Brief Correction: Tennessee's 5 Lies to SCOTUS about Gender Affirming Care
next week scotus will hear oral arguments in a case on whether states can ban affirming care
On December 4, the United States Supreme Court will hear oral arguments in United States v. Skrmetti, considering the constitutionality of Tennessee’s ban on gender affirming care for trans minors. Earlier this year, the parties in this case provided the court with briefs outlining the legal stances underpinning their arguments. Unsurprisingly, the brief from Tennessee Attorney General Skrmetti grossly misrepresents the science of gender affirming care. Here, we will correct these lies with the actual scientific facts.
First, I want to address what may be seen as a naïve question given our politics: If the court is deciding the law, then why is the science important? Individual states have broad legal powers to regulate medicine within their borders, particularly when medical practices pose a safety risk. These state powers were expanded in 2022 by the ruling in Dobbs v. Jackson Women’s Health Organization which eliminated the constitutional right to abortion care.1 Dobbs provides the legal foundation for Skrmetti’s brief (which cites it 11 times).
Against this legal backdrop, Skrmetti paints gender affirming care as a harmful medical practice which preys on youth. Of course, this depiction is false, but according to his logic, the Tennessee legislature was only acting to protect its citizens from harm when it enacted its ban.
Therefore, the outcome of the case may rest on individual justices’ beliefs about the science of gender affirming care. While I doubt any of the justices are QSL readers, affirming facts can be hard to come by today. So, below I counter Skrmetti’s 5 major falsehoods with 5 facts to help inoculate the public before the flurry of news around the case.
Fact 1: The recent increase in trans identification is due to societal acceptance.
Skrmetti complains of “an ‘unexplained’ spike in minors identifying as transgender and receiving a gender-dysphoria diagnosis,” echoing the social contagion theory (i.e. the idea that **waves hands** transness spreads quickly in social circles like a pathogen2) - a sort of “lavender scare” tactic ca. 2024.
A 2022 study published in the journal Pediatrics found no evidence for the social contagion theory, definitely concluding that it “should not be used to argue against the provision of gender-affirming medical care for [trans] adolescents.” While it is true that more people than ever are coming out as LGBTQIA2S+, the number reached a peak in 2018 and has since decreased, according to the Pediatrics study. This apex came a few years after the height of the “transgender tipping point” of social visibility.
Further evidence from a similar study published the same year agrees. This survey of Canadian teens receiving affirming care reported that youth waited 3-6 years between gaining self-knowledge of their gender and their first visit to the gender clinic. Together, these data strongly repudiate the social contagion theory that underpins Skrmetti’s brief.
However, as
reminds us, fixation on the number of trans young people is pure sensationalism. Instead, consider why there are so few trans elders in comparison? She does a great job addressing these distinctions in light of social contagion theory, and I recommend her recent piece.
Fact 2: There is a strong medical consensus in favor of gender affirming care for trans youth.
Skrmetti casts affirming care as a recent medical development compared to an alternative model of care which he calls “watchful waiting” (otherwise known as doing nothing, the consequences of which in the next section). Given these two alternative approaches to “care,” he disparages the medical authority that provides guidelines on affirming care practices, the World Professional Association for Transgender Health (WPATH), as run by “social justice lawyers.”
In reality, WPATH is a transnational consortium of health professionals with expertise in providing care for transgender and gender non-conforming peoples. Since 1979, WPATH has consolidated the field’s knowledge to issue guidelines on best practices in treating gender dysphoria. Known as the Standards of Care (SOC), 8 editions have been published over the years with the 8th edition released in 2022. SOC-8 meticulously details guidelines for health practitioners over 260 pages with input from 119 scientists.3 Among this group of authors, health care providers from every continent are represented, a truly worldwide collaboration.
WPATH is a consistent target of right-wing commentators who in March released an error-laden report seeking to disparage the organization. However, WPATH is not the only medical organization to promote gender affirming care as the best practice when working with trans youth. Other organizations which have issued public statements in support of affirming care for trans youth include the American Medical Association, the World Health Organization, the American Academy of Pediatrics, and the American Psychological Association.
Fact 3: Gender affirming care is safe.
In his brief, Skrmetti emphasizes the risks outweigh the benefits of gender affirming care for minors. In reality, the only risk he identifies (rather creepily) is infertility, and he omits the myriad of studies showing benefits for youth receiving affirming care.
Medical research suggests the benefits of affirming care for youth are vast. A 2022 study found affirming care is associated with lower odds of depression (60% decrease) and suicidality (75% decrease). Importantly, the rates of regret for trans youth receiving affirming care are astonishingly low - only 3% according to a recent report.
In contrast, a September 2024 study revealed that anti-trans laws increase rate of suicidality in trans youth by as much as 72%. This is corroborated by experiences of youth with the United Kingdom’s National Health Service (NHS). The NHS has waitlists to receive gender affirming care, and the long waiting period has materially increased suicides among trans youth. The total of these data confirm that this benefits of affirming care far outweigh the minuscule risks.
Another piece of evidence that affirming care is safe comes from trans youth themselves. Patients taking puberty blockers report fewer adverse health events associated with the drugs than Advil or Adderall. Further, the benefits youth receive are intangible. Consider the testament of Ryan, a 16-year-old trans boy who received affirming care in Tennessee prior to the ban and is a party in Skrmetti (via his lawyers, citations omitted):
Since beginning treatment, Ryan’s mental health has improved dramatically. He has transformed back into the vocal, outgoing person that he was before puberty. For years he suffered from gender dysphoria, and nothing could address his anguish the way hormone therapy has. With testosterone, Ryan has “found [his] voice again” and is thriving. Without it, life is unimaginable for him.
Fact 4: Puberty blockers are reversible.
Skrmetti falsely claims that puberty blockers cause irreversible changes to the body. Instead, puberty blockers are completely reversible and there are no long-term consequences associated with them.
Puberty blockers are a class of drugs called gonadotropin-releasing hormone (GnRH) agonists. When someone takes a GnRH agonist, the brain and body respond by shutting down production of estrogens and androgens, consequently halting the surge of hormones that drives puberty. Notably, once someone stops taking a GnRH agonist, then their body will return to their endogenous hormone cycle. This allows puberty to proceed normally - just delayed.
In April, I wrote an extensive post detailing the science behind puberty blockers. If you want to know more about GnRH agonists’ mechanism of action and pharmacology (as well as the hormonal basis of puberty), I recommend checking it out!
Fact 5: Vanderbilt University Medical Center followed best affirming care practices until Skrmetti’s office intervened.
Skrmetti told SCOTUS that the Tennessee legislature banned gender affirming care for minors after (faux) outrage at transition-related procedures performed at the Vanderbilt University Medical Center (VUMC). However, the standard of care provided at the clinic has been greatly exaggerated.
VUMC was founded in 2018 and followed the medical recommendations laid out by WPATH. Since its founding, the center performed 5 top surgeries per year and 0 bottom surgeries. All surgical patients were 16 or older and had parental consent - in line with WPATH standards of care.
The publicity given to gender affirming care and VUMC since 2022 prompted investigations of the clinic by Skrmetti’s office. As part of this investigation, the clinic turned over sensitive medical data from over 100 current and former patients. A report from the United States Senate Finance Committee found that VUMC “betrayed” its patients by turning over this sensitive information to Skrmetti. The report also found that Skrmetti’s investigation into VUMC abused his authorities to investigate Medicaid and protect consumers. As committee chair Senator Ron Wyden (D-OR) said in April:
“A handful of red-state attorneys general are misusing their authority to terrorize transgender teens in their states, violating patients’ privacy, and causing real harm to vulnerable kids… At the same time, while some hospitals have admirably resisted these overbroad fishing expeditions, Vanderbilt University Medical Center failed its responsibility to protect their patients’ privacy. Giving up on patient privacy, particularly after the repeal of Roe v. Wade,… is an utter betrayal of a medical provider’s responsibility.”
As you can see, Skrmetti’s strategy is the legal equivalent of throwing shit against a wall and seeing what sticks. Fortunately, the Supreme Court will also hear arguments on behalf of three trans youth who are represented by trans attorney Chase Strangio, the co-director of the ACLU’s LGBTQ & HIV Rights Project. Strangio is a leading expert on trans folx and the law, and I doubt he will let Skrmetti’s lies go without a strong rebuttal.
Regardless, we will know the extent of the Supreme Court’s decision by June but can gauge the likely outcome based on the justice’s questions during oral arguments. If their questions broadly assume Skrmetti’s falsehoods, push back on Strangio’s truths, or center interpretations of Dobbs, then Tennessee’s ban (and others around the country) will likely stand. However, if arguments compare the situation to alternative precedents (such as Bostock v. Clayton County, which extended Title VII of the Civil Rights Act to include discrimination based on sexual orientation and gender identity), then a just decision may yet be possible.
In Skrmetti, a bellwether justice is likely Justice Neil Gorsuch. Gorsuch unexpectedly authored the majority opinion protecting queer people in Bostock which drew the public ire of the conservative legal movement. If Gorsuch capitulates to this pressure and tries to backtrack his jurisprudence during the Skrmetti arguments, the path to a majority in favor of affirming care will be slim (but not impossible).4
Until then, please take care of yourself! No matter what SCOTUS decides, the science will not change. The facts outlined above will still be true. Trans youth will still exist and deserve affirming care. We are not going back.
Doctors aren't trained in queer health. But you can help!
Friends and allies, this is yet another reminder that misogyny and transphobia are politically linked issues!
Emphasizing how the rhetoric compares trans people to a disease!!!
Trust me. It’s hard enough to get 5 scientists to agree on something, let alone 119.
Chief Justice John Roberts also voted in the majority (with the liberal justices and Gorsuch) in Bostock, but Gorsuch drew more pushback from the right-wing powers that be. There are also two new justices since Bostock: Amy Coney Barrett and Ketanji Brown Jackson.
I like your structure and prose, love the fact checking and counter arguments, you make a clear set of points!
thanks for putting down the facts here! I'll definitely be keeping an eye on this case.