On December 4, the United States Supreme Court will consider one of the hottest health issues of the day: medical care for transgender youth.

The Biden administration is continuing on behalf of trans youth and their families by Tennessee on state ban on gender-affirming care in the United States v. Skrmetti case.

The court’s decision could affect access to health care for nearly 1.6 million transgender Americans of all ages in the United States, including in the Midwest. where gender-affirming care is prohibited in several states including Indiana, Kentucky, Missouri, Iowa, Ohio, Nebraska and Oklahoma.

The Checkup’s question is: What is at stake in this case for access to health care for people in the Midwest and across the United States?

Lizzy McGrevy, community engagement specialist for Side Effects Public Media, spoke with Ryan Levi, producer for the health policy news organization Tradeoffs, about this topic.

This transcript has been edited for length, style and clarity.

Lizzy McGrevy: Hi Ryan! Thanks for joining us again on The Checkup. Can you start by defining gender-affirming care for us?

Ryan Levi: Yes, gender-affirming care is this umbrella term that actually encompasses several different types of medical care that help a person’s physical appearance align with their gender identity.

So the things that we hear about most often, and that are banned in these state laws, are things like puberty blocking drugs, hormonal therapy –– estrogen and testosterone –– and in rare cases, gender affirmation surgeries.

In 2021, when we will have the best datathere have been approximately 42,000 diagnoses of gender dysphoria among minors. It is a clinical condition in which a person experiences distress resulting from a mismatch between their body and their gender identity. And of those 42,000 diagnoses, there were about 1,400 prescriptions for puberty blockers and 4,000 for hormones. So it’s a fairly small fraction of transgender children who actually benefit from this type of gender-affirming care.

Much of this care is really just conversations with providers addressing questions about gender, helping children and their families think about the appropriate course of action for them.

McGrevy: Can you give us an update on what medical experts are saying about gender-affirming care for minors?

Levi: Yeah. Thus, the evidence here is hotly debated and highly controversial.

What we can say is that almost every major medical group in the United States supports gender-affirming care for minors –– the American Medical Association, American Psychiatric Associationthe summit pediatric associations. They all cite studies showing that there is very high satisfaction and very little regret among trans children and their families when it comes to receiving this care. Studies have shown that hormone therapy notably leads to reduction of depression, anxiety And suicidality.

On the other hand, however, opponents of gender-affirming care argue that these studies are of poor quality and that the evidence remains unclear overall. There are simply too many unknowns, and it is also said that these treatments can cause physical and psychological harm. But some experts strongly oppose it.

But the uncertainty that reigns there has been enough to policy makers in the UKseveral European countries and obviously many states here in the United States to restrict or prohibit this care.

McGrevy: So there’s a lot of uncertainty about that, it seems, but in the meantime, the Supreme Court will take up this United States v. Skrmetti case. Can you give us a little more information about this case?

Levi: Yes, this stems from Tennessee’s ban on gender-affirming care, passed in 2023. This law, like many of these bans, prohibits doctors from providing puberty blockers, hormone therapy, or birth surgery. gender affirmation to transgender minors.

Some trans youth and their families sued Tennessee, alongside advocates and the federal government, and got a federal judge to block the law from taking effect in 2023. Then the state appealed, a higher court overturned this decision and the decision was made. the law came into force. Now the Biden administration is taking the case to the Supreme Court to try to overturn this law.

McGrevy: And what do opponents of Tennessee’s ban say about this?

Levi: Yeah, so they say it’s a clear example of gender discriminationand that’s important, because in the legal world, if a state passes a law that treats people differently based on their gender, the state has to clear a higher burden or a higher bar to prove that there is a good reason to have this type of discriminatory law.

So the federal government is arguing that these bans, and particularly Tennessee’s, require a higher level of oversight and that they discriminate on the basis of gender, because they say trans children, under these laws , do not have access to the care that cisgender children can obtain. .

“There’s really no way for a doctor to decide who will have access to care without looking at the gender of the patient in front of them,” says Katie Eyer, a professor at Rutgers Law School. “So it’s really just a matter of differential treatment of people for the same treatments based on their gender.”

McGrevy: Well, I’m going to go out on a limb and guess that not all legal experts agree with Katie on this. What else do you hear?

Levi: Yeah, so the other side, Lizzy, says it’s not about sex. It is about things the state does all the time –– regulate what children can do and regulate the medical care that can be provided in their state.

“There are certain things kids can’t do: They can’t vote, they can’t drive a car, and they can’t get married,” says Jim Blumstein, a law professor at Vanderbilt University. “Parents can’t tell a child, ‘You don’t have to go to school.’ Then the government can force you to go to school.

McGrevy: The Supreme Court will hear this case in December, and I’m sure it will hear from many more people. What are the different outcomes and scenarios we can expect? And this should be heard in December. So, is the new Trump administration playing a role in all of this?

Levi: The Supreme Court could decide this case in three high-level ways.

They could govern in the name of the federal government and overturn the law. This would likely lead to an end to these types of blanket bans across the country.

They could side with Tennessee and uphold the law, which — in addition to keeping these bans on gender-affirming care in place — would also provide additional legal support for other laws targeting the transgender community that states have passed. Laws that specify which bathrooms they can use or which sports teams they can play on. Legal experts also worry that a ruling on Tennessee could threaten federal anti-discrimination protections for transgender patients, and open the door to states banning gender-affirming care for adultswhich we have already seen attempted in Florida And Missouri.

And the third option here is a bit more of a middle ground approach. And that would involve the Supreme Court saying that, yes, this law is an example of sex discrimination, so it requires a higher standard of proof. But they would send the case back to a lower court to decide whether this law meets that higher standard and whether Tennessee can prove it has a good enough reason to ban such care for transgender children.

You mentioned President-elect Donald Trump and what his administration might do. They could change the position of the federal government on this point, which could open the door to Supreme Court justices dismissing the case and avoiding making any sort of decision. It’s still too early to know exactly what will happen, but the election definitely throws a new twist into this matter.

McGrevy: Thanks for this information, Ryan.

You can listen to more of Ryan Levi’s reporting on this case on the last episode compromises.

If you have any questions for The Checkup about healthcare, health policy, or want to know more about some of Tik Tok’s viral health claims, let us know. You can email [email protected].

Side Effects Public Media’s Roundup is a regular audio segment on WFYI’s daily podcast, WFYI News Now.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations in and around the Midwest, including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky, WGLT in Illinois and KOSU in Oklahoma.