The US Supreme Court invents rationale to take health care from trans youth
In December 2024, the Supreme Court of the United States (SCOTUS) heard arguments in US v. Skrmetti to determine whether Tennessee’s ban on health care for trans adolescents is constitutional. Over six months later, they released their decision: Yes, states can take health care from trans people.
The SCOTUS opinion was authored by Chief Justice John Roberts and joined by Justices Thomas, Alito, Gorsuch, Kavanaugh, and Barrett. Justices Sotomayor, Kagan, and Jackson dissented.
The crux of the opinion is the notion that restrictions on medical care to treat gender dysphoria are not rooted in classifying patients by “sex” (used to refer to sex assigned at birth). Sex is a protected classification which the government may not use to discriminate. If SCOTUS had found that sex classifications (or other distinctions based on a “suspect class”) are at play in the Tennessee ban, then courts must used “heightened scrutiny” to determine the law’s constitutionality.
But, the SCOTUS majority pretends to not see the sex classifications that the Tennessee law is imbued with. Rather, they claim that the only classifications at hand in the current Tennessee law are age (in that the law applies to minors and not adults) and the medical use of specific treatments (e.g. puberty blockers, sex hormone therapies). Neither of these classifications trigger heightened scrutiny.
In doing so, Roberts (as well as Barrett, Thomas, and Alito who wrote separate concurring opinions) echo the lies on trans health care that Tennessee promoted in their legal brief for Skrmetti. Their comments present life-saving health care as ongoing “fierce scientific and policy debates.” They ignore that such debates were manufactured by right-wing misinformation machines.
Additionally, attorneys for the trans adolescents who brought the case had argued that, at minimum, Tennessee’s law discriminates against trans people who comprise a “suspect class." Ultimately, SCOTUS majority did not decide the validity of this argument1 because it determined that Tennessee’s ban doesn’t classify people by trans identity. Rather, what everyone has claimed to be a classification of trans people is actually a the aforementioned classification on the medical use of specific treatments - i.e. a specific medical treatment following a diagnosis of gender dysphoria.
Yet, Roberts goes out of his way to say that the Skrmetti decision does not affect the Bostock decision. Bostock protects queer and trans people from workplace discrimination because such discrimination “because of” their sex (assigned at birth). Invocation of Bostock is not warranted here because the opinion claims that a trans person’s sex (assigned at birth) does not change the application of Tennessee’s ban.
This twisted logic presented by the SCOTUS majority is best demonstrated by a hypothetical that Roberts poses in the summary (or syllabus) of the opinion:
If a transgender boy seeks testosterone to treat gender dysphoria, SB1 prevents a healthcare provider from administering it to him. If his biological sex were changed from female to male, SB1 would still not permit him the hormones he seeks because he would lack a qualifying diagnosis.
This comparison gets at the heart of the SCOTUS majority’s logical missteps. The Tennessee law does not regulate diagnoses, it regulates treatments. There is a distinction between the two which is critical here because whether the boy in question receives testosterone treatment hinges on their sex assigned at birth.
Due to this inaccurate misconstruction, the proposed hypothetical is not a fair comparison. One one hand, you have a trans boy who has been medicalized by seeking a diagnosis and subsequent medical treatment. On the other hand, you have a cis boy who apparently has never been to the doctor and therefore remains unmedicalized.
Ultimately, this illogical conflation gets at a continuing conundrum that transsexual people have faced for decades: in order to attain full bodily autonomy and undergo a medical transition, we generally must first allow ourselves to be turned into medical specimens. This leads not only to gatekeeping of trans health care by medical providers but also to pathologization of trans identity by the state for political purposes.
This Skrmetti decision legitimizes efforts to withhold the means of medical transition from trans Americans who seek it. State level bans will remain intact, and the federal efforts to restrict care will continue to be permitted. Notably, nothing in the decision would preclude legislatures from targeting care for trans adults.
But, the fight must continue. We will not just give up because John Roberts is a mediocore logician. Support trans-led organizations who can help fill the gaps left behind by political hatred, lobby politicians at all levels to prioritize the protection of transgender people, protest organizations that preemptively cut off trans health care, and educate your friends and neighbors.
And don’t forget about trans youth. There are basic actions that you can do to preserve their dignity. A recent survey of trans youth in Australia found that supporting someone’s social transition can decrease anxiety and increase happiness. Similarly, the 2024 Trevor Project survey of queer youth offers concrete actions for all of us to reflect on moving forward:
They may take our health care away, but we can always continue to show up as ourselves and uplift our trans siblings.
from the archive
Although Justices Barrett (joined by Justice Thomas) and Alito provided some half-baked analysis that claims trans people are not a “suspect class” because trans people do not “exhibit obvious, immutable or distinguishing characteristics that define them as a discrete group” (Barrett) and have not experienced a history of discrimination (Alito).
Thank you Ev. Dead on accurate as always. I’m not floored by the decision, but I could not imagine how Gorsuch would sign on to this decision after authoring Bostock. Of course, I was thinking about this court through the lens of logic, and that was clearly where I went wrong.
I was disheartened by the news today. And yet, I told myself that our community must soldier on. This is just a chapter in a book that's still a work in progress. Hugs.