WASHINGTON — The Supreme Court on Monday waded into the culture-war debate over gender-affirming care for transgender minors by agreeing to resolve challenges to a law in Tennessee that seeks to restrict it.
The justices will hear a Biden administration appeal of a court ruling that upheld the measure. Oral arguments and a ruling are expected in the court’s next term, which starts in October and ends in June 2025.
The case marks the first time the court will issue a ruling in the battle over transgender rights for teens, which has raged in both the health care and education contexts.
A young person holds a Pride Flag outside the House chambers before a legislative session, on Feb. 26, 2024, in Nashville, TN.George Walker IV / AP
“The future of countless transgender youth in this and future generations rests on this Court adhering to the facts, the Constitution and its own modern precedent,” said Chase Strangio, a lawyer at the American Civil Liberties Union, which also challenged the law.
The state measure restricts puberty blockers, hormone therapy and surgery for minors.
In a separate case, the court in April allowed Idaho to mostly enforce a similar law.
More than 20 states have enacted similar bans, according to the Movement Advancement Project, an LGBTQ rights think tank. Whatever the court rules will affect those states as well.
Major medical organizations say that gender-affirming treatments are an effective way of treating gender dysphoria, the clinical term given to the distress people can experience when their gender identity is in conflict with the gender assigned to them at birth.
Plaintiffs, including transgender teens and their families, say the law violates the Constitution’s 14th Amendment, which requires that the law apply equally to everyone, in part by barring medical treatments for transgender people that are available to others. They also say the law violates the right of parents to make health care decisions for their children.
Solicitor General Elizabeth Prelogar urged the Supreme Court to take up the issue, saying that the law “is part of a wave of similar bans preventing transgender adolescents from obtaining medical care that they, their parents, and their doctors have all concluded is necessary.”
A federal judge blocked the Tennessee ban on puberty blockers and hormone therapy but left in place a ban on surgeries.
In a separate Kentucky case the justices did not act on, a federal judge blocked the ban on puberty blockers and hormone therapy. The plaintiffs did not challenge the restrictions on surgery.
In a ruling addressing both laws, the Cincinnati-based 6th U.S. Circuit Court of Appeals ruled in favor of the states in September.
Judge Jeffrey Sutton wrote that no one was questioning “the existence of gender dysphoria or the distress caused by it,” but indicated the question of what treatments should be available to those 17 or under should be left to elected officials.
“This is a relatively new diagnosis with ever-shifting approaches to care over the last decade or two. Under these circumstances, it is difficult for anyone to be sure about predicting the long-term consequences of abandoning age limits of any sort for these treatments,” he wrote.
The plaintiffs then asked the Supreme Court to step in. The court has until now largely stayed out of disputes involving transgender students.
In 2021, the Supreme Court declined to take up a case about the question of whether transgender students can use school bathrooms that correspond with their gender identities as court battles have continued around the country. The court turned away a similar case in January.
On a related issue, the court last year allowed a transgender girl in West Virginia to participate in girls’ sports.
The court’s biggest intervention on trans issues writ large came in a surprise 6-3 ruling in 2020 written by conservative Justice Neil Gorsuch. He concluded that federal law that bars sex discrimination in employment protected transgender and gay people, a ruling that angered conservatives.
Florida Gov. Ron DeSantis Friday signed into law a measure prohibiting ethics investigations from being launched until they are prompted by a complaint from someone with personal knowledge of the alleged wrongdoing. The measure (SB 7014) was widely opposed by government watchdog organizations who warned it will undermine state ethics laws at both the state and local levels.
“Let’s be clear: This has never been about minimizing frivolous complaints; this is about making complaints almost impossible,” said Amy Keith, executive director of Common Cause Florida, after DeSantis’s action. “Governor DeSantis says he believes that Floridians deserve protection from corruption, but his actions today speak otherwise,” she added. Those who backed the measure said complaints have been “weaponized” against candidates.
Born in the Senate Ethics Committee, the legislation purportedly seeks to limit time frames for investigating ethics complaints. It also requires public complaints be based entirely on a filer’s personal knowledge of wrongdoing, which sponsors said was to discourage “frivolous” complaints.
But critics say the bill will gut ethics enforcement completely, eliminating the ability to file anonymous complaints or tips that lead to investigations and uncover legitimate wrongdoing.
Jose Arrojo, Executive Director of the Miami-Dade Ethics Commission, voiced concerns that the new law could limit means of even bringing ethics concerns to the attention of officials. “No more anonymous whistleblowers. No more employees referring information to us,” Arrojo said.
Florida Gov. DeSantis signs legislation that makes it harder to file ethics complaints https://t.co/koNYW7oXBE
DeSantis just signed a controversial ethics bill that will result in less oversight in a state government where ethics are as rare as competent governors. https://t.co/v02kBswNtm
— Lesley Abravanel 🪩 (@lesleyabravanel) June 22, 2024
Florida Gov. Ron DeSantis just signed a bill weakening the state's ethics laws.
SB 7014 will require all future ethics complaints to be based upon "personal knowledge."
It will also stop any local government ethics office from ever again self-initiating investigations.
DeSantis just signed a bill which restricts the ability for ethics boards to launch their own investigations, giving a green-light to public corruption in a state already plagued by public corruption scandals. He also did it late on a Friday night to minimize media coverage. https://t.co/6EDfAf4FaY
DeSantis Has been systematically undermining Florida sunshine laws during his entire tenure as governor. Of course he’s going to sign such a law—he, along with his Reputation legislature, is unethical.
“If I do it (my party does it), it’s ethical, & don’t you dare question it” Definitely “small government,” of “we the people” & not at all the controlling “deep state” they always blame on the other side…/s… “How dare you ask for my (a public servant) travel & meeting records…”
“Personal knowledge of the alleged wrongdoing” is a fancy name for giving themselves a license to commit ‘white collar crimes’, such as bribery, embezzlement, money laundering, wage theft, etc.
The sort of thing where the only person who knows of the offense itself is the person(s) committing it, but everyone else can certainly bear witness to the after effects of it.
The Cass report was a complete ideological bias hit job. Yes, it got great traction at first as the anti-trans haters ran with it. But like all hate driven junk science it withered on the vine. Hugs. Scottie
Many of the largest medical and psychological organizations have rejected the Cass Review’s recommendations on trans youth. The Royal Australian and New Zealand College of Psychiatrists is the latest.
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Two months ago, the Cass Review was released in the United Kingdom. This review, guided and advised by individuals with ties to SPLC-designated hate groups and who met with Governor Ron DeSantis’ medical board—handpicked to ban care in Florida—has led to severe restrictions in the U.K., including criminalizing the possession of puberty blockers. The response outside the U.K. has been much more critical, with numerous medical organizations and doctors worldwide rejecting its recommendations. The latest major medical body to speak out is the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the leading organization for training psychiatrists in both countries.
The Cass Review, a highly criticized evaluation of transgender care, was developed in the United Kingdom by Dr. Hillary Cass, a pediatrician without direct experience in transgender care. Although it was presented as an unbiased and neutral review, intentionally excluding transgender individuals from the decision-making process, it was later revealed that advisors with ties to the Society for Evidence-Based Gender Medicine, an SPLC-designated hate group, were involved. Dr. Cass has since controversially blamed being trans on pornography and labeled the American Academy of Pediatrics as a “left-leaning organization” due to its support for the medical care of transgender youth.
Last month, a handful of members of the RANZCP, some of which are notable figures in anti-trans activism in the country, wrote a letter to the organization stating that they had “serious concerns” about gender affirming care for transgender youth. They pointed to the Cass Review as justification for their concerns. The top signature on the letter is that of Jillian Spencer, who stated in an interview that she was fired for “being a danger to trans and gender-diverse children.” Now, the college has responded.
In a response posted to the RANZCP website, the college announced that the Cass Review is one of “a number of reviews,” and that it rejects the call for a “government inquiry” into trans care in the countries it represents. It further states that transgender care should be “patient centered” and individualized to a patient’s needs. Lastly, it expresses a full support for transgender youth and rejects claims that being transgender is a “mental health condition”:
“The College is committed to respectful, sensitive and appropriate mental health care being provided to individuals who identify as LGBTIQ+. Being Trans or Gender Diverse is not a mental health condition, and the RANZCP unequivocally supports the rights of trans and gender diverse people to have equal access to safe and effective mental health care that is underpinned by dignity, empathy and respect.
…
The College emphasises that assessment and treatment should be patient centred, evidence-informed and responsive to and supportive of the child or young person’s needs and that psychiatrists have a responsibility to counter stigma and discrimination directed towards trans and gender diverse people.”
The statement from the Royal Australian and New Zealand College of Psychiatrists is the latest in a series of rejections of the Cass Review’s findings by medical organizations worldwide. Last month, the American Academy of Pediatrics responded to the review, disagreeing with many of its claims and asserting that the organization supports “individualized health care for each patient, in consultation with their family and health care team” when it comes to transgender youth. The Endocrine Society also dismissed the recommendations, stating, “Medical evidence, not politics, should inform treatment decisions.”
In Canada, the Canadian Pediatric Society rejected the Cass Review’s recommendations, announcing that “current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient’s mental and psychosocial health.” Children’s Healthcare Canada, which oversees the country’s children’s hospitals, concurred, stating, “Our position remains unchanged on the topic.”
Evidence continues to support the use of gender affirming care for transgender youth. A Cornell review of more than 51 studies found “gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.” Numerous studies show lower suicidality, with as much as a 73% reduction in suicidality for trans youth who are allowed care. In a recent article that was not considered by the Cass Review in the Journal of Adolescent Health, puberty blockers reduced depression and anxiety significantly. In Germany, a recent review by over 27 medical organizations has judged that “not providing treatment can do harm” to transgender youth. Due to strong evidence around transgender care, the American Psychological Association released a historic policy resolution condemning bans on gender affirming care. Notably, they are the largest psychological association in the world, with representatives elected to represent 157,000 members.
The lack of credibility given to the Cass Review outside the United Kingdom, especially in the United States, has frustrated its proponents. In a recent article published in The BMJ titled “Gender medicine in the US: how the Cass review failed to land,” anti-trans writer Jennifer Block laments that Erin Reed, the author of this article, highlighted the review’s anti-trans political ties with DeSantis’ picks, which hampered its acceptance. Although Block incorrectly claims that only a single meeting took place (Cass advisor Dr. Kaltiala attended several meetings and even advocated for the ban as a primary witness), she accurately demonstrates that the document’s political roots have been detrimental to its acceptance among credible scientific organizations. These political roots were recently confirmed when Conservative Women and Equalities Minister, Kemi Badenoch, admitted that “gender critical” individuals were placed in health roles to facilitate the Cass Review—a mechanism remarkably similar to how Florida’s review led to the banning of care in the state, borrowing from DeSantis’ strategy.
Despite its lack of acceptance abroad, the Cass Review continues to do tremendous damage in places predisposed to targeting transgender healthcare. It has already been cited in the United States to ban care in South Carolina, a Republican-controlled state. In the United Kingdom, it has led to the criminalization of possessing puberty blockers. As more medical organizations reject its findings, politicians will undoubtedly use its conclusions to push forward with bans on gender-affirming care for transgender youth, despite having little evidence to justify such decisions.
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