The Supreme Court heard arguments on Wednesday in just its second major transgender rights case, a challenge to a Tennessee law that bans gender-affirming care for minors.
Click here to listen to a replay of the oral argument
The nationâs top court will weigh whether Tennesseeâs law violates the equal protection clause of the 14th Amendment, requiring that people in similar circumstances be treated the same under the law. Both sides in the case say they are acting to protect minors from harm.
At least 26 states have adopted laws restricting or banning such care for minors, and most of those states face lawsuits.
Here's the latest:
Prelogar pushes in her closing arguments for a narrow ruling
She pointed out that the arguments in favor of Tennesseeâs law could also potentially support nationwide restrictions on transgender health care for minors.
The issue could remain at the center of the political conversation after the inauguration next month of President-elect Donald Trump, who made opposition to transgender rights central to his campaignâs closing message.
Arguments have concluded
The arguments in front of the justices wrapped up after more than two hours.
Rice argues Tennesseeâs law doesnât discriminate based on sex
âOur fundamental point is there is no sex-based line here,â Rice said.
Rice argued that the Tennessee law is instead aimed at the purpose of the treatment.
Children can get puberty blockers to treat early onset puberty, but not as a treatment for gender dysphoria.
Justices again ask about the implications of Tennesseeâs law in other areas
Justice Amy Coney Barrett asked Tennessee Solicitor General Matt Rice about the possible impact of both laws restricting women and girls from womenâs and girlsâ sports competitions â and those that keep them out of womenâs and girlsâ bathrooms in schools or other public buildings.
At least 24 states have sports laws. At least 11 have bathroom laws.
Where the justices seem to be leaning so far
The courtâs three liberal justices seem firmly on the side of the Biden administration and the families who are challenging the Tennessee law.
But itâs not clear that any of the courtâs six conservatives will go along.
Five conservatives have voiced varying degrees of skepticism of the challengersâ arguments. Gorsuch has yet to say anything.
Tennesseeâs state solicitor general begins arguments
Tennessee Solicitor General Matt Rice is now before the court to defend the stateâs law, following the conclusion of ACLU attorney Chase Strangioâs time at the podium.
Strangio cites laws against cross-dressing and more as examples of âde jureâ
Justice Amy Coney Barrett earlier had asked if there were examples of âde jure,â or by law, discrimination against transgender people rather than private discrimination.
Strangio cited laws against cross-dressing and previous bans on military service by transgender people.
President Joe Biden in 2021 reversed a Trump-era policy that largely barred transgender people from serving in the military. Trump has indicated he plans to reinstate that ban when he takes office in January.
Roberts suggests lawmakers should make the decision on such care â not judges
âThe Constitution leaves that question to the peopleâs representatives, rather than to 9 people, none of whom is a doctor,â Roberts said in questioning Strangio.
Alito seems skeptical about whether gender-affirming care reduces suicide risk
Strangio notes that multiple studies show the care reduces the risk of depression and suicidality.
Transgender youth in the United States have been flooding crisis hotlines since the election of Donald Trump, who made anti-transgender themes central to his campaign.
ACLU attorney begins arguments
ACLU attorney Chase Strangio has begun his arguments against Tennessee's ban. He follows U.S. Solicitor General Elizabeth Prelogar, who finished answering questions after spending more than an hour at the podium.
Brown Jackson references Loving v. Virginia decision
Justice Ketanji Brown Jackson said she saw some parallels between the case and a 1967 landmark decision that legalized interracial marriage.
She said that in the Loving case, which addressed a Virginia law, âeveryone seemed to concede that a racial classification was being drawn as a starting point. The question seemed to be whether it was discriminatory.â
Barrett sounds skeptical of the governmentâs argument
Barrett wasnât on the court when the 2020 case was decided so this is her first time diving into the issue as a justice.
She sounded skeptical of the administrationâs argument that the law discriminates because of sex. She was equally skeptical that the court should for the first time declare that discrimination against transgender people should be viewed as similar to bias based on race, sex and national origin, all of which have a special legal status.
Barrett said transgender people have not experienced the same long history of discrimination written into the law in the same way those other groups faced.
âAll other suspect classes do have that long de jure history of discrimination,â Barrett said, using the Latin phrase for âaccording to law.â
Kavanaugh asks about sports participation
Justice Brett Kavanaugh, who has coached his daughtersâ youth basketball teams, asked about the impact of a ruling on gender-affirming care in that realm.
âIf you prevail here on the standard of review, what would that mean for women and girls sports?â he asked. âWould transgender athletes have a constitutional right to participate in girlsâ sports?â
At least 24 states have adopted restrictions on transgender women and girls in womenâs and girlsâ sports competitions. There have also been legal challenges to those laws, with mixed verdicts so far.
Prelogar said thatâs a different issue and suggested the court could say in an opinion that sides with her argument that the Tennessee law would not impact the sports issue.
Kavanaugh expresses concern about patients who later change their minds
âHow do we as a court choose which set of risks is more serious in deciding whether to constitutionalize this whole area?â Kavanaugh said.
Research and reports from individual doctors and clinics suggest that detransitioning is rare.
Kagan asks if all bans on such care for minors would need to be struck down
Twenty-six states have passed versions of bans.
Prelogar said some might stand up to heightened scrutiny by courts than others.
âWe do think there is a real space for states to regulate here,â Prelogar said.
She pointed to West Virginiaâs as one that might fare better because it gives a path for treatment for teens who are considered by medical providers to be at risk for self-harm or suicide.
âSome children suffer incredibly with gender dysphoriaâ
During questioning by Justice Sonia Sotomayor, Prelogar noted that every major medical organization has supported gender-affirming care for transgender youth, and many have filed briefs supporting the challenge to Tennesseeâs law.
âSome children suffer incredibly with gender dysphoria, some attempt suicide,â Sotomayor said.
The groups include the American Medical Association and the American Academy of Pediatrics.
Prelogar is focusing on the sex-based nature of Tennesseeâs law
Justices Thomas and Alito both asked about when the states can and cannot have sex-based laws.
âWe think the court just needs to recognize the sex-based classification and send this case back,â Prelogar said, adding that the treatments can be âcritical, sometimes lifesaving, care to individuals with severe gender dysphoria.â
Tennesseeâs law bars puberty blockers and hormone treatment only for transgender minors.
A reminder of the Justices to watch
The votes of Chief Justice John Roberts, Justice Neil Gorsuch and Justice Amy Coney Barrett probably will decide this case.
Hereâs a look at where the Justices stand:
Roberts and Gorsuch joined the courtâs liberal justices (Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson) in the 2020 workplace discrimination case won by LGBTQ+ plaintiffs.
Three conservative justices, Samuel Alito, Brett Kavanaugh and Clarence Thomas, dissented on that case.
Barrett has no high court track record on transgender issues, although she votes with the other conservatives in most of the high-profile cases.
If the parties challenging the Tennessee law hope to win, they need at least two conservative justices on their side, along with the three liberal members of the court.
Alito suggests this case diverges from the 2020 case
Alito, who seems likely to vote to uphold the Tennessee ban, is using his questioning of Prelogar to persuade his colleagues that this case is different from the one four years ago where the court sided with LGBTQ+ people.
The Bostock decision in 2020 found that the landmark Civil Rights Act of 1964 banned discrimination against LGBTQ+ people in the workplace.
That âinvolved the interpretation of particular language in a particular statute,â Alito said.
This case involves the Constitutionâs equal protection clause, a key provision of the 14th Amendment.
Alito zeroes in on European policies
Alito focused on where European countries stand on gender-affirming care for minors, noting that Finland, Norway and Sweden have policies discouraging it from being available routinely to minors.
Prelogar noted that those countries donât go as far as Tennesseeâs outright ban on the treatments for transgender minors.
Alito asks about a UK report that questioned such care for minors
The report asserts there is âno good evidence on the long-term outcomes of interventions to manage gender-related distress.â
But advocates for transgender people have a lot of questions about the report.
â¶The AP delved into it here
Roberts asks whether the issue is better left to elected lawmakers
Chief Justice John Roberts, who is one of the most closely watched justices in this case and previously voted in favor of transgender rights in the workplace, is asking whether this question might be best left to state legislatures.
Prelogar responds that the state does have regulatory powers, but argues Tennesseeâs law is too broad.
Court is in session and arguments are underway
Supreme Court arguments have begun over Tennesseeâs ban on health care for transgender minors. The first attorney to argue is U.S. Solicitor General Elizabeth Prelogar, arguing against the ban.
Tennessee has become an eager adopter of anti-trans legislation over the years
The Republican-controlled Statehouse and GOP Gov. Bill Lee have signed off on legislation banning transgender athletes from participating in girlsâ sports.
Republicans have also blocked businesses from setting their own rules about bathroom access â a move that critics have warned targets transgender people.
This year, they placed a ban on the spending of state money on hormone therapy or sex reassignment procedures for prisoners and required public school employees to out transgender students to their parents.
Tennesseeâs Republican lawmakers didnât stop at banning care for minors
Shortly after enacting the ban on gender-affirming care, the Republican-dominant Legislature also passed legislation penalizing adults who help minors receive gender-affirming care without parental consent.
Supporters of the proposal couldnât point to any examples of minors leaving the state to receive gender-affirming care without their parentâs consent, but said it was needed anyway to protect children.
Republican Gov. Bill Lee later signed off on the first-in-the-nation proposal.
Tennessee passes more anti-LGBTQ+ legislation than any other state
Over the years, Republican-dominant Tennessee has not only been among the top states to introduce the most anti-LGBTQ+ legislation but also the top state to enact such legislation.
According to the Human Rights Campaign, Tennessee has enacted more anti-LGBTQ+ laws than any other state since 2015, identifying more than 20 bills that advanced out of the Legislature earlier this year. That includes Gov. Bill Lee signing off on bills banning the spending of state money on hormone therapy or sex reassignment procedures for prisoners â though it would not apply to state inmates currently receiving hormone therapy â and requiring public school employees to out transgender students to their parents.
Hereâs some of what is at stake
Attorneys for the families challenging Tennesseeâs law have warned a ruling upholding the measure could open the door for more attempts to restrict the care for transgender adults as well as youth.
Florida is the only state that has enacted a law restricting gender-affirming care for transgender adults, though similar restrictions have been attempted in at least two other states.
Ohio Gov. Mike DeWineâs administration earlier this year proposed and then backed off rules that advocates said would have blocked access to gender-affirming care provided by independent clinics and general practitioners.
Missouriâs Republican attorney general last year pushed for an emergency rule that would have placed limits on care for adults, but state officials abruptly dropped it. Missouri later this year enacted a law banning some gender-affirming care for minors.
Most adults still are allowed to access gender-affirming health care under the Missouri law, but Medicaid wonât cover it.
Today may be the solicitor generalâs last major case
Arguing for the Biden administration is U.S. Solicitor General Elizabeth Prelogar. Sheâs the second woman to serve in the role in the countryâs history, and this could be the last major case she argues as solicitor general â essentially the federal governmentâs top lawyer before the Supreme Court.
Matt Rice, Tennesseeâs state solicitor general, will defend the law before the high court. He served in 2019 as a clerk for Justice Clarence Thomas, who dissented from a ruling that term that a landmark civil rights law protects LGBTQ+ workers.
Tennessee isnât trying to ban all uses of puberty blockers
The treatments at the heart of todayâs arguments are also used by minors who are not transgender, including intersex people. Tennessee and other states have not tried to ban puberty blockers or hormone treatments for those uses.
Puberty blockers can be used to delay sexual development in children who go through puberty before age 8 or 9. Adolescents with delayed puberty can be treated with hormones.
Justice Clarence Thomas will ask the first question
Thomas was famously silent during arguments for years at a time because he said he relied on written briefs and thought his colleagues interrupted too much.
But when the court started hearing cases remotely during the COVID-19 pandemic, the justices altered their practice and asked questions one by one, instead of the usual free-for-all. Even after they returned to the courtroom, the justices have informally agreed to allow Thomas, the longest-serving member of the court, to go first.
He has asked questions at every argument session heâs attended since the courtâs first remote arguments in May 2020.
How long will arguments last?
Donât be fooled by the hour the court has allotted. The session could easily go twice as long.
Gone are the days when Chief Justice William Rehnquist would cut lawyers off mid-sentence when the red light went on at their podium. Chief Justice John Roberts was more lenient even before the coronavirus pandemic forced changes to the structure of the arguments.
The Biden administration is supporting the challenge to Tennessee's law
But the administrationâs position seems likely to change after Trump takes office.
He campaigned against transgender rights, using demeaning language and misrepresentations as he pledged to remove âtransgender insanityâ in schools and restrict participation in womenâs sports.
A father and his and transgender daughter travel out of state to receive care
Brian Williams of Nashville, Tennessee, says his transgender daughter, L.W., has to travel to another state to receive the health care that âwe and her doctors know is right for her.â
Williams, speaking on a Zoom call arranged by the legal team representing the family and others at the Supreme Court, said L.W. approached him and his wife, Samantha, several years ago to share âhonestly and openly her painâ over her gender identity.
She began taking puberty-blocking drugs at age 13 and started hormone therapy a year later, Williams says.
Today, her father says, she is a â16-year-old planning for her future, making her own music and looking at colleges.â
Williams says heâs not expecting people to understand everything about the family. But he asks others to âopen your hearts and listen.â
What are Biden and Trumpâs stances on the case?
President-elect Trump backed a national ban on such care as part of his 2024 campaign in which he demeaned and mocked transgender people. Trump and his allies also promised to roll back protections for transgender people throughout the campaign.
Meanwhile, in its waning days, the Biden administration, along with families of transgender adolescents, will appeal to the justices to strike down the Tennessee ban as unlawful sex discrimination and protect the constitutional rights of vulnerable Americans.
Earlier this year, the administration and Democrat-led states extended protections for transgender people, including a new federal regulation that seeks to protect transgender students.
The scene outside the Supreme Court
People on both sides of the issue are gathered outside the court for demonstrations that are increasing in volume ahead of arguments.
They carried signs reading âChampion Godâs Designâ and âKids Health Mattersâ on one side and âFight like a Mother for Trans Rightsâ and âFreedom to be Ourselvesâ on the other.
Speeches and music filled the air on the sidewalk outside the courtâs marble steps.
More than 500 bills restricting the rights of LGBTQ+ people were introduced in statehouses this year
Multiple bills related to transgender youth have already been filed in Texasâ legislature ahead of its session next year.
The proposals include a bill that would make it easier to sue providers of gender-affirming medical care for children.
Other bills include restrictions on which public restrooms transgender people can use, and limits on how topics related to sexual orientation and gender identity are taught in schools.
While this case is about a Tennessee law, it holds national significance
At least 26 states have adopted laws banning gender-affirming medical care for transgender minors. Federal judges in Arkansas and Florida have struck down the bans in those states as unconstitutional, though an appeals court has put the Florida ruling on hold. The ban in New Hampshire is to take effect on Jan. 1.
Several Democratic-controlled states have policies seeking to protect access to gender-affirming care.
Additionally, at least 24 states have bans barring transgender women and girls from competing in certain womenâs and girlsâ sports competitions. And at least 11 have laws barring transgender women and girls from using girlsâ and womenâs bathrooms at public schools â and in some cases, in other government facilities.
Level of scrutiny: A legal issue that could play a decisive role in the case
Most laws are reviewed and upheld under the lowest level of scrutiny, known as rational basis review. Indeed, the federal appeals court in Cincinnati that allowed the Tennessee law to be enforced held that lawmakers acted rationally in adopting the law to address the risks they perceived in gender-affirming care for minors.
But when discrimination is present, judges take a closer look.
Sex discrimination gets heightened scrutiny, which requires states to identify an important objective and show that the law helps accomplish it. Racial discrimination, not at issue here, is reviewed under strict scrutiny â the highest level â and laws rarely survive such a demanding examination.
The votes of Roberts, Gorsuch and Coney Barrett probably will decide this case
Roberts and Gorsuch joined the courtâs liberal justices in the 2020 workplace discrimination case won by LGBTQ+ plaintiffs. Three conservative justices, Samuel Alito, Brett Kavanaugh and Clarence Thomas, dissented.
If the parties challenging the Tennessee law hope to win, they need at least two conservative justices on their side, along with the three liberal members of the court. Barrett has no track record on transgender issues, although she votes with the other conservatives in most of the high-profile cases.
When is a decision expected on this case?
The Supreme Court almost always issues its decisions by early summer, usually before the end of June. The transgender health case could be one of the last cases decided, which is typical of highly contentious issues. One additional potential cause for delay is the Trump administration could weigh in soon after he takes office. Itâs not clear how that might affect the case.
The first transgender attorney ever to argue before the Supreme Court
Chase Strangio will be the first openly transgender attorney to argue before the nationâs highest court, representing families who say Tennesseeâs ban on health care for transgender minors leaves their children terrified about the future.
Strangio will bring months of intense legal preparation to the case as well as hard-won lessons from his own experience.
âI am able to do my job because I have had this health care that transformed and, frankly, saved my life,â he said. âI am a testament to the fact that we live among everyone.â
Strangio grew up outside of Boston and came out as trans when he was in law school. Now 42, heâs an American Civil Liberties Union attorney whose legal career has included representing former Army intelligence analyst Chelsea Manning, challenging a ban on transgender people serving in the military and helping win an LGBTQ+ worker-discrimination case at the Supreme Court. Heâs also the father of a 12-year-old, the son of a father who supports Trump, and has a close relationship with his Army veteran brother.
ⶠRead more about Strangio and his history as a transgender advocate
When was the last time the Supreme Court took up a case on transgender rights?
The Supreme Courtâs only other major case on transgender rights was in 2020 when the court ruled that workplace discrimination against LGBTQ+ people was sex discrimination in violation of the federal civil rights law commonly known as Title VII.
The court concluded in separate cases involving a gay man and a transgender woman that they were discriminated against because of their sex. Justice Neil Gorsuch, an appointee of Donald Trumpâs in his first term in the White House, wrote the 6-3 opinion for the court. Chief Justice John Roberts was the only other conservative member of the court in the majority.
What is being argued before the court?
The nationâs top court will be weighing whether Tennesseeâs law violates the equal protection clause of the 14th Amendment, requiring that people in similar circumstances be treated the same under the law. Both sides in the case claim they are acting to protect minors from harm.
Transgender attorney Chase Strangio will represent families who say Tennesseeâs ban leaves them terrified for the future and that access to this kind of care is life-saving.
Tennessee, meanwhile, will argue before the Supreme Court that treatments like puberty blockers and hormones carry risks for young people and its law protects them from making treatment decisions prematurely.
By MARK SHERMAN
Associated Press
WASHINGTON (AP) â The Supreme Court is hearing arguments Wednesday in just its second major transgender rights case, which is a challenge to a Tennessee law that bans gender-affirming care for minors.
Click here to listen to the oral arguments that begin 9a.m. CST
The justices' decision, not expected for several months, could affect similar laws enacted by another 25 states and a range of other efforts to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use.
The case is coming before a conservative-dominated court after a presidential election in which Donald Trump and his allies promised to roll back protections for transgender people.
Four years ago, the court ruled in favor of Aimee Stephens, who was fired by a Michigan funeral home after she informed its owner that she was a transgender woman. The court held that transgender people, as well as gay and lesbian people, are protected by a landmark federal civil rights law that prohibits sex discrimination in the workplace.
The Biden administration and the families and health care providers who challenged the Tennessee law are urging the justices to apply the same sort of analysis that the majority, made up of liberal and conservative justices, embraced in the case four years ago when it found that âsex plays an unmistakable roleâ in employers' decisions to punish transgender people for traits and behavior they otherwise tolerate.
The issue in the Tennessee case is whether the law violates the equal protection clause of the 14th Amendment, which requires the government to treat similarly situated people the same.
Tennessee's law bans puberty blockers and hormone treatments for transgender minors, but not âacross the board,â lawyers for the families wrote in their Supreme Court brief. The lead lawyer, Chase Strangio of the American Civil Liberties Union, is the first openly transgender person to argue in front of the justices.
The administration argues there is no way to determine whether âtreatments must be withheld from any particular minorâ without considering the minor's sex.
âThat is sex discrimination,â Solicitor General Elizabeth Prelogar wrote in her main court filing.
The state acknowledges that the same treatments that are banned for transgender minors can be prescribed for other reasons. But it rejects the claim that it is discriminating on the basis of sex. Instead, it says lawmakers acted to protect minors from the risks of âlife-altering gender-transition procedures.â
The law âdraws a line between minors seeking drugs for gender transition and minors seeking drugs for other medical purposes. And boys and girls fall on both sides of that line,â Tennessee Attorney General Jonathan Skrmetti wrote in the state's Supreme Court brief.
While the challengers invoke the 2020 ruling in Bostock v. Clayton County for support, Tennessee relies on the court's precedent-shattering Dobbs decision in 2022 that ended nationwide protections for abortion and returned the issue to the states.
The two sides battled in their legal filings over the appropriate level of scrutiny the court should apply. It's more than an academic exercise.
The lowest level is known as rational basis review and almost every law looked at that way is ultimately upheld. Indeed, the federal appeals court in Cincinnati that allowed the law to be enforced held that lawmakers acted rationally to regulate medical procedures, well within their authority.
The appeals court reversed a trial court that employed a higher level of review, heightened scrutiny, that applies in cases of sex discrimination. Under this more searching examination, the state must identify an important objective and show that the law helps accomplish it.
If the justices opt for heightened scrutiny, they could return the case to the appeals court to apply it.
Gender-affirming care for youth is supported by every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association.
But Tennessee is pointing to health authorities in Sweden, Finland, Norway and the United Kingdom that found that the medical treatments "pose significant risks with unproven benefits.â
None of those countries has adopted a ban similar to the one in Tennessee and individuals can still obtain treatment, Prelogar wrote in response.
The Williams family of Nashville, Tennessee are among those challenging the state law. Brian Williams said that as a result of puberty blockers and hormone treatments, his transgender daughter, L.W., is a â16-year-old planning for her future, making her own music and looking at colleges.â
But because of Tennessee's ban, she has to travel to another state to receive the health care that âwe and her doctors know is right for her.â
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WASHINGTON (AP) âOn Wednesday, the Supreme Court will hear arguments in a case involving Tennesseeâs ban on gender-affirming care for transgender people under age 18.
At least 26 states have adopted laws restricting or banning such care for minors, and most of those states face lawsuits.
The nation's top court will be weighing whether Tennesseeâs law violates the equal protection clause of the 14th Amendment, requiring that people in similar circumstances be treated the same under the law. Both sides in the case claim they are acting to protect minors from harm.
Gender-affirming care is supported by the American Medical Association, the American Academy of Pediatrics and other medical groups. Hereâs a look at whatâs typically involved:
Evaluation and diagnosis happen first
Young people who persistently identify as a gender that differs from their sex assigned at birth are often referred to clinics where teams from various medical specialties provide gender-affirming care.
Such care begins with an evaluation, which can include a pediatrician and a mental health specialist who assess the degree of distress, if any, the young person is experiencing.
Those who meet defined criteria may be diagnosed with whatâs called gender dysphoria if their distress is continuous and significant.
Some young people and their families may decide to try a social transition involving a new hairstyle, clothing, name or pronouns. Experts agree that allowing children to express their gender in a way that matches their identity is beneficial.
Chazzie Grosshandler, 18, of Chicago, said she was 9 years old when she told her parents she was a girl and ânot just a boy who likes girly things.â She started receiving care two years later.
âThe first-ever step of gender-affirming care for me was when I told my parents that I was a girl and that I had felt this way for a long time and that they accepted me,â she said. âI think people get really confused when they hear the word âcareâ that it has to be something medical. But the truth is that itâs more than just medical. Itâs love and acceptance.â
Puberty blockers can be a next step
A subset of young people may be offered additional interventions such as puberty blockers to ease distress and give them time to explore their gender identity.
The drugs, known as GnRH agonists, block the release of key hormones involved in sexual maturation. Theyâve been used for decades to treat precocious puberty, an uncommon medical condition that causes puberty to begin abnormally early.
The medication starts after a young person show early signs of puberty â enlargement of breasts or testicles. This typically occurs around age 8 to 13 for those assigned female at birth and a year or two later for those assigned male at birth.
The drugs can be given as injections every few months or as arm implants lasting up to a year or two. Many of the effects are reversible â puberty and sexual development resume as soon as the drugs are stopped. Researchers are exploring the effects of puberty blockers on bone development, but no research has shown an increased risk for bone fractures.
Young people can stay on puberty blockers for several years.
Some transgender youth may take hormones
After puberty blockers, trans adolescents go through puberty either with or without hormone treatment.
Some may choose to take hormones to make their bodies more closely match their gender identity. They take manufactured versions of either estrogen or testosterone â hormones that prompt sexual development in puberty. Estrogen comes in skin patches and pills. Testosterone is available in injections, implants or gels.
Guidelines recommend starting these when teens are mature enough to make informed medical decisions. Many transgender people take the hormones for life.
If the medication is stopped, some physical changes remain. Testosterone generally leads to permanent voice-lowering, facial hair and development of the Adamâs apple. Estrogen can lead to permanent breast development.
Research on long-term hormone use in transgender adults has found potential health risks including a modest risk for blood clots with estrogen and negative cholesterol changes with testosterone.
Surgery is rare
Gender-affirming surgery in transgender teens is far less common than hormone treatment. When it is done among transgender youth, itâs almost always breast reduction surgery in older transgender males.
Even so, that type of surgery is extremely rare. Perhaps surprisingly, breast reduction among minors is most frequently performed in males who are not transgender. This is for a condition called gynecomastia, which means having more breast tissue than usual.
A study looking at millions of 2019 insurance claims found 151 breast reductions performed for U.S. minors. Nearly all â 97% â were not transgender.
Hormones and well-being
Research suggests that transgender youth are prone to stress, depression and suicidal thoughts. Some studies suggest treatment for gender dysphoria can improve young peopleâs well-being, but some nuances remain unclear.
In one study, researchers spent two years testing and tracking 315 transgender youth who received hormone therapy. Depression and anxiety symptoms eased and life satisfaction increased among those designated female at birth, but not among those designated male at birth. The researchers speculated that the youth designated male at birth might be more affected by stress from being different from most of their peers.
In the same study, published last year in the New England Journal of Medicine, two participants died by suicide â one after six months and the other after a year.
Longer term studies on treatment outcomes are underway.
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