Inside the Tennessee Family Shaping the Landmark Transgender Health Care Case at the Supreme Court

On a pleasant evening in February in Nashville, a teenager with curly hair and her father ascended the steps to the viewing gallery in the Tennessee Senate. Below them, legislators were about to make crucial decisions impacting her family’s medical choices.

As they peered over the ornate Senate railings last year, Tennessee Republicans voted to outlaw specific medications and treatments essential for transgender youth struggling with gender dysphoria.

L Williams embodies many traits of an ordinary teenager: she enjoys video games, brownies, and socializing with friends. She experiences the typical ups and downs of 11th grade and occasionally takes out the recycling—after a gentle nudge from her mother.

However, on December 4, L will find herself climbing another set of stairs.

This time, they will lead to the U.S. Supreme Court, where her experience will play a crucial role in a landmark legal battle that could shape medical care for transgender youth across the country.

The teen, referred to as L in legal documents, and her parents, Brian and Samantha Williams, filed a lawsuit against Tennessee in 2023 to contest the ban on gender-affirming care that they observed being enacted. This legislation requires Tennessee doctors to halt treatments like puberty blockers and hormone therapies for transgender patients like L by March 2024.

This ruling threatened to disrupt her ongoing medical care and pose serious risks to her well-being.

Two additional Tennessee families with transgender children and a Memphis doctor have also joined in the legal action.

In response to Tennessee’s law, the Williams family sought to find medical professionals outside the state. Many Tennessee families impacted by the legislation chose to relocate to other regions that felt safer for their circumstances.

However, Brian and Samantha Williams are determined to stay in Tennessee, the place where they have established deep family roots and where they have marked their children’s growth on a doorway in their dining room.

For the Williams family, the lawsuit signifies their refusal to back down, asserting their rights to remain in Tennessee and to make sensitive medical choices for their children.

“I can’t bear the thought of returning to the bleak time before I could come out and seek the care my doctors prescribed,” L expressed last year after initiating the lawsuit.

The Tennessean has agreed to keep L’s full identity confidential for safety reasons as she is still a minor, while Samantha and Brian Williams are publicly named plaintiffs in the suit.

Lawyers for the U.S. Department of Justice and the ACLU are set to present their arguments on December 4, claiming that the Tennessee law violates the Equal Protection clause by discriminating based on sex.

The very treatments that Tennessee Republicans claim are harmful to L remain accessible to her non-transgender peers and other youths in Tennessee—provided they are not undergoing treatment for gender dysphoria.

“I never imagined we would be headed to the Supreme Court,” Samantha revealed in July while sitting with Brian and L at their dining table, reflecting on the remarkable direction L’s journey has taken over the last four years.

Yet, Samantha questioned why they shouldn’t advocate for themselves and for others in Tennessee faced with similar challenges.

Balancing daily life as a major Supreme Court case approaches

Even though the upcoming U.S. Supreme Court case has garnered significant national attention, it has occasionally taken a backseat in the Williams household this fall.

While they kept an eye on legal developments, their lively Nashville home was filled with the everyday hustle of two parents managing their careers while raising two teenagers.

Their backyard is scattered with Nerf darts, remnants of a PVC-pipe air cannon that Brian built with the kids, and they welcomed a playful kitten named Mushroom into their family this fall.

On a particular October evening, the family gathered around their kitchen island, crafted from reclaimed rafters by Brian. L snacked while her parents discussed dinner options.

Nearby, a handwritten list displayed their family rules, emphasizing the values of kindness and community, which include “love your friends and neighbors,” “own your achievements and mistakes,” and “apologize when you hurt others.” Adding a light-hearted touch, they included “know how to throw a party.”

While lawyers were busy filing extensive briefs throughout the summer, L was starting her 11th grade, managing multiple Advanced Placement classes.

L has always had a knack for creativity. As Samantha picked up a pipe cleaner toy left behind by Mushroom, she reminisced about how L used to create entire “fleets” of aircraft using pipe cleaners. L still dreams of becoming a pilot.

Last summer, she took the initiative to create her first video game through self-taught programming and has been producing electronic music with her friends for years. By October, she had gotten a new DJ deck just in time to throw a Halloween party for her friends, with her dad Brian helping her decorate the DJ table with spider webs and hang skeletons around the room.

Despite feeling proud to challenge Tennessee’s law, L admitted to some nerves about the potential outcomes. What could their lawsuit mean for transgender rights nationwide? How might Donald Trump’s potential reelection affect the case as transgender Americans worry about their federal access to care?

While discussing the rapidly changing circumstances at the family’s dining table in July, L reflected on the stress it brings.

“It’s tough,” L stated, thoughtfully considering her words.

She emphasized that everyone should engage in politics, as it has significant effects on people’s lives. “But I really wish I could take a break from politics and not have to worry about it all the time,” she confessed. “It feels like I have to be ready with arguments and knowledge to defend my views when someone confronts me.”

This is a concern for Samantha as well.

On February 15, 2023, just days after L and her father witnessed the Tennessee Senate pass the version of the care ban, Samantha spoke out against the bill in front of a House committee.

With L’s 15th birthday party approaching, Samantha’s voice quivered as she shared the simple party plans—pizza and brownies—emphasizing what every child deserves in contrast to what she saw as an infringement on parental rights.

“She is a happy, healthy kid who isn’t hurting anyone. Her joy, her smiles, her confidence come from the blockers she’s been on for a year and a half,” Samantha asserted.

During the testimony, Williams and another mother of a transgender teen faced aggressive questioning from lawmakers.

“It was incredibly frustrating because they wouldn’t even take a moment to acknowledge our stories. I tried to share it as personally as possible,” Samantha explained. “She should be excited about pizza with her friends, not worrying that you might take away her care.”

L expressed that it was sometimes frustrating and infuriating to see lawmakers debate matters impacting her everyday life, but she longed to communicate directly with them regarding the bill.

“Often, they treat transgender teenagers like they are too young to understand,” L noted. “I believe they will face a lot of cognitive dissonance, and they may need to confront their flawed opinions or reveal their true beliefs, which could be much worse.”

Raising Concerns

When Tennessee lawmakers reconvened in 2023, their main goal was to ban gender transition treatments for minors, led by the Republican supermajority.

Backers of the bill argued that medications like puberty blockers, which prevent the onset of puberty and its associated physical changes, could lead to long-term issues including reduced bone density and potential infertility. They also claimed that the long-term psychological effects of these gender transition treatments for young people remain largely unstudied and that teens are not mature enough to give consent.

“These treatments have long-lasting negative consequences that cannot be reversed,” stated bill sponsor Rep. William Lamberth, R-Portland, last year, suggesting that transgender teens should receive mental health support instead until they reach adulthood to make medical decisions.

The legislation specifically prohibited certain medical procedures intended for a specific purpose but did not ban the medications entirely. Despite their concerns about the harmful long-term effects on young people, lawmakers still permitted Tennessee teenagers to obtain these medications for non-transgender-related issues like hormone discrepancies or early puberty.

Major medical organizations in the U.S. disagree, claiming that the treatment is both safe and effective, often saving lives for transgender youth who experience higher instances of depression and suicidal thoughts.

The Tennessee Chapter of the American Academy of Pediatrics urged Republican Governor Bill Lee to reject the measure, arguing that doctors should be able to adhere to evidence-based medicine rather than political pressures. No healthcare professional with experience in treating transgender individuals endorsed the bill during testimony.

“Those who oppose Tennessee’s law have the opportunity to push for a different legislation via the democratic process,” remarked Attorney General Jonathan Skrmetti, whose office will represent the state in defending the bill come December, in a recent commentary for The Hill. “While the federal government can choose to adopt a transition-first and ask-questions-later strategy, the Constitution does not impose that same obligation on Tennessee.”

However, the “ask-questions-later strategy” starkly contrasts with the experiences of the Williams family as they discussed their child L’s journey of coming out as transgender.

“We dedicated a great deal of time to understand this situation; we asked numerous questions and consulted with both doctors and therapists,” Brian explained. “We thoroughly researched it, and then suddenly, someone else is telling me that this isn’t right and it shouldn’t happen?”

As L entered her teenage years, she began to experience severe anxiety and discomfort. She felt as though she was “drowning and trapped” within her own body, which made concentrating in class and connecting with peers nearly impossible.

L expressed feeling “deeply emotionally distressed” at the thought of going through male puberty, a process that would bring about physical changes which might not be reversible even if she chose to pursue a gender transition at 18. She felt such discomfort using the boys’ restroom at school that it led to urinary tract infections, as outlined in the lawsuit.

“You’re at a stage where you’re dealing with puberty, and on top of that, it’s this awful version of puberty,” L stated. “Of course, nobody feels completely at ease during puberty, but for me, it was extremely distressing.”

She first shared her feelings with a friend in 2019, but it wasn’t until late 2020 that she revealed her truth to her mother.

Samantha and Brian soon found a therapist for L, who began regular sessions after being diagnosed with gender dysphoria. Several months later, with guidance from their pediatrician, the family consulted with a medical team at Vanderbilt University Medical Center about starting puberty blockers to delay the onset of male puberty.

Long discussions and debates occurred within the Williams household, often taking place in Samantha and Brian’s room. Brian occasionally played the devil’s advocate, much to Samantha’s annoyance, which she humorously recounted to lawmakers last year. At times, her parents challenged ideas that L felt differently about.

“We had to remind ourselves that as parents, it’s our responsibility to take our time while addressing these questions,” Samantha emphasized.

“Your role as a parent is to care for your child and endeavor to do what’s best for them,” Brian added.

In 2021, the Williams family concluded that puberty blockers were the right choice for L, bringing her significant relief. By January 2022, L had come out to her wider family, peers, and teachers. Over a year after beginning puberty blockers, L’s medical team and her parents opted for hormone therapy, intended to suppress testosterone while boosting estrogen levels in her body.

“I wasn’t at ease with my current situation, and I felt a pressing urgency to proceed with this,” she explained, noting that it is “challenging to be the first transgender person someone meets.”

“It’s tough to manage school, puberty, and everything else simultaneously. That’s why I’m against the law because it will profoundly affect the lives of many kids, adding to the stress they already experience from school and the dysphoria they endure.”

Racing to find new doctors

In 2023, Samantha and Brian initially thought they might be excluded from the upcoming restrictions. L was already undergoing treatment, and they believed their extensive consultations with their medical team would protect her from any abrupt changes, Brian said. They thought the state couldn’t simply stop her treatment.

But they soon discovered Tennessee’s capability to enforce such a ban. As they campaigned against the legislation, Samantha began searching for an out-of-state clinic that would take L on as a patient before the medication was rendered illegal in Tennessee come March 2024. This became a race against time as the availability of treatments shifted swiftly beneath them.

Before 2023, only three states had enacted gender transition bans. By the time Tennessee’s law came into force in June 2023, 20 states had implemented bans on medical treatments for minors in some capacity, creating a wall of restrictions around Tennessee that limited access to treatments L had been receiving for years.

For the Williams family, it felt like a cascading series of failures. Samantha worked tirelessly to stay ahead. After reaching out to at least a dozen clinics nationwide, she finally found an option in Cincinnati. Aware of the growing number of bans, she also scheduled an appointment in North Carolina as a precaution.

North Carolina would implement its own ban by August, but it had a crucial difference.

Unlike the law in Tennessee, North Carolina’s legislation would allow any teenagers already undergoing treatment in the state to continue receiving care. The Williamses made an appointment in Asheville that summer, but continued L’s treatment in Ohio throughout the winter of 2023, before Ohio’s ban was put in place in January 2024.

The scramble for treatment resulted in significant delays in L’s care, as each new clinic needed to carefully process her as a new patient.

“It’s not a matter of just walking in and getting prescriptions straight away,” Brian explained. “There’s a whole series of procedures you have to go through.”

Anger and frustration over legislative debate

In the meantime, L observed legislative discussions that often filled her with anger and frustration. She noted that the rhetoric she encountered in the legislature mirrored many of the arguments she had previously seen online. The hostility directed at transgender individuals was strikingly evident to her.

“Puberty brings irreversible changes,” L pointed out. “Saying that individuals should wait until they are 18 to make their decision carries significant consequences and permanent outcomes. By pushing that narrative, you strip them of a vital choice, if nothing else,” L articulated. “That approach appears a bit hypocritical, unless you fundamentally believe that transgender people are inferior. Many won’t admit it, but that’s often at the core of what they think.”

The underlying messages surrounding the bill were often more troubling than the explicit statements made in committees: The initial.

The revised version of the bill effectively categorized gender-affirming care as a type of abuse, insinuating that legislators viewed parents like Samantha and Brian as potential threats to their children.

Proponents of the bill labeled this care as “mutilation.” Additionally, a rally associated with this movement in 2022 drew participants from the white nationalist group, The Proud Boys, as a national anti-trans agenda gained traction among far-right extremists in recent years.

“It’s a bit nerve-wracking,” Brian admitted, expressing his concerns about confronting the state over a controversial issue that has provoked significant backlash. “But it feels somewhat rebellious. I dislike what these individuals are doing, and I want to make that known.”

A few months after the Williams family filed their lawsuit, a judge appointed by Trump temporarily halted Tennessee from enforcing the law. The judge found that the state lacked adequate medical evidence and may have violated constitutional rights. However, several months later, the 6th U.S. Circuit Court of Appeals overturned that decision, supporting Tennessee’s stance.

The arguments set for December in the Supreme Court will focus on this appellate ruling. Tennessee intends to argue that it has a legitimate interest in restricting medical treatment for minors seeking to address gender dysphoria.

While lawyers from the Department of Justice (DOJ) and the ACLU contend that the state’s uneven ban constitutes sex discrimination, Tennessee maintains that it is entitled to impose “age and use-based restrictions,” arguing that the law applies uniformly, without distinction based on gender.

This December, in between attending her 11th grade classes and her social activities, L plans to travel to Washington, D.C. with her family to observe a debate about her access to medical care.

“I feel a sense of pride in being part of this, but I’m also anxious that the outcome may not be favorable. I’m a bit worried that the verdict might rest on my shoulders,” L expressed, recognizing that the potential ruling could either uphold or dismantle access to gender-affirming care nationwide.

“I’m trying to stay positive, though, because optimism is important in such situations.”