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Supreme Court upholds Tennessee ban on transgender youth medical care

https://www.msn.com/en-us/health/other/supreme-court-upholds-tennessee-ban-on-transgender-youth-medical-care/ar-AA1GXSQu?ocid=hpmsn&cvid=ff028ac4ea1b4e80d48b0decf1e52d73&ei=93

Story by Lawrence Hurley (18 June 2025)

WASHINGTON — The Supreme Court on Wednesday upheld a Tennessee law restricting gender transition care for minors, delivering a major blow to transgender rights.

The 6-3 ruling is likely to have a broad impact as 24 other states have already enacted laws similar to the one in Tennessee, which bars gender transition surgery, puberty blockers and hormone therapy.

Those laws now look set to survive similar legal challenges. The ruling does not affect states that do not have such bans, meaning care in those states will still be available.

The court in an opinion authored by Chief Justice John Roberts concluded that the Tennessee law does not constitute a form of sex discrimination that would violate the Constitution's 14th Amendment.

Trans rights activists have also warned that a ruling allowing bans on care for trans minors could pave the way for similar restrictions aimed at adults.

The legal challenge was brought by the administration of former President Joe Biden as well as transgender teens and their families.

The ruling does not definitely resolve all legal issues relating to the state bans as it did not address a separate argument under the 14th Amendment that the laws violate the right of parents to make health care decisions for their children.

Fox News (https://www.foxnews.com/politics/sotomayor-warns-skrmetti-decision-cause-untold-harm-transgender-children-scathing-dissent) quoted Justice Sotomayor's dissent, which she atypically read from the bench:

Sotomayor said the 6-3 decision in United States v. Skrmetti, issued along ideological lines, improperly discriminated against minors based on their sex.

Sotomayor ... said the majority "refuses to call a spade a spade" and "obfuscates a sex classification" to allow the Tennessee bill to withstand constitutional tests.

"The Court's willingness to do so here does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight," Sotomayor said. "It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them."

Sotomayor, whose dissent was joined by Justices Ketanji Brown Jackson and Elena Kagan, said doctors would offer such medical treatments based on a patient having gender dysphoria. A law banning that practice requires a heightened level of scrutiny that the Supreme Court's majority recklessly did not apply, Sotomayor alleged.

"The majority subjects a law that plainly discriminates on the basis of sex to mere rational-basis review," Sotomayor wrote. "By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent."

Hi Everyone

Legal Strategies to Overturn Gender-Affirming Care Bans

Introduction
This report explains why the United States Supreme Court recently upheld Tennessee's ban on puberty blockers for gender dysphoria, why absolute immunity protects legislators from personal liability and how advocates can still defeat such laws.

Although Tennessee claims safety concerns the same medicine remains legal for precocious puberty which exposes a clear contradiction in the State's policy and the known side effects are identical for every child who takes it.

This analysis is limited to puberty blockers for minors and does not examine cross sex hormone therapy.  It stresses that puberty blockers act identically in all patients whether prescribed for precocious puberty or gender dysphoria so a ban aimed only at gender dysphoria lacks medical validity [6] [7] [9].

Why the Supreme Court accepted the ban despite stronger evidence
The Justices applied rational-basis review, the most deferential constitutional standard.  Tennessee claimed there was "reasonable public concern" about long-term safety and relied on three overseas guideline reviews that labelled existing studies "low certainty" [6] [7] [8].  The Court treated this limited material as enough to make the issue "debatable" and therefore constitutionally permissible [1].  It did not weigh higher-quality data from peer-reviewed longitudinal studies or the consistent endorsements issued by major United States medical societies [9] [10].  As a result the decision rests on evidence many clinicians regard as incomplete and on a legal test that allows legislative bias to override expert consensus.

Why absolute legislative immunity blocks direct suits against lawmakers
Under the Speech or Debate Clause and parallel state provisions legislators cannot be sued for damages stemming from their votes.  This immunity is structural not a judgment on the wisdom of those votes.  Because courts cannot address the substance of a claim when legislators are shielded by immunity, plaintiffs must focus on the officials who enforce the law rather than the politicians who enacted it [11].

From flawed reasoning to practical resistance
The Supreme Court's reliance on selectively low-quality data leaves patients exposed to legislation driven by political bias rather than medical facts.  To protect access to care, litigators, clinicians and community groups must shift their attention from legislators to enforcement authorities and employ the strongest legal tools available.

Primary legal paths to halt enforcement
The most effective courtroom strategies concentrate on those who apply the statute not those who wrote it.  Advocates should pursue the following avenues in tandem choosing the one that offers the fastest protective order for each family or clinic:

• File Ex parte Young actions seeking injunctions against state health officials licensing boards or prosecutors who would apply the ban [11]
• Challenge the statute under federal equal-protection due-process or Title IX grounds and request preliminary relief before any medical service is denied [1]
• Invoke state constitutional guarantees of privacy bodily autonomy or single-subject rules that have annulled similar laws in other jurisdictions
• Pursue federal administrative complaints under Section 1557 of the Affordable Care Act when state policies conflict with sex-based nondiscrimination rules

The only viable way to stop a harmful statute in court is to sue an executive official who enforces it.  Under Ex parte Young (1908)[11] plaintiffs may obtain an injunction against a health commissioner attorney general or board that threatens prosecutions or license revocations because enforcement is an executive act that is not immune.

A direct personal lawsuit against politicians for the health impact of their votes is barred by absolute legislative immunity so legal efforts must instead focus on enforcers electoral change and ethics mechanisms.

Current cases already using Ex parte Young
Each of the following actions invokes Ex parte Young to bypass sovereign immunity and secure injunctions against state officers who would enforce the bans rather than seeking damages from the legislators who passed them:

• Brandt v Rutledge (Arkansas) [2]
• Eknes-Tucker v Ivey (Alabama) [3]
• United States v Skrmetti (Tennessee) [1]
• Doe v Ladapo (Florida) [4]
• Poe v Drummond (Oklahoma) [5]

Expanded evidence context
Tennessee based its "public concern" argument on the Finnish 2020, Swedish 2022 and English Cass 2023 reviews.  Yet the State still allows the same puberty blockers for precocious puberty so any claimed safety risk must logically apply to all recipients which exposes an internal inconsistency in the ban.  The three reviews reclassified puberty blockers as experimental yet still permit their use on a case by case basis. [6][7][8].

Critics emphasise that the Cass team discarded more than ninety-eight percent of available studies and declared only two as high quality then used that artificially shrunken pool to claim uncertainty.  The selection method ignored standard grading tools accepted across paediatric oncology and epilepsy, omitted multiple positive cohort studies and elevated anecdotal reports that aligned with its predetermined sceptical stance.  This heavy filtering demonstrates an unmistakable bias aimed at creating doubt rather than accurately weighing the full body of evidence.

By contrast the American Academy of Pediatrics reaffirmed its supportive policy in August 2023 and is completing a comprehensive systematic review [9].  The Endocrine Society the Pediatric Endocrine Society the World Professional Association for Transgender Health and Australia's Royal Children's Hospital Melbourne all maintain that puberty blockers are medically necessary within rigorous protocols [10].

Other publicly documented programmes in additional jurisdictions further show that mainstream services continue to provide the same treatment under similar safeguards:

• Amsterdam University Medical Center in the Netherlands, home of the original Dutch cohort studies [12]
• Children's Hospital of Eastern Ontario in Canada which follows national paediatric endocrine guidance [13]
• Gender identity services within the Spanish National Health System that apply SEEN (Spanish Endocrinology Society) protocols [14]

Known side effects chiefly temporary reductions in bone-mineral accrual occur in every child who takes the drug whether for precocious puberty or gender dysphoria and the values typically rebound when treatment ends or gender-affirming hormones begin [6] [7] [10].  Placebo-controlled trials are unethical because withholding treatment forces irreversible puberty on minors who do not want to go through normal puberty.  Instead researchers should gather long-term evidence through prospective cohorts and registries.

Supplementary Evidence to Bolster Litigation
The following four strands strengthen court filings and make preliminary relief more likely.

• Document concrete harm: Collect sworn declarations from families who lost care and emergency-room data showing self-harm spikes after bans took effect. First-hand injury helps satisfy irreparable-harm tests.
• Show economic fallout: File statements from paediatric endocrinologists, hospital systems and insurers describing staff flight, clinic closures and increased uncompensated-care costs. Courts have cited physician shortages and budget strain when enjoining health-care restrictions.
• Trace legislative intent: Quote floor speeches and committee testimony where sponsors portrayed gender care as ideology while ignoring their own medical boards. Evidence of discriminatory motive undercuts any claim that the statute rests on neutral health concerns.
• Add overlapping federal protections: Besides Section 1557, plead claims under the Americans with Disabilities Act and the Rehabilitation Act. Gender dysphoria appears in DSM-5[15], so withholding standard treatment can constitute disability-based discrimination, giving plaintiffs another federal hook.

Legal routes that remain despite the current precedent
Advocates should file routine public-records requests to uncover lobbying communications that misstate medical science and coordinate with national medical associations so each brief contains an authoritative statement that the prevailing clinical standard contradicts every dysphoria-specific ban.

• Build extensive factual records showing improved mental-health outcomes stable bone density after treatment and the absence of long-term harm so that even rational-basis review cannot ignore the evidence
• Reframe equal-protection claims by demonstrating that the ban functions as a sex-based classification because it denies medication only when it produces characteristics aligned with a patient's identified gender
• Challenge bans under state constitutions that recognise stronger privacy or health-care rights than the federal baseline such as explicit autonomy clauses or heightened scrutiny for health legislation
• File Section 1557 complaints with the United States Department of Health and Human Services to block Medicaid or private insurers from imposing exclusionary coverage rules
• Combine litigation with electoral strategies medical-ethics complaints and economic pressure campaigns to deter copycat legislation in other states

Conclusion
Although lawmakers are shielded by absolute immunity the statutes they pass are not.  The Supreme Court's acceptance of selectively low-quality evidence highlights the need for thorough factual records, robust constitutional arguments and strategic use of Ex parte Young against enforcement officials.  By uniting medical data federal and state constitutional protections and focused injunctions advocates can still overturn bans that deny minors safe reversible and widely endorsed medical care.

Bibliography
[1] United States v Skrmetti, 605 U.S.  ___ (2025)
[2] Brandt v Rutledge, Case No.  4:21-cv-00450 (E.D.  Ark.  2023)
[3] Eknes-Tucker v Ivey, 22-11707 (11th Cir.  2023)
[4] Doe v Ladapo, No.  4:23-cv-00114 (N.D.  Fla.  2023)
[5] Poe v Drummond, No.  5:23-cv-00540 (W.D.  Okla.  2023)
[6] Council for Choices in Healthcare in Finland (COHERE) Recommendation, June 2020
[7] Swedish National Board of Health and Welfare Guideline Update, February 2022
[8] NHS England Interim Clinical Policy referencing the Cass Review, March 2024
[9] American Academy of Pediatrics, "AAP reaffirms gender-affirming care policy," August 4 2023
[10] World Professional Association for Transgender Health, Standards of Care Version 8, 2022
[11] Ex parte Young, 209 U.S.  123 (1908)
[12] Amsterdam University Medical Center, Centre of Expertise on Gender Dysphoria: Treatment Protocols, updated 2023
[13] Children's Hospital of Eastern Ontario, Division of Endocrinology and Metabolism, Gender Clinic Care Pathway, 2024
[14] Spanish Society of Endocrinology and Nutrition (SEEN), Clinical Guidelines for Gender Incongruence, 2023
[15] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edition 2013

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Disclaimer: I'm not a lawyer and the above report is only a suggested outline that provides general information for discussion; it should not be considered legal advice and readers should consult qualified legal counsel before taking any actions based on it. The ideas presented should be disseminated widely to those who are capable of pursuing the discrimination that is being perpetrated against us.

Best Wishes Always
Sarah B
Global Moderator