Standing up for the Health and Wellbeing of LGBTQIA+ Youth: A Response to U.S. v. Skrmetti  

It is hard to imagine something more important to protect and promote than the safety, health, and wellbeing of children and youth. Yet, on June 18th—during Pride Month, no less—the Supreme Court failed to protect young people and their families from political attacks on their identities, health and wellbeing and their health care. In the case before the court, U.S. v. Skrmetti, three transgender adolescents, their families, and a Memphis-based medical provider challenged a Tennessee law that bans access to gender-affirming healthcare for transgender, non-binary, and gender diverse youth under 18 years old and forbids access to care offered via telehealth by an out-of-state provider. Tennessee is one of 25 states that have enacted bans on gender-affirming care, restrictions that affect 40 percent of youth ages 13-17 who identify as transgender.  In upholding Tennessee’s law, the Supreme Court not only failed to protect the challengers in the case, but failed to defend the rights and autonomy of over 1.6 million people and 5 percent of all young adults across the country. As Justice Sotomayor stated in her dissent the ruling will invite “untold harm to transgender children and the parents and families who love them.”  

Gender-affirming care at its core is health care that is responsive and affirming to each person and their identity. It consists of a range of social and medical supports to help people align their physical gender expression with their gender identity, including respecting preferred pronouns and clothing, using the child’s chosen name, reconstructive mastectomy, hair removal, puberty blockers and hormone therapy. These are important health care supports, necessary for the safety, health and wellbeing of young people. Gender affirming care is supported and deemed medically necessary by major medical organizations including the American Medical Association, the American Academy of Pediatrics, and the World Health Organization. 

Across the country, young people, their families, and their health providers have repeatedly asserted that gender-affirming care is essential and that losing access will be devastating. In spite of their testimony, which is backed by decades of practice and research, legislators have politicized affirming care in an effort that directly harms and attempts to erase and disempower LGBTQIA+, and specifically transgender, non-binary, and gender diverse young people.  

Unfortunately, we know the harm the Supreme Court’s decision, and the Tennessee ban will cause to young people. Research is clear that these bans and other discriminatory efforts harm our communities and young people, leading to a spike in  anxiety, depression, and suicidal ideation for transgender, non-binary, and gender diverse youth. Bans have disrupted the lives of many and will hurt the health of those whose treatments have been disrupted or who will never be able to access care. For some, the only option is now to seek care out of state, which would upend their entire life— work and school— disconnecting them from their families and communities, as well as requiring substantial resources to make the move. This is not only impractical for all, but impossible for many. Youth who are in state custody, including those in foster care or juvenile detention, are particularly vulnerable as they already lack control over decisions about their bodies, and do not have the option of relocating to a state where they can receive the health care they need and should be able to expect. The impact of the Supreme Court decision will have disproportionate consequences for these young people that cannot be ignored.  

Our children, young people, and families deserve so much better, and we have a responsibility as a country to protect their health and wellbeing. The health of young people cannot continue to be politicized. In the face of these dangerous setbacks, we must continue to advance solutions that affirm and respect each of us and ensure we all have access to the health care we need, when we need it, aligned with medical best practice, and without political interference.  

We all have a role to play in supporting the health and wellbeing of children, youth, and families. Policymakers must pass protections for affirming care in states without bans and eliminate restrictions where they exist. Community advocates and health providers must continue to serve families, including through providing information about accessing care in supportive states. Providers in states without bans must not preemptively stop offering care out of fear. Moreover, philanthropy should step-up and provide needed funding for families who must travel for care or who face legal retaliation, as well as funding community advocates providing care and support, and pushing back and providing protection from harm. At CSSP, we remain committed to advancing health justice and affirming communities for us all. The core of our work is about promoting the health and wellbeing of children and families. We invite you to join us as we continue our fight. To learn more about CSSP’s commitment to advancing the health and wellbeing of LGBTQIA+ youth on our website.