Courts Are Rejecting Politicized Attacks on Care for Trans Kids

Courts Are Rejecting Politicized Attacks on Care for Trans Kids

By Dan Vergano

Ads attacking transgender people may have driven votes in the 2024 election, but bans on health care for trans teens are increasingly falling short, both in the courts and in medical reviews. Voices of reason can fight back, it turns out, against a manufactured moral panic.

Around 1.3 percent of middle school students in the U.S., children on the cusp of adolescence, identify as transgender. Acceptance and awareness of transgender individuals has grown, akin to a “Gender Revolution” as National Geographic called it in 2017. The acceptance, in part, triggered politicized attacks, some frankly weird, centered on banning trans people from sports and ending gender-affirming care for them.

Those attacks on trans kids might be effective politics, but they are lousy medicine. Courts and medical reviews are increasingly coming down on the side of gender-affirming care.

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Put simply, gender-affirming care supports people’s own views of themselves. If they want changes in pronouns, names, hairstyles, or clothing, puberty blocking treatment as adolescents, or hormone replacement therapy—that’s okay. What matters is they receive comprehensive medical and psychological care along the way, whatever they and their parents decide. In the U.S. this approach is endorsed by the World Professional Association for Transgender Health and the Endocrine Society as well as a host of other medical organizations. “Critics of our gender-affirming care policy mischaracterize it as pushing medical or surgical treatments on youth; in fact, the policy calls for the opposite,” wrote the then-president of the American Academy of Pediatrics, Moira Szilagyi, in 2022.

Nevertheless, since 2021, 27 states have erected laws or policies limiting minors’ access to this care. These bans are “exacerbating the already high rates of depression, anxiety, and suicide attempts among this vulnerable population,” according to the American Psychological Association. Tennessee’s ban is now under review by the U.S. Supreme Court in U.S. v. Skrmetti, with nationwide implications.

In the meantime an Ohio appeals court in March blocked that state’s ban on gender-affirming care for minors, saying it violated the state’s constitution. That court also weighed in on medical standards in its decision: “The medical evidence and clinical experience presented in this case demonstrate that, when provided in appropriate circumstances, gender-affirming care can meaningfully improve the health and well-being of transgender adolescents,” found the judges, noting lower rates of depression and other mental health issues. State medical experts testifying in favor of the ban had cited the usual criticisms of “sufficiency and quality of the research” and European restrictions (but not bans) of gender-affirming care for minors. But the judges didn’t buy that, finding “the state did not present, and the trial court did not find, any contrary evidence-based standards [emphasis theirs] accepted by any nationally or internationally recognized professional medical groups,” in the decision.

Fans of trans-care bans regularly employ arguments about insufficient evidence and European restrictions, spreading disinformation. In 2023, for example, Arkansas attorney general Tim Griffin responded to a federal judge blocking his state’s ban, saying, “There is no scientific evidence that any child will benefit from these procedures,” on X. This echoed his state’s ban, which decried “the lack of any long-term longitudinal studies” on puberty-blocking drugs. In other words, we should wait a few decades, while kids suffer, to see if lifesaving care sufficiently satisfies lawmakers like the ones who believe trans kids are “demons” and “mutants.” This moving-the-goalposts demand for extra evidence for gender-affirming care—embedded in Arkansas’ original 2021 ban—has subsequently been copy-pasted into other state laws pushed by partisan religious activists. “These bans were produced as part of an intentional strategy by social and religious conservatives to demonize and scapegoat transgender people,” said Indiana University constitutional law expert Steve Sanders, speaking last year at a Federalist Society event reported by USA Today.

Of course in reality plenty of evidence demonstrates gender-affirming care’s benefits, as an Association of the Scientific Medical Societies in Germany review concluded in March. The German review also found “no proven effect treatment alternative,” according to news reports. That joins a French medical review released in December, which also backed gender-affirming care. So much for European resistance.

The now-apparent outlier in all this is the U.K.’s National Health Service (NHS) Cass Review of gender-affirming care released in April of 2024, which claimed, surprise, “remarkably weak evidence” for the benefits of gender-affirming medicine. It led to a ban there on puberty blockers—medications that delay puberty—calling for them only within a clinical trial. (This suggestion remains unimplemented; you simply cannot conduct an ethical blinded test of puberty blockers.)

Reviews of the Cass Review have found math errors, outsized demands for evidence, and unethical recommendations among its flaws. U.S. and Australian specialists found that “the (Cass) Review obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method.” It also inexplicably excluded clinicians who work with trans kids. “The fact that so many have taken such an error-filled document at face value, using it to drive policy for vulnerable children, is very unfortunate,” University of Wollongong epidemiologist Gideon Meyerowitz-Katz concluded last August, in an eight-part review.

Back in the courtroom, the Cass Review has also failed to persuade a federal judge, who cited its “unfounded medical opinion[s],” in March. He instead blocked a Trump administration executive order banning funding for hospitals that provided gender-affirming treatment to people under 19, calling it “essential care.”

One notable U.S. judge impressed by the Cass Review, or its brand of arguments, is Supreme Court justice Samuel Alito, a partisan in judicial robes. He relied on it in December arguments to argue for Tennessee’s ban, despite the review not being evidence in the case. Alito’s endorsement only underlines the political roots of the case against gender-affirming care.

Even some Republicans can’t stomach this assault on people’s lives. “These are gut-wrenching decisions that should be made by parents and should be advised by teams of doctors,” said Governor Mike DeWine of Ohio. He vetoed that state’s ban in 2023, only to be overridden by his legislature. We’ll see if that argument carries the day, as it should, over the politicians who so far have proven willing to trample on kids.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.