Puberty, Privacy, and Policy

On December 11, the Montana Supreme Court temporarily blocked SB99, a law that sought to ban gender-affirming care for transgender youth, citing state constitutional privacy protections. At the same time, the United Kingdom announced it was indefinitely extending a ban on new prescriptions of puberty blockers—except in clinical trials—due to insufficient safety data, aligning with broader European policy shifts toward more restrictive approaches for minors with gender dysphoria. These divergent decisions underscore the complex global landscape of transgender healthcare as the U.S. Supreme Court prepares to rule on U.S. v. Skrmetti, a lawsuit challenging Tennessee’s ban on gender-affirming care for transgender children.

Tennessee’s SB1 bans puberty blockers, hormone therapies, and surgeries for transgender minors, while permitting the same treatments for children who identify with their assigned sex at birth. The Supreme Court is set to determine whether SB1 violates the Equal Protection Clause by treating individuals differently based on sex, and whether the state has a compelling interest in regulating these treatments due to safety concerns. The Court’s ruling could profoundly impact transgender healthcare policies nationwide. A decision upholding Tennessee’s law could embolden other conservative states to impose similar bans, creating a fragmented healthcare landscape across the country. Conversely, striking down the law could set a landmark legal precedent safeguarding transgender minors’ medical autonomy.

The stakes are high for the approximately 300,000 transgender youth aged 13–17 in the United States, where 24 states have already banned all gender-affirming treatments, and 2 states have prohibited surgeries. These adolescents face considerable challenges: nearly 50% report depression, and over 40% have seriously considered suicide.

The American Academy of Pediatrics and the American Medical Association continue to advocate for individualized, medical gender-affirming treatment, emphasizing its role in reducing mental health risks. They also urge states to refrain from interfering in private medical decisions. However, other countries including Sweden, France, Norway, and the Netherlands, where puberty blocking treatment was first innovated, have recently adopted a more cautious stance, advocating psychological support for gender dysphoria while awaiting further research on the long-term safety and efficacy of puberty blockers and hormones.

What do you think? Should the state play a role in the medical decisions of transgender children and their parents?