fall. Arguing on behalf of transgender Tennesseans before the justices will be U.S. Attorney General Elizabeth Prelogar. Defending the law will be Tennessee Attorney General Jonathan Skrmetti.
Bans on gender-affirming care across the country “are creating profound uncertainty for transgender youth and their families across the country — and causing particularly serious harm in Tennessee and other states where they are allowed to take effect,” Read Prelogar’s request to the judges to hear the case.
Skrmetti wrote in a statement: “We fought hard to preserve Tennessee’s law that protects children from irreversible gender discrimination. I look forward to ending the fight in the United States Supreme Court. This case will bring much-needed clarity on whether the Constitution contains special protections for gender identity.”
What prompted all these new laws restricting gender-affirming care? “I can’t point to any specific external event,” Dawson says. “But it’s almost as if these policies spread like wildfire—once a few states enacted them, other states followed suit.”
Conservative groups like the Alliance Defending Freedom and the Heritage Foundation have urged state lawmakers to address the issue. “The experimental gender reassignment procedures imposed on our children are often irreversible,” said Matt Sharp of ADF. wrote last year“And such drugs and procedures are not only dangerous, but also experimental and unproven.” ADF did not respond to NPR’s request for comment for this story.
For the American Principles Project, the ban represents “an effort to rein in the predatory transgender industry,” as president Terry Schilling wrote in statement this weekThe American Principles Project did not respond to multiple requests for comment from NPR for this story.
‘Nothing changes’
These claims — and the speed with which lawmakers act on them — are puzzling. Dr. Kade Goepferdeducational director and medical director of Children’s Minnesota’s Gender Health program. Goepferd has been providing the same type of care to gender-diverse children for 20 years.
“We don’t have any new ways of approaching care. We don’t have any new medications. There’s no new groundbreaking research coming out—nothing has changed,” they said. “If anything, care has become more standardized, more guideline-driven.”
All major U.S. medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and the American Psychological Association, gender affirming care support safe and necessary
Erin Reeda journalist and transgender activist, has been closely following these laws as they pass through state legislatures.
“I have watched thousands of hours of legislative hearings on this issue — there is probably no other topic that is getting as much legislative time in the United States right now in legislatures across the country,” she said. “Legal and transgender legislation seems to come in waves throughout American history. This is not just an isolated incident.”
She asserted that this is not out of public concern either: “Regardless of people’s personal feelings about transgender care, they don’t want lawmakers to spend time on this issue.”
She pointed to one NORC-LA Times Poll released in June found that 77% of Americans agreed with the statement: “Elected officials largely use the transgender and gender non-binary debate to distract attention from more pressing priorities.”
There’s also a religious aspect to the push for these laws. “When God created us, he created us male and female, and that’s it — there’s no choice,” Davey Hiott, the Republican majority leader in the South Carolina House of Representatives, told reporters in January. “Anyone else who wants to change that at birth or change that during their lifetime, we need to stand up against that.”
In May, South Carolina became the 25th state to enact a ban on health care for teens based on gender identity.
Travel to care
Dawson points out that the law targets the use of various medical interventions, not the interventions themselves, so she questions the argument that drugs or hormone treatments are unsafe.
“There are exceptions for youth who need to access these services—the very services that are prohibited—for the purposes of gender-neutral care,” Dawson notes. Almost all of the restrictions include penalties for health care providers; some target parents, teachers, and counselors.
For Goepferd’s Minnesota clinic, the bans in neighboring states meant about a 30% increase in patient calls.
“Even though we have added additional medical and mental health staff to try to keep up, our waiting list is still over a year long,” they said, which is a long time when it comes to puberty.
Goepferd added that patients traveling to Minnesota as often as every three months from other states is a logistical nightmare and complicates coverage. “We’re really set up to take care of Minnesotans — we’re not really set up to take care of the entire Midwest.”
Kellan Baker, CEO of Whitman Walker Institute“Every day, there are new restrictions being proposed and enacted on how transgender people can move around the world, not just in terms of accessing health care but also, for example, going to school, playing on a sports team,” he said.
In Baker’s view, state lawmakers passing these laws are “attacking children to score political points and exploiting the fact that many people may not know a transgender person,” he said. “There aren’t many transgender people — the best estimate we have is about 0.6 percent of the U.S. population identifies as transgender.”
