WASHINGTON − On Wednesday, the Supreme Court will deliberate on whether states can stop transgender minors from receiving puberty blockers and hormone therapies, a significant issue in the ongoing culture wars. This case arrives at the court following President-elect Donald Trump’s campaign pledge to put a halt to what he referred to as “left-wing gender insanity.”

The conservative court’s ruling on the case from Tennessee could influence not only access to these medical treatments across many states but may also bear on other current legal disputes concerning regulations that target transgender individuals, such as those about bathroom use and participation in sports.

Here’s a brief overview of this prominent case before the court this term.

What medical treatments are being contested?

In 2023, Tennessee established a law that prohibits doctors from providing puberty blockers or hormone therapy to minors diagnosed with gender dysphoria—the psychological discomfort that may arise when a person’s assigned sex does not align with their gender identity.

Puberty blockers can halt the production of testosterone and estrogen to postpone puberty changes, allowing the adolescent more time to make decisions about their body. Hormone therapy helps develop physical characteristics that correspond with their gender identity, such as breast development or facial hair.

The law in Tennessee also includes a ban on surgical procedures for transgender minors, but a lower court has dismissed a challenge regarding that aspect.

The state argues it has a “compelling interest in encouraging minors to appreciate their sex” and aims to prevent treatments that could lead minors to develop a negative view of their assigned sex.

Which states have banned gender-affirming care?

Starting with Arkansas in 2021, 26 states have instituted various restrictions on gender-affirming treatments.

The Williams Institute at UCLA School of Law, which researches demographics related to sexual orientation and gender identity, estimates that approximately 113,900 individuals aged 13 to 17 who identify as transgender reside in states where access to puberty blockers and hormone therapies is limited.

While comprehensive statistics on the prevalence of these treatments are lacking, the institute reports that a “significant number” of transgender youths have used them.

A health insurance claims study indicated that from 2017 to 2021, 4,780 minors began using puberty-blocking medication for gender dysphoria, while nearly 15,000 commenced hormone therapy, as noted in research by Reuters and Komodo Health Inc.

Who is contesting the ban?

A trio of families, along with a doctor from Tennessee who treats adolescents experiencing gender dysphoria, filed the initial challenge against the law. Their case is represented by the American Civil Liberties Union.

The Biden administration has joined the case.

Attorneys from both the ACLU and the Justice Department will be arguing against lawyers from Tennessee in front of the Supreme Court.

What is the rationale for arguing that Tennessee’s ban is unconstitutional?

The Justice Department and the ACLU assert that the ban discriminates based on sex and transgender status. For instance, a teenager assigned as male at birth may receive testosterone to treat delayed puberty, but a teenager assigned as female at birth who requires testosterone for gender dysphoria may be denied it.

The families’ lawyers have stated in a brief, “Stripped of its illusory justifications, SB1 is a naked attempt to enforce Tennessee’s stereotypes regarding how a person should `identify’ and `live’ based on their sex assigned at birth, causing severe harm to transgender minors and their families.”

How does Tennessee justify the law?

The state defends the law by stating that the restrictions on treatments are based on their intended use and the age of the patient, rather than on the individual’s sex or transgender status.

Utilizing puberty blockers or hormone therapies.

According to the state, transitioning to another sex differs significantly from the use of treatments for addressing delayed or early puberty. Tennessee argues that the prohibition on these treatments is justified due to the potential risks that outweigh the unproven benefits.

“The legislature concluded that the analysis of costs and benefits justified allowing surgeries and medications covered by SB1 in some cases but not in others,” the state’s lawyers stated in a Supreme Court filing. “This does not constitute discrimination.”

What does the evidence indicate?

Prominent medical organizations, including the American Academy of Pediatrics, assert that there is evidence showing that puberty blockers and hormone therapy can alleviate depression, anxiety, and the risk of suicide among adolescents experiencing gender dysphoria.

The federal district court judge who initially reviewed the case found that the medical experts cited by the state to argue that the treatments were overly risky were “not very convincing based on the existing evidence.”

Tennessee highlighted in its briefs to the Supreme Court that some European nations have increased restrictions on these treatments. For instance, the National Health Service in England halted prescriptions for these medications outside of clinical trials after determining that more information is needed for healthcare providers and patients to make informed choices.

The Biden administration contended that the “more nuanced regulatory approaches” adopted by European countries differ from the absolute bans enforced by Tennessee and other states, which they believe overlook the benefits while exaggerating the risks associated with the care.

What have outside organizations said?

Given the case’s significant visibility, over 80 organizations have submitted briefs advocating for different outcomes.

Opponents of Tennessee’s legislation include the American Academy of Pediatrics, the American Psychological Association, the American Bar Association, the NAACP, numerous transgender individuals who have benefited from gender-affirming healthcare, including actor Elliot Page, along with Democratic attorneys general and congressional leaders.

Supporters of Tennessee’s legislation consist of the Family Research Council and similar conservative groups, Republican governors and attorneys general from various states, tennis star Martina Navratilova, the U.S. Conference of Catholic Bishops, and several individuals who claim that social and medical gender transitions did not alleviate their past gender dysphoria and may have worsened their situations.

What have lower courts ruled?

District courts have largely ruled in favor of families contesting the bans across different states. However, three appellate courts, including the Cincinnati-based 6^th U.S. Circuit Court of Appeals, have upheld the laws. A split 3-judge panel remarked that the developing issue of gender dysphoria may be appropriately addressed by state legislatures.

“This is a relatively new diagnosis with continuously changing treatment approaches over the last decade or two,” noted U.S. Circuit Judge Jeffrey Sutton, appointed by President George W. Bush, who authored a 2-1 majority opinion last year. “Given these circumstances, it is challenging for anyone to predict the long-term impacts of removing age restrictions for these treatments.”

What might the Supreme Court’s ruling be?

The court may choose to endorse the 6^th Circuit’s conclusion, declare Tennessee’s ban unconstitutional, or instruct the appellate court to reevaluate the law using a stricter criterion.

When can we expect a decision?

A ruling from the court is anticipated by the end of June.

What could be the implications of the decision?

If the Supreme Court upholds the ban, access to puberty blockers and hormone therapy would vary based on the state a young individual resides in.

A sweeping ruling that supports Tennessee could simplify the process for states or the federal government to impose limitations on gender-affirming care for adults.

On the other hand, a ruling that declares the ban as discriminatory against transgender individuals would ensure ongoing access to these treatments and could empower advocates for transgender rights in their battle against other legislation.

How might Donald Trump’s potential return to the White House impact the case?

Should Trump assume office again, the Justice Department may inform the Supreme Court of its desire to withdraw the federal government’s challenge to Tennessee’s law. In this scenario, the court might allow the case to proceed with the families remaining as the sole challengers or could choose to dismiss it altogether.

Both parties agree that the court should address this matter promptly, favoring a definitive ruling without significant postponements.

What other transgender cases are awaiting a decision from the court?

The justices are currently considering multiple transgender-related matters, which include:

• Whether it is permissible for states to bar transgender athletes from participating in female sports teams.
• Whether states can omit gender-affirming healthcare from employee health plans or those available to low-income residents.
• Whether a middle school student can be prevented from wearing a t-shirt stating “There Are Only Two Genders.”
• Whether parents have the right to contest a school’s plan to support a child’s gender identity prior to its implementation.

Appeals on these issues are currently pending before the court.

What do the surveys indicate?

A survey conducted by Gallup in May revealed that over 60% of adults were opposed to laws that prohibit gender-affirming care for minors. A slightly lower, yet still majority opposition was noted in a March NPR/PBS NewsHour/Marist Poll.

Surveys have shown greater support for limiting transgender athletes to teams that align with their assigned sex at birth, with 69% of adults endorsing this view in a 2023 Gallup poll.

However, a 2022 survey by the Pew Research Center found that 64% of respondents favored protecting transgender individuals in workplaces, housing, and public areas, following the Supreme Court’s significant ruling against workplace discrimination toward LGBTQ employees under federal civil rights laws.