In a devastating update, the United States Supreme Court voted along party lines to uphold Tennessee’s unethical blanket ban on gender-affirming care for transgender minors. United States v. Skrmetti was decided 6-3 and has potentially severe consequences for adult care as well.

The case asked the Court to consider whether transgender individuals constitute as a class, since we are united and targeted based on identity, and whether blanket bans as previously determined to be unconstitutional were similar when targeting transgender healthcare. After all, other populations are guaranteed the equal right to medically necessary care since previous decisions established that medical discrimination was illegal. However, the Court ignored all of those questions when presenting their argument for siding with the state of Tennessee and stated gender dysphoria was an exception to previous rulings on blanket bans, and thus, medical providers and legislators were allowed to discriminate against transgender people.

Their logic is derived from stating that the current ban on gender-affirming care for minors is based on gender dysphoria and not sex, so it cannot be classified as sex-based discrimination – the same logic used by the Trump administration when removing LGBTQIA+ protections under Title IX. Of course, this logic is flawed: at this moment, the Court views transgender identity as a mental health issue, but they are choosing to ignore that other aspects of Tennessee’s laws (as well as other states across the country) wish to prosecute transgender people for sex crimes based on sex assigned at birth. In her coverage of the topic, Erin Reed wrote, “The Tennessee law, Justice Sotomayor and the dissent argue, explicitly classifies on the basis of sex—so overtly that the majority’s attempt to sidestep that reality reads as disingenuous. The statute itself declares that one purpose of the ban is to ‘encourage minors to appreciate their sex,’ and yet the majority still concludes it does not constitute sex-based classification.” This argument also fails to consider that while gender dysphoria is currently classified as a mental disorder, it is the required diagnosis for medically necessary treatment for transgender individuals. The World Health Organization and other experts on mental and physical health have declassified transgender identity itself as a mental illness since our distress is caused by the dysphoria or disconnect between internal gender and outward expression. As NPR wrote, “[The] Supreme Court decision was a big win for Tennessee and 24 other states, but there are many questions that remain unanswered.”

Permitting states to ban gender-affirming care, the medically necessary and most effective treatment for gender dysphoria, to treat transgender people in distress is as nonsensical and inhumane as banning other medications like insulin for the treatment of diabetes or banning the prescription of albuterol for asthma.

The current ruling is also dangerous, since it seems to permit states to ban transgender healthcare entirely – not just for minors. The conservative Court is not arguing that states have a right to ‘protect children from medical treatments’ like gender-affirming care; they are arguing that states have a right to ban gender-affirming care entirely.

Regarding the Supreme Court’s decision, Human Rights Campaign President Kelley Robinson released the following statement:

“Today’s Supreme Court decision is a devastating blow to transgender youth and the families who love them, but it will not break our resolve. Families may now have to make the heartbreaking choice to leave their state or split their families, or take on extensive financial burdens, to ensure that their kids can access medically necessary care.

“This Court chose to allow politicians to interfere in medical decisions that should be made by doctors, patients, and families—a cruel betrayal of the children who needed them to stand up for justice when it mattered most.

“As parents, advocates, and community leaders, we know that our fight doesn’t end in courtrooms—it lives in our communities, our hearts, and our unwavering commitment to each other. Still, we will not be deterred. We will support families forced to make impossible choices, fund legal challenges, and build a movement so powerful that no politician can ignore us. Together, we will turn this pain into power and keep fighting until every transgender person in America can live with dignity, safety, and the freedom to be who they are.”

Erin Reed also reported that “Though the majority avoided that outcome, three justices—Justices Samuel Alito, Clarence Thomas, and Amy Coney Barrett—wrote separately to express that they would have gone further, explicitly denying transgender people equal protection under the law.” While the Court’s decision does not affect transgender individuals living in states that protect gender-affirming care, it further divides the country. Gleeful legislators are banning the most effective treatment for transgender people, the most proven deterrent that lowers the suicide rate amongst the trans community – depending on where you live, you may not be able to legally obtain medically necessary healthcare that has been the gold standard throughout the world for decades and you can be prosecuted for traveling elsewhere to receive such care.

While the decision is terrifying, the war for transgender rights isn’t over. United States v. Skrmetti specifically targets gender-affirming care for minors, and while legislators have talked about expanding healthcare bans to adults, no laws have actually been written. It also isn’t the end for transgender minors either – social justice advocates will continue to fight the Supreme Court for equal rights, despite this loss. If the GOP can stack the Court to overturn Roe v. Wade, there is always hope for a better future. Chase Strangio from the ACLU stated, “Though this is a painful setback, it does not mean that transgender people and our allies are left with no options to defend our freedom, our health care, or our lives. The Court left undisturbed Supreme Court and lower court precedent that other examples of discrimination against transgender people are unlawful. We are as determined as ever to fight for the dignity and equality of every transgender person, and we will continue to do so with defiant strength, a restless resolve, and a lasting commitment to our families, our communities, and the freedom we all deserve.”

In addition to this news, I wanted to give context that other news sources aren’t covering. United States v. Skrmetti rose to the Supreme Court on whether gender-affirming care bans on transgender minors are constitutional – Tennessee lawmakers defended the law by citing bogus claims that gender-affirming care is unsafe and experimental.

It is not hard to make up research, and I’ve talked about this at length. It has been proven via various leaks that the GOP is writing laws based on astroturf organizations and the pseudoscience they publish as legitimate research – but these organizations never have actual backing, and you won’t find real-life members because they’re fabricated to lobby. While Trump and the GOP love to accuse the left of doing so, they are actually the only ones who use paid activists in this manner. Anyone can produce research and you can make your ‘research’ prove your hypothesis if you are willing to tamper with data and the research process – which is why ‘research’ organizations like the Society for Evidence-Based Gender Medicine are never acclaimed or published by legitimate agencies like American Psychiatric Association, American Psychological Association, World Health Organization, and American Public Health Association. The reality is gender-affirming care, including care for minors, is overwhelmingly supported by research. Research being conducted and published under the current political regime is purposely misleading, inaccurate, and propagandistic.

Secondly, these legislators have not met actual transgender youth who have experienced the supposed woes of being forced into medical procedures. If you are under the age of 18, it is incredibly difficult to access gender-affirming medical care due to the international requirements established by WPATH. The World Professional Association for Transgender Health is just as legitimate as a health institution as the World Health Organization, and has produced credible research for decades supporting gender-affirming care. The recent accusations that scientific bodies like WPATH and WHO are untrustworthy because they do not side with GOP pseudoscience are created solely to bring harm. The WPATH itself has made an official statement denouncing Trump’s pseudo-research.

Even in the most liberal states, it is a grueling process for minors to get gender-affirming medical care.

First, a young person must be fully out as transgender – including their parents and guardians, family members, school, and community. For them to be fully out, that minor has identified as transgender for an extended period, since no, people do not just wake up and decide to be trans.

After coming out, that transgender minor must socially transition – this means they have picked another name they are going by, pronouns, hairstyle, clothing, hobbies, and other aspects of gender. They have gone through the trouble of picking a name that fits their gender identity and have told others, likely begun outwardly expressing their gender without medical intervention, and have changed minor forms that don’t require legal orders, like email addresses, school assignment rosters, and social media accounts.

That transgender minor must now engage with regular counseling and get a diagnosis for gender dysphoria – which they can only do after establishing their transgender identity is long-standing and not a phase for that provider. It is at this point that the minor must have the full support of all their legal guardians, since minors cannot easily access therapy, and definitely cannot engage with medical care without their parents’ explicit consent.

Assuming the minor has completed every step above completely and has identified as transgender for an extended time, they MIGHT be eligible for medical care. WPATH only allows puberty blockers to be prescribed to minors who have reached Tanner stage two, or in other words, shown visible signs of puberty beginning as their sex assigned at birth. The minor must also prove that they are capable of making informed decisions, further establish that their gender identity is not a phase, and not the consequence of a mental disorder other than gender dysphoria.

The minor and their guardians must locate a doctor who is trained to provide such care and show proof of their gender dysphoria diagnosis and ongoing mental health treatment. Depending on the provider, they might be required to have two letters from qualified mental health professionals stating that medical treatment has been deemed medically necessary. Most doctors require transgender minors to engage in puberty blockers before hormone replacement therapy, even if they’re sixteen, and they will not move to HRT until the minor has been on puberty blockers for a minimum amount of time.

After the youth has been on puberty blockers for a sufficient amount of time, they may be moved to hormone replacement therapy – which means estrogen or testosterone will be prescribed instead of puberty blockers to commence puberty.

If the transgender minor is unsure whether they may want biological children one day, they MIGHT be eligible for reproductive services such as sperm or egg freezing. However, these reproductive services aren’t common since most transgender people are told from the beginning that transition will likely make them unable to have biological children.

If the minor is assigned female at birth, they MIGHT be eligible for top surgery if they did not engage with puberty blockers fast enough to prevent breast growth and have been on HRT for a minimum of twelve months. However, this itself is even more rare than minors accessing medical gender-affirming care entirely, and the vast majority of surgeons will require their patients to wait until age eighteen.

Transgender minors are not able to freely access other surgical procedures. While technically possible, medical providers are not willing to perform these procedures before the age of eighteen. If someone tries to argue about whatever conspiracy they believe, force them to pull details like their office number and credentials. If they are unable or unwilling to call that provider’s office and obtain at least verbal proof, they are lying.

As mentioned before, the Supreme Court ruling affects more than just minors – the logic embraced paves a route for states to ban gender-affirming care entirely because they deem it as ‘experimental.’ The reason gender-affirming care for minors is seen as so experimental is because research is more mixed regarding puberty blockers compared to HRT, but puberty blockers are never intended as the end result for gender-affirming care. Puberty blockers are used as a means to pause natal puberty and give minors time to establish their gender identity as more than a phase before continuing with non-reversible side effects of HRT. While hormone replacement therapy has non-reversible side effects, it is extremely effective and has exceedingly low regret rates, and thus has substantial positive results compared to puberty blockers. Yet again, for minors, puberty blockers are an integral part of the process for them to receive care.