A state’s right to protect children

On Wednesday, the U.S. Supreme Court will hear oral arguments in United States v. Skrmetti, a case asking whether states can protect children from risky and life-altering gender transition drugs and surgeries. In the landmark case, the Biden-Harris administration is arguing that the Constitution requires medical experimentation on children. The Supreme Court should reject that argument—the states have long exercised their authority to regulate the practice of medicine and protect children from harmful drugs and procedures.

About half of the states have enacted laws—like the Tennessee laws at issue in Skrmetti—that protect minors from harmful drugs and surgeries. They are seeking to protect children from a very real threat. The Biden-Harris administration has pushed gender transition treatments regardless of age. And the number of youth identifying as transgender has exploded in the last decade. Even as the number of transgender-identifying adults has remained constant, the number of young people who want to change their sex has doubled in just the last few years. Gender dysphoria—being clinically uncomfortable in the body you were born with—is now overwhelmingly seen in adolescent girls. In the United Kingdom, the number of girls who want to be boys has increased by more than 4,000% in the last decade. Horrifyingly, these cases appear in “clusters of peers” and are associated with increased social media use.

Indeed, the state of Tennessee intervened to protect the health of its children after media outlets reported that Vanderbilt University was providing gender-transition procedures to minors—with one doctor referring to the procedures as “huge money makers.” Vanderbilt doctors admitted they possessed “very, very little data to guide [the] treatment” and were “still figuring it out.” Indeed, Vanderbilt’s lead clinician presented a seminar titled “Caring for the Transgender Patient: With Little Evidence, but a Lot of Love.” She conceded that the long-term effects of cross-sex hormones on youth were unknown.

States like Tennessee argue that children cannot consent to life-altering procedures involved in gender transitions. In fact, studies show that if transition drugs and procedures are not administered to children, gender dysphoria desists or goes away on its own for 85% of children with gender dysphoria. And transition drugs and surgeries are risky. Puberty blockers—the first drugs used in a transition—prevent the sex glands from producing estrogen or testosterone. This results in decreased bone density and undeveloped sex organs and can threaten normal brain maturation. Almost all minors who are placed on puberty blockers continue with cross-sex hormones, which can cause lifelong infertility. Cross-sex hormones also increase the risk of heart attacks, hypertension, and various forms of cancer in girls. Boys who take them have an increased risk of blood clots, tumors, and coronary artery disease. And, of course, gender transition surgeries permanently remove healthy organs.

The Biden-Harris administration insists that gender transition drugs and procedures are beneficial for minors. That’s not what the science says. Many countries that pioneered such procedures in the early 2000s have since reversed course, effectively banning them except in controlled research settings. They have concluded that “the efficacy and safety, benefits and risks of treatments are not proven” and “the risks” of puberty blockers and cross-sex hormones “are likely to outweigh the expected benefits.” They’ve called gender reassignment for minors “an experimental practice” and the evidence in support of gender interventions “remarkably weak evidence.” Proponents of these drugs and surgeries often suggest that hormone treatments reduce suicidality. But a comprehensive independent review from the U.K. emphasized that “the evidence found did not support this conclusion.”

Further, the World Professional Association for Transgender Health (WPATH), the advocacy organization that the Biden-Harris administration insists represents the gold standard in care, has been roundly (and justly) criticized for its anti-science approach. WPATH, for example, initially commissioned a Johns Hopkins–led study to provide evidence for its treatment guidelines. When the study “found little to no evidence” that children and adolescents benefit from gender-transition interventions, WPATH declined to publish it. The Biden-Harris administration also interfered with WPATH’s drafting of the supposedly science-based treatment guidelines. After reviewing the near-final guidelines—which included age minimums for life-altering surgeries—U.S. Assistant Secretary for Health Adm. Rachel Levine’s team asked WPATH to remove the recommended age minimums because of their effect on litigation. WPATH caved, removing all age minimums.

Despite the fact that science suggests that the best approach to gender dysphoria is counseling and a wait-and-see approach, the Biden-Harris administration insists that the equal protection clause in the Constitution requires that experimental and life-altering drugs and procedures be available for children. The solicitor general argues that because Tennessee permits the drugs to treat things like precocious puberty, it must also permit them to be used for gender transitions. That’s wrong. Tennessee’s law imposes use-based restrictions on certain drugs and operations. Such distinctions are essential to ethical medical practice. Take morphine for example. Using the drug to treat pain is not the same as using it for suicide. So, too, for so-called “top surgeries.” It is one thing to perform a mastectomy to remove cancer and quite another to remove healthy breasts to make a girl look more like a boy.

Too many of America’s children are in crisis. But the answer is not to pump them full of life-altering drugs and perform risky permanent surgeries. The answer ultimately relies upon the fact that they are beautifully and wonderfully made in the very image of God and are loved beyond measure just as they are. States like Tennessee are right to protect children from the devastating gender ideology of the day.