Transgender people under 18 face laws that prevent them from accessing gender-affirming health care in 25 states — just a few years ago, not a single state had such a law.
The Supreme Court has agreed to hear a case from Tennessee in its next term challenging that state’s ban on gender-based care for youth.
“The pressure was building for the Supreme Court to weigh in here,” says Lindsey Dawson, Director of LGBTQ Health Policy at the health research organization KFF.
Most state bans have been challenged in court, Dawson notes, with 20 state bans currently in effect. “We had seen split decisions in the appeals courts, which is always an indicator that a case may be ripe for the Supreme Court.”
The details of state bans vary, but laws generally prohibit transgender minors from accessing puberty blockers, hormones, and surgery (which is very rare for minors).
At the docks
Oral arguments in the Supreme Court case will take place in the fall. US Attorney General Elizabeth Prelogar will argue before the judges on behalf of transgender people from Tennessee. Defending the bill will be Tennessee’s Republican Attorney General, Jonathan Skrmetti.
Bans on gender-based care across the country “are creating profound uncertainty for transgender teens and their families around the nation — and causing particularly acute harm in Tennessee and other states where the laws have been allowed to take effect,” the petition said. Prelogar addressed the justice to take the case.
Skrmetti wrote in a statement: “We fought hard to protect Tennessee’s law protecting children from irreversible gender manipulation. I look forward to finishing the fight at the United States Supreme Court. This case will bring much-needed clarity to whether the Constitution contains special protection for gender identity”.
What prompted all these new laws restricting gender-affirming care? “I can’t point to a specific external event,” Dawson says. “But it’s almost as if these policies were like wildfire — once a handful implemented them, other states followed suit.”
Conservative groups such as the Alliance for the Defense of Freedom and the Heritage Foundation have encouraged state lawmakers to take up the issue. “Experimental gender transition procedures performed on our children are often irreversible,” wrote ADF’s Matt Sharp last year. “And not only are such drugs and procedures dangerous, they are also experimental and unproven.” ADF did not respond to NPR’s request for comment for this story.
For the American Principles Project, the bans represent “efforts to curb the predatory transgender industry,” as president Terry Schilling wrote in a statement this week. The American Principles Project did not respond to NPR’s multiple requests for comment on this story.
‘Nothing has changed’
These claims – and the speed with which lawmakers have acted on them – mystify Dr. Kade Goepferd, chief education officer and medical director of the Minnesota Children’s Gender Health program. Goepferd has been providing the same type of care to gender diverse children for 20 years.
“There is no new way that we are approaching this care. There are no new medications that we are using. There was no new ground-breaking research study that came out – nothing has changed,” they say. “If anything, care has become more standardized, more guideline-based.”
All major American medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and the American Psychological Association, support gender affirming care as safe and necessary.
Erin Reed, a journalist and transgender activist, has closely followed these laws as they have moved through state legislatures.
“I’ve watched thousands of hours of legislative hearings on this — there’s probably no other topic that’s taking up as much legislative time in the United States right now in statehouses across the country,” she says. “Laws targeting queer and trans people seem to come in waves throughout American history. This is not just an isolated incident.”
It also doesn’t come from a huge public concern, she asserts: “Regardless of what people personally think about transgender care, they don’t want lawmakers to spend time on it.”
She points to a NORC-LA Times poll released in June that found 77% of Americans agreed with the statement: “Elected officials mostly use debates about transgender and non-binary people to distract from more pressing priorities.”
There is also a religious aspect to the push for these laws. “When God created us, he created us male and female, and that’s it — there’s no other choice,” South Carolina House Majority Leader Davey Hiott, a Republican, told reporters in January. “All these other people who want to change it from birth or change it in their lifetime, we have to stand up against that.”
In May, South Carolina became the 25th state to pass a ban on foster care for youth.
The journey to care
Dawson points out that the laws target the use of various medical interventions, not the interventions themselves, so she questions arguments that drugs or hormone treatments are unsafe.
“There are exceptions for young people who need to access these services — the same services that are prohibited — for non-gender-affirming care purposes,” Dawson notes. Almost all restrictions involve penalties for medical providers; some parents, teachers and counselors targeted.
For the Goepferd clinic in Minnesota, the bans in surrounding states have meant about 30% more calls from patients.
“Even though we’ve added additional medical and mental health staff to try to keep up with this, our waiting list is still over a year long,” they say, which is a long time when it comes to puberty. .
Patients traveling to Minnesota as often as every three months from other states is a logistical nightmare and makes insurance coverage complicated, Goepferd adds. “We’re really committed to taking care of Minnesotans — we’re not really committed to taking care of the entire Midwest.”
It’s not just health care laws that have passed, notes Kellan Baker, executive director of the Whitman Walker Institute, an LGBTQ research and advocacy group. “There are new restrictions being proposed and passed every day about how transgender people can move around the world, not just in terms of accessing medical care, but, for example, going to school, playing on a sports team,” he says.
In Baker’s view, state lawmakers who pass these laws are “attacking children to score political points and taking advantage of the fact that many people may not know a transgender person,” he says. “There aren’t that many transgender people — the best estimates we have are about 0.6% of the US population identify as transgender.”
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