Last year, Tennessee banned doctors from medically slowing a teenager’s puberty or giving them hormones or surgery to change their gender.
Families of transgender teens in the state have filed lawsuits to protect their right to make their own medical decisions, and now the case is before the United States Supreme Court. The proceedings ended on Wednesday and the court is expected to render its decision by the summer.
The Tennessee law claims to have a “compelling interest in encouraging minors to appreciate their gender” and prohibiting procedures “that might encourage minors to disregard their gender.”
Tennessee is one of two dozen states that ban what is commonly called gender-affirming care. The court’s decision could therefore have broad implications.
Gender-affirming care is a range of social, psychological, behavioral and medical interventions designed to help a person affirm their gender identity, according to the World Health Organization.
The American Medical Association, which represents more than 250,000 American doctors, adopted a resolution last year, calling for protection of this type of care. More than 30 major medical associations and health organizations around the world support health care for transgender adults and youth, which they believe can help prevent suicide among this vulnerable population.
Here’s what the science says.
Puberty blockers and hormone therapy
Most patients with gender dysphoria, which is distress due to a mismatch between biological sex and gender identity, have already gone through puberty when they first seek treatment, Dr. Joshua said. Safer, an endocrinologist and executive director of the Mount Sinai Center for Transgender Medicine. and surgery in New York. Only a handful of them are in the early stages of puberty.
In these cases, Safer said, puberty blockers can be used to delay the onset of puberty or stop it in its tracks. These medications, called GnRH agonists, stop the body from producing sex hormones, such as testosterone and estrogen.
In people assigned male at birth, this treatment slows the growth of facial and body hair, prevents the deepening of the voice, and limits the growth of the sexual organs. according to the Mayo Clinic. In people assigned female at birth, it limits breast development and stops menstruation.
Puberty blockers are meant to be taken temporarily because the body needs sex hormones, Safer said. For example, they play a major role in the growth and development of bones.
“A year or two for sure and that’s it,” he said. “You can’t show up and take puberty blockers for 10 years.”
Experts say delaying puberty gives transgender patients more time to explore and integrate their identity before shedding puberty blockers. When they do, they can proceed to gender-affirming hormone treatment or resume puberty of the sex they were assigned at birth.
The two-year benchmark is based on safety data in children experiencing precocious puberty, when a child’s sexual development occurs too early, for which the drug was initially approved. One of the arguments before the court is whether it would be legal to block the drug’s use for one purpose – early puberty – while denying its use for another.
Critics of puberty blockers argue that there is not enough research showing that temporary use of these drugs during childhood does not have lasting health effects. They also say there is little data showing that puberty blockers lead to beneficial mental health outcomes among transgender youth.
The Cass Review: transgender care in England
Opponents of gender-affirming care for people under 18 often cite The Cass Review, named after British pediatrician Dr. Hilary Cass, who chaired the review.
National Health Services England commissioned the survey report in 2020 to assess gender-affirming services in the UK, citing long waiting lists at gender identity clinics due to a sharp increase of the number of young adults seeking care.
The final report, released in April 2024, concluded that there was a lack of evidence supporting medical interventions such as puberty blockers and hormone therapy to manage gender-related distress in adolescents.
Live updates from the Supreme Court:Final arguments in transgender care case
Cass recommended that these interventions be used for research purposes only, prompting NHS England to stop prescribing puberty blockers to transgender adolescents outside of a clinical trial and to open new gender centers that embrace a more “holistic” approach. according to a press release published in August.
Many experts – from the United States and around the world – are concerned about the report and the government’s response.
Dr. Carl Streed, Jr., president of the US chapter of the World Professional Association for Transgender Health, disagrees with the methodology and conclusions of the Cass report. He failed to include numerous studies showing the benefits of puberty blockers and hormone therapy, he said.
More research on transgender youth is always welcome, but cutting off care in an effort to get more data can have harmful consequences, he said.
“When we prohibit care or slow it down, we affect an entire age cohort and put them at risk for worse mental health,” said Streed, who is also the head of research at Boston Medical Center’s GenderCare Center.
Is Tennessee’s ban ‘best for children’?
While the science continues to be debated, opponents of Tennessee’s ban say the law has nothing to do with science.
Passed in 2023, Tennessee law prohibits doctors from administering puberty blockers or hormonal treatment to a minor seeking treatment for gender dysphoria.
The state says it has a “compelling interest in encouraging minors to appreciate their gender” and prohibiting procedures “that might encourage minors to disregard their gender.”
“The blanket ban on providing evidence-based gender-affirming care reveals that it’s all about policy, not evidence,” Streed said.
Transgender Lawyer Makes History:Takes Puberty Blockers and Hormone Therapy Case to Supreme Court
Steve Sanders, an expert on sexuality, gender identity and law at Indiana University, said the science behind puberty blockers and hormone therapy for transgender youth is “spotty and observational.” But the bans in Tennessee and other states are likely not the product of a “serious, thoughtful, serious, deep debate about what’s best for children.”
“These bans were developed as part of an intentional strategy by social and religious conservatives to demonize and scapegoat transgender people,” he said during a panel discussion hosted by the Federalist Society , a group of conservative lawyers.
Dr. Roy Eappen, an endocrinologist with the conservative organization Do No Harm, supports the bans in effect in Tennessee and other states. Although they don’t address the crux of the problem, which he says is a lack of scientific evidence, the bans succeed in stopping care that he says could harm minors.
“When doctors don’t do their job, it’s up to the state to intervene,” he said.
Health risks of banning gender-affirming care
There is no routine protocol for gender-affirming care, Safer said. Each treatment plan is individualized according to the needs of the patient.
But in general, doctors are cautious when treating transgender youth.
“The approach to young people is conservative,” Safer said. “We try to be thoughtful and conservative when we support parents and children. »
Despite conservative treatment, doctors who work in transgender care argue that children and adolescents who identify as transgender should have these treatments as options.
As with other medications, experts say there are risks with taking puberty blockers and hormones. For example, tthe American Academy of Pediatrics says a child taking puberty blockers might experience stress or lose self-esteem as their peers reach puberty.
However, every major medical organization in the United States says studies show that gender-affirming care for transgender youth leads to better mental health outcomes, including a lower risk of depression and suicidal tendencies in the short term.
“As a scientist, I will never turn down additional funding for research. Asking more people to collect data more carefully is not controversial,” Safer said. “But the data (in favor of gender-affirming care) is quite strong. Withholding care is associated with harm, just as withholding any medical care.”
Contributor: Maureen Groppe.
Adrianna Rodriguez can be reached at adrodriguez@usatoday.com.