WASHINGTON − On Wednesday, the Supreme Court will examine whether states can restrict transgender youths from using puberty blockers and hormone therapy, a contentious issue that has become a flashpoint in American culture wars, especially after President-elect Donald Trump spoke out against what he termed “leftist gender madness.”

The court’s ruling on this case from Tennessee could not only shape the accessibility of specific medical treatments nationwide but also have broader implications for ongoing legal disputes regarding other limitations on transgender individuals, including those concerning restroom usage and participation in sports.

Here’s an overview of this significant case the court is addressing this term.

What medical treatments are being debated?

Tennessee’s law, instituted in 2022, prohibits medical practitioners from administering puberty blockers or hormone therapy to minors diagnosed with gender dysphoria, which is the emotional distress individuals may face when their assigned sex does not align with their gender identity.

Puberty blockers prevent the production of testosterone and estrogen, postponing the physical changes of puberty, thus giving adolescents more time to make informed choices. Hormone therapy induces physical changes that align with a person’s gender identity, such as breast development or facial hair.

The law also bans surgical procedures for transgender minors, but a previous court ruling dismissed a legal challenge regarding this aspect.

The state argues that it has a “compelling interest in helping minors accept their biological sex” and in banning treatments that “may lead minors to reject their sex.”

Which states have banned gender-affirming care?

Following Arkansas’s ban in 2021, 26 states have enacted varying degrees of restrictions on gender-affirming care.

The Williams Institute at UCLA School of Law, which focuses on research related to sexual orientation and gender identity, estimates that there are roughly 113,900 transgender individuals aged 13 to 17 living in states with limits on puberty blockers and hormone therapy.

While comprehensive statistics on treatment prevalence are scarce, the institute notes that a “significant number” of transgender youth have undergone these treatments.

A research study examining health insurance claims determined that from 2017 to 2021, 4,780 minors began taking puberty blockers for gender dysphoria, while nearly 15,000 initiated hormone therapy, according to a study co-conducted by Reuters and Komodo Health Inc.

Who is contesting the ban?

The law was challenged by three families along with a Tennessee doctor who provides care to adolescents experiencing gender dysphoria. They are being legally represented by the American Civil Liberties Union.

The Biden administration has lent its support to the case.

Attorneys from both the ACLU and the Justice Department will be presenting their arguments against legal representatives for Tennessee in front of the Supreme Court.

What is the rationale for claiming Tennessee’s ban is unconstitutional?

The Justice Department and ACLU assert that the ban discriminates based on sex and transgender status. A teenager assigned male at birth can receive testosterone treatment for delayed puberty; however, a teenager assigned female at birth who seeks testosterone for gender dysphoria is denied that option.

“When stripped of its unfounded justifications, SB1 is merely an attempt to impose Tennessee’s stereotypes about how someone should ‘identify’ and ‘live’ according to their assigned sex at birth, causing significant harm to transgender minors and their families,” the families’ lawyers argued in their submission.

What defense does Tennessee present for the law?

The state claims that the restrictions on treatments are based on their intended purpose and the age of the patient, not influenced by the patient’s sex or transgender identity.

Utilizing puberty blockers or hormone therapy

The state argues that transitioning to another sex is not the same as addressing issues like delayed or early puberty. Tennessee believes the ban on these treatments is warranted due to the numerous risks involved and the lack of concrete benefits.

The state’s attorneys informed the Supreme Court in a filing that the legislature concluded that the evaluation of costs and benefits justified allowing the surgeries and medications specified in SB1 for some circumstances and not for others. “That does not constitute discrimination,” they stated.

What evidence is available?

Prominent medical organizations such as the American Academy of Pediatrics indicate that there is evidence suggesting that puberty blockers and hormone therapy can alleviate depression, anxiety, and the risk of suicide among adolescents suffering from gender dysphoria.

The federal district court judge who initially reviewed the case found that the doctors cited by the state to argue against the treatments were “minimally persuasive based on the existing records.”

In its briefs to the Supreme Court, Tennessee pointed out that some European nations have tightened treatment restrictions. For instance, England’s National Health Service stopped prescribing these medications outside clinical trials after determining more data is needed for informed decision-making by doctors and their patients.

The Biden administration countered that the “more nuanced regulatory approaches” taken by European nations differ significantly from the blanket bans enacted by Tennessee and other states, which, they argue, overlook the benefits while exaggerating the risks associated with this type of care.

What have external groups expressed?

Given the prominence of this case, over 80 organizations have filed briefs urging the court to reach a particular decision.

Opposition to Tennessee’s legislation comes from the American Academy of Pediatrics, the American Psychological Association, the American Bar Association, the NAACP, numerous transgender adults who have benefitted from gender-affirming healthcare, including actor Elliot Page, as well as Democratic state attorneys general and members of Congress.

Supporters of Tennessee’s law comprise the Family Research Council and other conservative organizations, several Republican governors and attorneys general from multiple states, tennis icon Martina Navratilova, the U.S. Conference of Catholic Bishops, and individuals who claim that social and medical gender transitions did not alleviate their gender dysphoria experienced during youth and made their situations worse.

What have lower courts decided?

District courts have predominantly supported families challenging bans in various states. However, three appellate circuits, including the Cincinnati-based 6^th U.S. Circuit Court of Appeals, have upheld the laws. A divided three-judge panel suggested that the evolving nature of gender dysphoria may be left to state legislatures.

“This is a relatively new diagnosis, with continuously evolving care approaches over the past decade or two,” U.S. Circuit Judge Jeffrey Sutton, appointed by President George W. Bush, stated for a 2-1 majority last year. “Given these situations, it’s challenging for anyone to accurately predict the long-term effects of completely lifting age limits for these treatments.”

What could the Supreme Court’s ruling be?

The court could either affirm the 6^th Circuit’s ruling, declare Tennessee’s ban unconstitutional, or instruct the appeals court to revisit the law using a stricter standard.

When will a decision be made?

A final opinion from the court is anticipated by the end of June.

What are the possible repercussions of the ruling?

If the Supreme Court upholds the ban, access to puberty blockers and hormone therapy will vary based on the region where a young person resides.

A sweeping decision favoring Tennessee could also simplify the process for states or the federal government to limit gender-affirming care for adults.

On the flip side, if the ruling states that the ban discriminates against transgender individuals, it would ensure continued access to these treatments and could empower advocates for transgender rights to challenge other laws.

Could Trump’s return to the White House influence the case?

Once Trump is in office again, the Justice Department might request the Supreme Court to withdraw the federal government’s challenge against Tennessee’s law. Consequently, the court could either persist with the case with the families as the remaining challengers or choose to dismiss it entirely.

Both parties agree that the court should address this matter promptly, advocating for a swift and definitive ruling without unnecessary delays.

What other transgender issues are under consideration by the court?

The court has been petitioned to evaluate various other transgender-related matters, including:

• Whether states have the authority to prevent transgender athletes from participating in women’s sports teams.
• Whether states can omit gender-affirming health care from employee or low-income health plans.
• Whether a middle school student can be barred from wearing a t-shirt that states, “There Are Only Two Genders.”
• Whether parents can contest a school’s gender identity support plan prior to its implementation with their child.

Appeals concerning these issues are currently pending before the court.

What do public opinion polls reveal?

In a Gallup survey conducted in May, over 60% of adults opposed laws that restrict gender-affirming care for minors. While the opposition was slightly less in a March NPR/PBS NewsHour/Marist Poll, it still represented a majority of respondents.

Support for limiting transgender athletes to teams aligning with their assigned gender at birth is more pronounced, with 69% of adults approving of that restriction in a Gallup poll from 2023.

Furthermore, a Pew Research Center poll from 2022 found that 64% of respondents were in favor of protecting transgender individuals in employment, housing, and public areas. This survey was conducted two years after the Supreme Court’s pivotal ruling against workplace discrimination based on sexual orientation or gender identity under federal civil rights law.