#skrmetti

Reminder that every major medical organization in the U.S. is in agreement on what age-appropriate, medically necessary care looks like for trans youth, including the American Academy of Pediatrics, the American Association of Child and Adolescent Psychiatry, the National Association of Social Workers, and more.

Dear friend,

Throughout all of human history, three things have always been true:

There are trans people.

There are boring assholes who try to make there not be trans people anymore.

In 2023 Tennessee wanted to join a growing number of states that restricted ‘sex transition treatments’ for children, by passing a law that would ban puberty blockers and hormones for any child if the purpose was to treat any kind of ‘gender incongruence’. This was challenged by 3 trans identifying children and a doctor, and ended up in the Supreme Court to decide whether or not Tennessee was violating the Equal Protection Clause of the 14th Amendment to the Constitution. This holds that no State shall ‘deny to any person within its jurisdiction the equal protection of its laws’. 

The SC was clear it did not sit in judgment on the ‘wisdom or fairness’ of Tennessee’s law but was concerned only to check it did not violate equal protection guarantees. By a 6-3 majority, there was no violation found. This law did not require heightened scrutiny, as it would if it attempted to treat race and sex differently. There was no sex discrimination because the ban applied to both sexes. Further, it satisfied ‘rational basis review’, with very rational objectives of protecting children’s health and welfare. 

Thus the ‘fierce scientific and policy debate’ about the medical and surgical transition of children, was appropriately left to the people of Tennessee to decide. 

The SC summarised at page 4 

Tennessee determined that administering puberty blockers or hormones to minors… carries risks, including irreversible sterility, increased risk of disease and illness, and adverse psychological consequences. The legislature found that minors lack the maturity to fully understand these consequences, that many individuals have expressed regret for under going such treatments as minors, and that the full effects of such treatments may not yet be known. 

It’s fantastic to see such a short and sober precis of what so many of us have been saying for years, and which sadly the English courts still seem reluctant to say, despite the work of Dr Cass in 2024. The Cass Review and its consequences in the UK gets specific mention at page 23, the SC noting its findings about ‘remarkably weak’ evidence in favour of medical transition. The SC cited Cass not as guidance on US law, but to ‘demonstrate the open questions regarding basic factual issues…’

Chief Justice Roberts delivered the opinion of the court and Justice Thomas concurred. His judgment provides some of the most excoriating criticisms of the appeal to experts made by the plaintiffs. The courts do not substitute their beliefs for the judgment of of legislative bodies. The claim that there is ‘overwhelming evidence’ to support medical transition is simply ‘untenable’. He notes there are particularly good reasons to question the expert class here 

… as recent revelations suggest that leading voices in this area have relied on questionable evidence, and have allowed ideology to influence their medical guidance.

At page 8 he takes aim at the ‘sanitized description’ of ‘gender affirming care’ and sets out at length the realities of these treatments alongside the lack of evidence to support that they do more good than harm. One particularly harsh reality is the impact on future fertility. He also takes time to discuss the Cass Review. 

At page 15 he makes the blindingly obvious point, which has apparently eluded many for a decade or more - regardless if this treatment is effective, States may legitimately question if they are ethical. States can reasonably conclude that the cognitive and emotional development of children inhibits their ability to consent to any of this. Further, that parents may have difficulty providing consent when they are ‘routinely warned’ that failing to affirm their child is to put the child on an inevitable path to suicide. 

It is very good to see explicit recognition of the narratives of those who ‘detransitioned’, as further evidence of how fragile this notion of ‘informed consent’ really is. Justice Thomas noted that even the WPATH experts were well aware of this; they commented how they were attempting to explain cross sex hormones to children too young to have even studied biology in high school; talking about fertility preservation to a 14 year old was like talking ‘to a blank wall’. 

On June 18, 2025, the Supreme Court ruled 6–3 in U.S. v. Skrmetti to uphold state bans on gender-affirming care for minors. Chief Justice John Roberts wrote the opinion. He claimed, “Our role is not to judge the wisdom, fairness, or logic of the law before us.” That is false. The Court’s job is to weigh fairness and protect constitutional rights. This ruling fails that duty. It will do real harm…

downsides of having a lawyer father: instead of asking me how i’m doing or if I’m okay after the SCOTUS’ most recent decision on trans healthcare*, he brings it up as if it’s a discussion between two lawyers and only offers “well it’s not like it effects you” as comfort (even tho it does)

*United States v. Skrmetti: a 6-3 decision today (6/18/25) upheld a tennessee ban on transgender healthcare for minors as it does not violate the equal protection clause of the 14th amendment. I’ll probably post a more in depth explanation of the case and what it means for trans people going forward but i need to be depressed about this first 🤪