In December, the U.S. Supreme Court will hear oral argument in a case that could have vast implications for children around the country. In United States of America v. Skrmetti, the Court will consider whether a Tennessee law that protects children from dangerous, life-altering “gender transition” drugs and surgeries is constitutional.
Let’s walk through where this lawsuit came from and what’s at stake in this important case.
Regulating medicine, protecting kids
At its core, this case is about the ability of states to govern the practice of medicine—a responsibility that states have exercised since our nation’s founding.
More specifically, Skrmetti is about protecting children from the harms of life-altering transition procedures, including the risk of sterility and stunted brain development. Tennessee’s law ensures that no more children will suffer from health-care providers putting ideology over science and lies over truth.
Models for treating children experiencing gender dysphoria have been a topic of intense conversation in recent years, both in Tennessee and across the globe. The medical clinic at Vanderbilt, the Volunteer State’s largest private university, began performing body-altering surgeries on children—permanently removing healthy body parts—in 2018. One doctor even referred to some of these harmful procedures as “huge money makers.”
Activists often misleadingly refer to these unnecessary surgeries as part of a process called the “gender-affirming” model. Other steps in the process typically include social transition and giving the child puberty-blocking drugs and cross-sex hormones that stop their natural development.
If that sounds like a dangerous model, that’s because it is. These drugs and surgeries cause catastrophic harm and offer no meaningful benefits.
What does the science say?
Growing international evidence reveals that transition drugs and surgeries do not help children but instead inflict life-changing, often irreversible harm. Notably, European countries that once pushed for transition drugs and surgeries for children are now reversing course and proactively protecting children from these procedures as evidence of the devastating harms increases.
In Finland, for example, public health authorities have concluded that “[i]n light of available evidence, gender reassignment of minors is an experimental practice.” And in England, a thorough review by the country’s National Health Service (NHS) of all available studies concluded that all claimed benefit from injecting puberty blockers or cross-sex hormones into children and teens is “very low quality.” This led the NHS to stop prescribing puberty blockers and the U.K. government to impose an “emergency ban” on such prescriptions in England, Wales, and Scotland.
In short, European medical professionals—from individual practitioners to state health institutions—have rejected transition procedures and are instead advocating for children to have medical care rooted in biology. To have a chance to become comfortable with their own bodies without irreversibly harming them and making them lifelong patients.
And victims of this ideology are also sounding the alarm. More and more young people are saying that they wished someone had prevented their doctors from inflicting irreversible damage to their bodies and minds. Their tragic suffering—together with the growing international evidence—informed the decision of the Tennessee legislature to prohibit medical professionals from experimenting and inflicting this kind of harm on children. It’s why Tennessee joined the majority of states that ensure children suffering discomfort with their sex are given support and medical care rooted in biological reality.
What does Tennessee’s law say?
In light of the revelations regarding Vanderbilt’s gender clinic and the actions of European health authorities, a bipartisan group of Tennessee legislators came together to protect children in their state from dangerous and often irreversible transition drugs and surgeries.
The result was SB1, a law that protects children by prohibiting health-care providers from performing or administering these harmful procedures on children experiencing discomfort with their biological sex.
Contrary to what activists may say, SB1 does not classify people based on sex or “transgender status.” Rather, the law imposes use-based restrictions on certain prescriptions and operations. In other words, what is the medical purpose of the drug or surgery?
Distinctions like this are essential to sound medical practice. Consider morphine: using the narcotic to address a patient’s pain is not the same as using it to assist a patient’s suicide, or to satisfy a patient’s addiction. The same drug can be used to accomplish entirely different purposes.
The same is true of SB1: governing the use of drugs and operations is an essential part of the state’s duty to protect its citizens—especially its most vulnerable.
How did this case end up at the Supreme Court?
In 2023, the ACLU sued the state of Tennessee, and the Biden administration intervened, claiming that Tennessee’s law violates the U.S. Constitution. The district court initially blocked the law from taking effect, but the U.S. Court of Appeals for the Sixth Circuit reversed, allowing the law to go into effect and finding that Tennessee was likely to succeed in its arguments that the law was constitutional. The Supreme Court agreed to review the Sixth Circuit’s decision after the U.S. Department of Justice and the ACLU appealed the case.
Tennessee Attorney General Jonathan Skrmetti—the state’s chief law enforcement official—is the named defendant in the case. His office will be defending Tennessee’s law before the Supreme Court.
The Court’s decision in this case will affect not only Tennessee but the entire country. Currently, 25 other states have similar laws protecting children. Since 2021, when the first of these commonsense laws was enacted, ADF and our allies have been instrumental to their enactment, and to their defense in the states where they have been challenged. For example, ADF is co-counsel with the Office of the Alabama Attorney General in Boe v. Marshall and with Office of the Idaho Attorney General in Labrador v. Poe helping to defend these states’ laws protecting children.
Every child deserves to be kept safe from harmful drugs and surgeries, and ADF is committed to exposing the devastating harms of gender ideology and ensuring that the medical profession provides health care based on science and truth.
What’s next?
On Dec. 4, 2024, the Supreme Court will hear oral argument in United States of America v. Skrmetti. The Biden administration is asking the Court to rely on guidelines that are not based on reliable science.
But no one has the right to harm a child. We have a responsibility to ensure that no child suffers at the hands of government officials or scandal-laden organizations that care only about advancing their agendas instead of science-based medicine. Children should never be used as pawns to advance dangerous agendas like gender ideology.
The state of Tennessee, like every other state in the union, has an interest in regulating the medical profession. But more than that, the state has a responsibility to look after the health and safety of its most vulnerable citizens.
As the Supreme Court prepares to consider this critical case, please pray for the children and families harmed by this devastating ideology and for the Tennessee Attorney General’s Office defending this important law.
