US ruling to impact trans healthcare, reproductive rights

LONDON - The U.S. Supreme Court will rule this month on whether Tennessee's ban on gender-affirming care for minors discriminates against transgender youth in the state.

The 2023 law prohibits healthcare supporting gender identity for people under the age of 18 who wish to change gender or are experiencing gender dysphoria.

The ruling could have far-reaching implications for trans healthcare and reproductive rights, such as birth control and abortion, experts say.

Here's what you need to know.

What is the case of United States v. Skrmetti?

Tennessee passed Senate Bill 0001 in March 2023, banning medical procedures such as hormone therapy, puberty blockers or surgery from being performed "for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex".

It does allow the same treatments for minors who do not identify as trans and for those with unrelated conditions, such as early-onset or delayed puberty.

The law says the state has a "compelling interest" in "encouraging minors to appreciate their sex" and protecting their ability to become "adults who can create children of their own".

Three trans teenagers and their families filed a lawsuit against state officials in 2023, arguing that the law violates their constitutional right to equal protection and discriminates against trans youth on the basis of sex.

Their case was backed by the Biden administration, and an injunction on the ban was initially granted, but was overturned by a federal appeals court in 2023.

The Trump administration withdrew the Department of Justice's support for the plaintiffs.

Tennessee's attorney general, Jonathan Skrmetti, is arguing in defense of the law. The case was referred to the Supreme Court in November 2023, specifically concerning the ban on hormone therapy and puberty blockers, and oral arguments were heard in December 2024.

A ruling is expected this month.

What are the implications of the case?

If the court sides with Tennessee, it could allow for other states to deny people gender-affirming care based on their identity, experts said.

"Similar laws categorically banning care for youth in other states will likely be upheld," said Sruti Swaminathan, staff attorney at the American Civil Liberties Union.

The law's clauses concerning minors' appreciation of their sex and future ability to have children are troubling, rights groups have said.

"It's an increasing encroachment of the government in these incredibly intimate decisions," said Leila Abolfazli, director of National Strategy on Abortion Rights at the National Women's Law Center.

"You can see how it then comes up in other areas like birth control access, fertility care or wherever the government wants to put its thumb on the scale of enforcing gender roles."

Comparisons with Dobbs v. Jackson Women's Health Organization, the 2022 case in which the Supreme Court struck down the constitutional right to an abortion, have been made by legal experts.

Skrmetti asked the Supreme Court to expand its ruling overturning abortion rights in a brief filed in October, arguing the Dobbs decision allows states to ban forms of healthcare in certain circumstances.

Are there other court cases on gender-affirming care for minors?

The United States is home to more than 1.6 million trans people, around 300,000 of whom are aged between 13 and 17, a 2022 report from the Williams Institute, a think tank at the University of California-Los Angeles, showed.

The majority of the trans population live in Republican-led states. 

Since 2021, 25 states have passed laws banning gender-affirming care for minors, while Arizona and New Hampshire prohibit gender-affirming surgery.

Seventeen states are facing lawsuits challenging laws and policies, said Swaminathan.

A Montana law was blocked in May, and federal judges struck down legislation in Arkansas, the first state to issue such a law, in 2023.

President Donald Trump signed an executive order that the federal government will not "fund, sponsor, promote, assist or support" gender-affirming care for anyone under the age of 19, which is being challenged in the states of Washington and Maryland.

(Reporting by Lucy Middleton; Editing by Ayla Jean Yackley.)