Psychologists are igniting debate ahead of the Supreme Court hearing Wednesday on a legal challenge to a state ban on medical treatment for transgender youths.
Tennessee’s law, known as S.B. 1, prohibits the use of puberty blockers and sex reassignment surgeries for minors. It was enacted in 2023.
Some mental health experts say providers need access to these treatments for clients who are suffering from gender dysphoria. Another expert says he has seen the harm to patients who later decide to detransition.
Erica E. Anderson and Laura Edwards-Leeper, clinical psychologists who treat gender dysphoria, filed a brief supporting those challenging the Tennessee law. They said an outright ban on treatments for youths suffering from gender distress is harmful and the categorical approach runs afoul of the standards of medical care, which requires each patient to have an individualized clinical assessment.
“While medical interventions are not appropriate for all patients, they are extremely beneficial for some patients. Thorough and proper individualized assessments play an essential role — ensuring that only young people who will most likely benefit from medical interventions will be treated with them,” the brief says.
Ms. Anderson and Ms. Edwards-Leeper say Tennessee’s law “requires health professionals to disregard these established standards by barring them from providing critical treatments even when properly determined to be clinically indicated.”
“Such a state-imposed prohibition on medical care is untenable. For patients denied access to critical care, serious adverse health consequences may result,” they said, referencing long-term distress and mental health concerns.
Joseph Burgo, a clinical psychologist and psychoanalyst, said he has counseled clients who have decided to detransition after receiving medical treatment for gender dysphoria.
Many of his clients are men who detransitioned from living as a woman after realizing they were gay.
“Dr. Burgo’s clinical experience demonstrates that gender affirming medical care fails to address internalized homophobia in teenage boys, and he respectfully aims to assist the Court by explaining this phenomenon,” says his filing in support of the state law. “Internalized homophobia and feelings of gender incongruity are mental health issues, and SB1 properly protects children from irreversible and harmful medical interventions before they come of age.”
Mr. Burgo’s argument is based on his experience and research, which suggests that gay boys are bullied and feel immense shame. They look to escape that shame in one way or another, and some accept the narrative that they were born in the wrong body, according to his filing.
The justices will decide whether Tennessee’s law violates the 14th Amendment’s equal protection clause, which requires governments to treat everyone equally.
It is the first major transgender rights case that the justices have agreed to hear since 2020, when they decided a civil rights case in favor of LGBTQ challengers, granting them protection from workplace discrimination.
The American Civil Liberties Union and the Justice Department brought the dispute over Tennessee’s law.
Courts have rejected similar bans on medical treatment for transgender minors in Alabama, Arkansas, Florida, Georgia, Idaho, Indiana and Kentucky, the ACLU said.
The 6th U.S. Circuit Court of Appeals let Tennessee’s ban take effect.
Three transgender minors, their parents and a doctor who treats transgender youths challenged the state law.
Represented by the ACLU, they argue that puberty-delaying medicine and hormone treatment have allowed the children to become happy and healthy.
“Every major medical association in the United States supports the use of the Guidelines for treating gender dysphoria in adolescents and recognizes that puberty-delaying medication and hormone therapy are safe and effective treatments for adolescents,” their filing says. “Indeed, those medical treatments are the only evidence-based treatment shown to be effective at alleviating gender dysphoria in adolescents.”
The Justice Department agrees. It said in its filing that the law is discriminatory because it allows specific treatments for some patients but would ban them for others based on their sex.
“A teenager whose sex assigned at birth is male can be prescribed testosterone to conform to a male gender identity, but a teenager assigned female at birth cannot,” U.S. Solicitor General Elizabeth Prelogar wrote in the government’s filing.
Tennessee Attorney General Jonathan Skrmetti said the state has an interest in protecting the health and welfare of its residents, including minors. He said the state legislature heard from people who have detransitioned and conducted research before passing the ban.
He said the state law does not violate the equal protection clause because it does not classify boys and girls differently.
“SB1 includes no sex classification. It draws a line between minors seeking drugs for gender transition and minors seeking drugs for other medical purposes. And boys and girls fall on both sides of that line,” Mr. Skrmetti said in his filing.
One percent of Americans are transgender, according to the Justice Department filing, and 22 other states have moved to enact laws similar to Tennessee’s.
The debate on transgender care is worldwide. European nations have adopted a more conservative approach but not outright bans.
The case likely will become one of the blockbusters of the court’s term, which began in October and runs through June.
The dispute drew the attention of Elliot Page, a transgender actor who used to go by the name Ellen Page. Mr. Page has won several Academy Award nominations and a Golden Globe Award.
In his brief filed in support of the groups challenging the state law, he was joined by 63 other transgender people, including scientists, lawyers, artists and actors. They say in the court filing that medical treatment for gender dysphoria has improved their lives.
“Without such care, their suffering would have continued,” their filing says.
A decision is expected by the end of June.
The case is United States v. Skrmetti.
• Stephen Dinan contributed to this report.
• Alex Swoyer can be reached at aswoyer@washingtontimes.com.
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