• Federal judges initially blocked gender-affirming care bans, but recent appellate court rulings have upheld them in multiple states.
• Over one-third of U.S. transgender youth live in states with these bans.
• The Biden administration has urged the Supreme Court to review the constitutionality of the bans.
• Appeals courts show mixed rulings, reflecting a divided legal stance on transgender rights.
• The Supreme Court’s decision will have major implications for transgender healthcare and rights in America.

The U.S. Supreme Court (SCOTUS) is facing increasing pressure to address the issue of gender-affirming care for minors. This pressure comes amidst a backdrop of conflicting legal rulings and growing legislative efforts across various states, primarily led by GOP representatives, to restrict or ban such care. Notably, the debate centers around the constitutionality of these bans, specifically regarding the equal protection and due process clauses of the 14th Amendment.

Throughout 2023, federal judges have frequently blocked bans on gender-affirming care, siding with LGBTQ+ and civil rights groups. These judges have often argued that banning gender-affirming care is likely unconstitutional under the 14th Amendment. However, this stance has been challenged by two federal appeals courts, which have found that gender-affirming care is not protected by the Constitution, using reasoning similar to the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which argued that abortion access is not “deeply rooted” in the nation’s history and therefore not protected under the 14th Amendment​​​​​​. (The 19th)

Recent decisions by the 6th and 11th Circuit Courts of Appeals have allowed gender-affirming care bans to take effect in states like Alabama, Tennessee, and Kentucky, affecting a significant number of transgender youth. These rulings have substantial implications, as they extend to all states within the jurisdiction of these appellate courts. These developments have led to situations where transgender adolescents are being weaned off their hormone treatments, significantly impacting their wellbeing​​. (The 19th)

Despite these challenges, not all federal appeals court rulings have been against transgender rights. For example, the 9th Circuit Court of Appeals upheld an injunction preventing Idaho from policing how transgender students join school sports, and the 4th Circuit found that the Americans with Disabilities Act extends protections to people with gender dysphoria. These rulings imply the 14th Amendment’s equal protection clause is applicable in these contexts​​. (The 19th)

Simultaneously, a significant number of transgender youth, representing over 35% of this population in the U.S., now live in states that have enacted or are at risk of enacting bans on gender-affirming care. These legislative efforts are driven by national anti-LGBTQ+ groups and go against the recommendations of major medical associations, which argue that gender-affirming care is medically necessary and should be a decision made between patients, their families, and doctors​​. (Human Rights Campaign)

The Biden administration has also intervened, asking the Supreme Court to review these cases. This request significantly increases the likelihood that the Supreme Court will consider a case addressing the constitutionality of gender-affirming care bans. The outcome of such a case remains uncertain, with concerns about how the Court, which has recently avoided transgender constitutional rights cases, might rule​​. (Nevada Local News)

SCOTUS is under pressure from various legal and political entities, including federal appeals courts, state legislatures, national anti-LGBTQ+ groups, medical associations, and the Biden administration, to address the constitutionality of gender-affirming care bans for minors. The Court’s decision, when it eventually comes, could have profound implications for transgender rights and healthcare in the United States.

Various studies and the consensus of major medical organizations support gender affirming care

1. Improved Mental Health Outcomes: Research consistently demonstrates that gender-affirming medical care, including puberty blockers and hormone therapy, leads to significant improvements in mental health for transgender youth, with reductions in depression, anxiety, and suicidality observed across various studies​​​​​​. (Psychology Today, PubMed)
2. Reduction in Gender Dysphoria: Gender-affirming care has been shown to effectively reduce gender dysphoria, thereby improving the overall well-being of transgender and nonbinary children and adolescents​​​​. (University of Massachusetts Amherst, Columbia University Department of Psychiatry)
3. Decreased Suicide Risk: Initiating hormone replacement therapy, especially between the ages of 14 and 17, is linked with a significant decrease in the risk of suicide attempts, highlighting the life-saving potential of timely gender-affirming care​​. (University of Massachusetts Amherst)
4. Support from Major Medical Organizations: Major medical organizations oppose legislation that would ban gender-affirming medical care for transgender adolescents, emphasizing the necessity of such care for the mental and physical health of transgender youth​​​​. (Psychology Today)
5. Long-Term Benefits and Lower Regret Rates: Longitudinal studies indicate sustained improvements in psychological functioning, with some surgeries, such as chest surgery for transmasculine adolescents, showing significant relief from dysphoria and very rare instances of regret​​​​. (Psychology Today, Columbia University Department of Psychiatry)
6. Social Transition and Hormone Therapy: Social interventions like changing names or pronouns, along with hormone therapy, have been found to lower rates of depression and anxiety in transgender children. Pubertal suppression and hormone therapy significantly decrease gender dysphoria and are associated with better mental health outcomes and life satisfaction​​. (Columbia University Department of Psychiatry)