This Term's Big Supreme Court Case and Next Term's Both Involve "Gender Care"

The Supreme Court correctly decided United States v. Skrmetti last week, and I filed a brief in Chiles v. Salazar, which will be argued in the fall.

United States v. Skrmetti

The past few years have seen an increase in invasive “gender care” for minors, including surgery and hormone therapy. Tennessee enacted a law in 2023, Senate Bill 1, banning these treatments on children. About half the states in the nation have similar laws.

Three minors, their parents, and a doctor sued to block the law on constitutional due process and equal-protection grounds. The Biden administration intervened to support them, claiming that denying medical interventions—such as “puberty blockers” and cross-sex hormones—to minors with gender dysphoria constitutes sex and transgender-status discrimination. The federal district court granted a preliminary injunction, holding that “transgender individuals constitute a quasi-suspect class, that SB1 discriminates on the basis of sex and transgender status, and that SB1 was unlikely to survive intermediate scrutiny.” The Sixth Circuit reversed, holding that the equal-protection claim was unlikely to succeed because SB1 doesn’t classify on the basis of sex, “trans-gender individuals” are not a suspect class, and SB1 would survive rational basis scrutiny.

After the Supreme Court took the case, I filed an amicus brief for the Manhattan Institute, building on the work of Dr. Leor Sapir, to relate that well-established scientific evidence and a growing international consensus among medical professionals and authorities advise against the use of “gender-affirming” medications as first-line treatments for pediatric gender dysphoria. The most comprehensive assessment of the risks and benefits of pediatric gender medicine to date, conducted in the U.K. by Dr. Hilary Cass and finalized in April 2024, found “remarkably weak” evidence for the safety and efficacy of such medications. The Cass Review calls for a cautious, individualized approach to gender dysphoria that prioritizes psychotherapy.

Medical organizations in the United States, however, largely diverged from this cautious international approach, favoring aggressive “gender affirming” treatments. Given the profound uncertainties and the untrustworthiness of clinicians who practice and claim special expertise in youth gender medicine, we concluded that states like Tennessee are justified in taking steps to protect minors from potentially harmful medical interventions that are not supported by rigorous, reliable evidence.