The Supreme Court on Wednesday handed to the states control over whether young people should have access to treatments for gender transition, preserving a patchwork of rules that has emerged across the country over the last five years.
Since 2021, states have split nearly evenly over whether to prohibit or protect access to puberty blockers and hormone therapies for transgender adolescents. Like the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which made access to abortion dependent on which state a person lives in, the decision this week is likely to deepen the state-by-state divide over medical care for young trans people.
Just as some states enacted more restrictive abortion limits after Dobbs, states that have enacted partial or total bans on transition treatment for minors may be emboldened to expand on them or enforce them more aggressively, said Brad Sears, a senior scholar at the Williams Institute, a U.C.L.A. program that studies L.G.B.T.Q. legal issues. And just as some states have enshrined reproductive rights in their constitutions, states that have enacted legal shields for health care workers who provide gender-transition treatments may push for more comprehensive protections.
“The reactions to the Dobbs decision are an appropriate place to go to see what might happen next,” Mr. Sears said. “If you overlay a map of the states with bans and the states with shield laws, you’re pretty much seeing two countries.”
In some ways, medical providers and families of trans adolescents have already adjusted to a fragmented legal landscape as states passed disparate laws in the absence of an overarching legal decision. In contrast to Dobbs, the decision to uphold a Tennessee law banning treatments for transgender youths did not overturn a constitutional right that had been recognized for decades. In all but two states that have enacted bans, courts have allowed the limits to go into effect even as legal challenges proceeded.
That has meant that some of an estimated 100,000 families with transgender children living in states with bans have moved to states that permit treatment. Other families have made arrangements to travel out of state for treatments. Many patients in Southern states where treatments are banned, for instance, travel to Virginia, while those in the Midwest often go to Minnesota.
Some patients have used telehealth providers, who are able to prescribe treatments without an in-person visit, so long as the patient is physically in a state where the treatments are legal and the provider is licensed to practice there.
“For us, the demand has been ramping up since 2021,” said Izzy Lowell, the founder of QueerMed, which treats transgender patients via telemedicine.
That year, Arkansas became the first state to pass a law prohibiting gender-transition treatments for minors, followed by Alabama in 2022. The Tennessee ban at issue in the Supreme Court case was part of a coordinated deluge that came next: Twenty-five Republican-held states have now enacted laws that restrict doctors from providing puberty blockers and hormone therapies to transgender minors. Two more, New Hampshire and Arizona, ban only surgeries. In the same period, at least 15 states dominated by Democrats have enacted laws or policies that protect health care workers from legal reprisal for providing puberty blockers or hormone therapies.
In the majority opinion in the Tennessee case, the justices declined to weigh in on the scientific debate around the treatments. The “wisdom, fairness or logic” of laws like Tennessee’s were best left “to the people, their elected representatives, and the democratic process.”
State officials’ reactions to the court’s decision reflected the split in state laws.
“Idaho was among the first states to pass a law protecting children from these dangerous procedures, and my office has been defending it in court ever since,’’ Raúl Labrador, the Republican attorney general of Idaho, said. “Today’s common-sense ruling by the Supreme Court protects children from these dangerous and irreversible procedures.”
In Illinois, Gov. JB Pritzker, a Democrat, said on social media that his state “has enshrined protections to meet this very moment.” He added, “In a time of increasing overreach and hateful rhetoric, it’s more important than ever to reaffirm our commitment to the rights and dignity of the LGBTQ+ community.”
Even with the court’s decision, many questions remain over the future of treatment for young trans people in this country.
The Trump administration has threatened to withhold federal funding to institutions that offer the treatment, leaving some families fearful that it may grow difficult to find medical care even in the states that permit it.
Other legal cases are still pending as well. Some of them focus on legal questions that are separate from the issues of the Tennessee case, which dealt with equal protection principles in the U.S. Constitution. Several challenges in federal court, for example, argue that the laws violate parents’ right to control their children’s medical care. Others in state courts challenge the legality of bans under the states’ constitutions.
Emily Bazelon and Azeen Ghorayshi contributed reporting
Amy Harmon covers how shifting conceptions of gender affect everyday life in the United States.
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