SCOTUS to rule on transgender medicine for teens

The US Supreme Court has tossed another briquette onto this year’s election barbeque. It has agreed to hear United States v. Skrmetti, in which the Biden Administration challenges a Tennessee law which has banned transgender treatment for minors.

Jonathan Skrmetti, the state Attorney-General, says that he is looking forward to defending the statute, one of dozens across the country which aim to protect teenagers from life-altering medical treatment. “This case will bring much-needed clarity to whether the Constitution contains special protections for gender identity," he says.

Americans are divided on whether being male or female is an innate characteristic. About 90 percent of Trump supporters believe that sex is real and only about 40 percent of Biden supporters. The Administration has been a consistent advocate of transgender rights, but it’s uncertain whether this is going to help the President in November. About two-thirds of black voters who support Biden believe that sex is innate, and their votes are important for his election chances.

The Tennessee law, Senate Bill 1 (SB1), was enacted last year. It prohibits all medical treatments which allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or which treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”

The Biden Administration argues that restricting puberty blockers and cross-sex hormones constitutes discrimination based on sex, which violates the equal protection clause of the 14th Amendment of the Constitution.

Tennessee contends that these treatments are unsafe and that teenagers are not mature enough to assess their long-term consequences. Whether or not drugs may be prescribed, Skrmetti argues in his brief, “does not turn on invidious sex discrimination but on the age of the individual and the risk-reward assessment of treating this medical condition

He cites a very sensible opinion in Court of Appeals for the 6th Circuit which declared that “life-tenured judges construing a difficult-to-amend Constitution should be humble and careful about announcing new substantive due process or equal protection rights that limit accountable elected officials from sorting out these medical, social, and policy challenges.”

In short, as in Dobbs, Tennessee (and other states) are asserting the right to determine the safety and appropriateness of medical treatment themselves, not the federal government.

The challengers of the Tennessee law are a 15-year-old transgender girl, a 15-year-old transgender boy, and a 12-year-old transgender boy -- all supported by doctors and their parents.

The brief submitted by Biden’s Solicitor General, Elizabeth Prelogar, attempts to refute Skrmetti’s argument that transgender medicine for teens is unsafe and lacks a sound evidence base. She cites various studies – but significantly, not the guidelines of the World Professional Association for Transgender Health (WPATH), which are – or used to be – regarded as authoritative. WPATH was a mainstay of the challengers’ argument.

There’s probably a good reason for the omission – the eighth edition of WPATH’s Standards of Care is in tatters. It has been attacked in the United States and abroad for its shoddy and partisan research. 


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A savagely entertaining dissection of WPATH and the Administration’s belief that puberty blockers and cross-sex hormones are life-saving, compassionate responses to gender dysphoria has been provided in an amici curiae brief from the Attorney-General of Alabama.

In responding to the challengers of Tennessee’s law, Alabama pointed out that around the world, and even in the United States, government agencies are questioning whether puberty blockers and cross-sex hormones are helpful. Even an agency within the US Department of Health and Human Services, the Agency for Healthcare Research and Quality, has been sceptical. One of its briefing notes admits that “There is a lack of current evidence-based guidance for the care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation.”

As for WPATH, Alabama’s brief states:

From what can be gleaned from the public record, WPATH is no normal medical organization. Its guidelines purport to be evidence-based, but WPATH admits it skipped the foundational step of conducting a systematic evidence review when it crafted its treatment recommendations for adolescents. It routinely suppresses scientific inquiry, silencing scholars who question the WPATH standard of “care” and censuring members who go public with their concerns.

What’s the hurry, asks Alabama.

Petitioners rush to this Court and ask it to decide these cases on a preliminary posture before more evidencecomes to light. Their fear is reasonable. Each day that passes seems to bring more evidence to light showingthat the WPATH emperor has no clothes. But that is no reason for this Court to rush. It may need to decide these cases one day, but it should do so only when it is assured the full story.

Indeed, the timing of the appeal to SCOTUS is puzzling. The Court will hear the case in its first term, sometime after October. It will be an unwelcome distraction in the closing weeks of the Biden campaign. There’s no certainty about what the Court will decide, but the outcome of Dobbs suggests that it will lean towards leaving medical policy in the hands of the states.

So what is the hurry? Perhaps Alabama’s cynical answer is correct – settle the matter as fast as possible before it becomes blindingly obvious that treating teenagers’ mental distress with powerful drugs is as unscientific as chicken-manure poultices for baldness. 

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Michael Cook is editor of Mercator  

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Showing 6 reactions

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  • Maryse Usher
    commented 2024-06-27 09:39:19 +1000
    I’m wondering if this Humpty Dumpty debate could be more quickly resolved if a major law firm was willing to tout for clients in a class lawsuit against doctors, school counsellors, psychiatrists and psychologists, surgeons and endocrinologists and most of all, Planned Parenthood; any authority who encourage and/or perform these hormonal and surgical mutilations on anyone at all – because anyone who wants to change their sex has psychological problems. A couple of successful big class action wins awarding big bucks against the perps would help a return to common sense.
  • Michael Cook
    commented 2024-06-26 08:45:39 +1000
    to Anon Emouse: well, the objections would not be the same, but yes, I would object. I have written about the dangers and ethics of cosmetic surgery in the past.
  • mrscracker
    I’m butting in Anon Emouse , sorry, but breast implants can be removed. They don’t involve mastectomies & depending upon the kind & size of implants & how the incisions are made, breastfeeding can still be an option.
    I don’t know about you but I don’t think that sort of cosmetic surgery is appropriate for minors. Even if precautions are taken so that nursing a baby isn’t impossible in the future, implants can still present problems. Young girls might not take that fully into consideration.
    And it looks like everyone you see in the Daily Mail goes to the same cosmetic surgeon. It’s not what you’d call natural looking.
  • Anon Emouse
    I wonder if Mr. Cook has the same objection to female cis-gendered minors receiving breast augmentation surgery.

    It seems to me that this should be of similar concerns, given your stated objections to transgender top surgery
  • mrscracker
    Some home remedies have actually turned out to be beneficial. Probably not chicken droppings for baldness though .
    At least applying chicken droppings to bald spots leaves no permanent damage, unlike the experimentation being done on our children today. You can excuse our grannies for doing the best they could using home remedies. Physicians today, not so much.
  • Michael Cook
    published this page in The Latest 2024-06-25 16:01:26 +1000