Commentary
The Supreme Court Weighs the Future of Child Sex Change Interventions
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On Wednesday, the Supreme Court will hear oral arguments in a case that could dramatically alter the legal landscape surrounding so-called “gender-affirming care” for children.
The case, United States v. Skrmetti, concerns a Tennessee law that prohibits children from accessing sex change interventions including surgeries, puberty blockers and cross-sex hormones. The Department of Justice (DOJ) intervened in the ACLU’s case against Tennessee over the law in 2023, arguing it violated protections guaranteed by the Constitution.
Currently, 26 states including Tennessee have passed laws restricting child sex change interventions. The Supreme Court’s decision in this case could therefore have wide-reaching consequences for the protection of children across the country.
Do No Harm is hosting a rally Wednesday morning on the steps of the Supreme Court to expose these harmful practices and urge the court to uphold the Tennessee law.
The Case
Tennessee’s law reflects the fact that child sex change interventions are dangerous, carry unknown long-term risks, and are supported by weak, dubious, and error-filled evidence. As such, the law prohibits minors, who cannot provide informed consent to life-altering procedures, from accessing these interventions.
Specifically, the law bans procedures enabling “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to address “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.”
However, the federal government, along with advocacy groups such as the ACLU and others, argue that the law discriminates against “transgender” children on the basis of gender identity.
The DOJ under President Joe Biden intervened in the case 2023, arguing the law denied minors “medically necessary” care and that it violated the Fourteenth Amendment’s Equal Protection Clause. Specifically, the DOJ argued that the law “permits all other minors to access the same procedures and treatments” for conditions unrelated to gender dysphoria, but prevents “transgender” children from accessing medical interventions to alter their appearance in accordance with their gender self-identification.
The U.S. Court of Appeals for the Sixth Circuit upheld Tennessee’s law, and the federal government appealed to the Supreme Court, which took up the case earlier this year.
Fundamentally, this case is about whether states can protect children from dangerous procedures and treatments that are completely out of step with the principles of evidence-based medicine.
And the scientific basis for these procedures is wanting, to say the least.
The Science
Child sex change interventions are not consistent with evidence-based medicine, and Tennessee’s law reflects this.
In October, Do No Harm filed an amicus brief laying out the lack of evidence supporting child sex change interventions, as well as the scientific errors in the DOJ’s argument against Tennessee’s law.
Another amicus brief filed by over 50 physicians explains how, given the marked lack of medical evidence for these procedures, Tennessee’s law is a perfectly reasonable prohibition. Do No Harm funded the preparation of that brief.
Several entities have conducted systematic reviews of the use of cross-sex hormones and puberty blockers to treat gender dysphoria, and all have concluded that the evidence underlying medical interventions for gender dysphoria in minors is weak.
For instance, health authorities in Finland, Sweden, and the United Kingdom have all restricted minors’ access to child sex change procedures in recent years as a result of these findings.
Moreover, the studies that purport to provide evidence for the efficacy of so-called “gender-affirming care” are riddled with flaws. Do No Harm recently published a report exposing many of the most often-cited studies for their methodological issues.
Unfortunately, the federal government and other advocates rely on studies that systematic reviews have concluded are flawed, subject to bias, or otherwise weak.
The Consequences
Should the Supreme Court find that Tennessee’s law violates the constitution, the consequences could be devastating to children across the country. Similar protections in dozens of states could be revoked, and children would once again be at the mercy of a medical establishment all too eager to subject minors to dangerous medical interventions.
Likewise, if the Supreme Court upholds Tennessee’s ban, states will likely be free to continue protecting children from harmful and unsupported medical procedures.
