Supporting Therapy Clients After the U.S. Election [Video]

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The Supreme Court is considering whether a ban on medical treatments for transgender youth violates the Constitution. The case centers on Tennessee's law but could have national implications. Roughly half of states have passed similar measures limiting gender-affirming care for minors. There were competing rallies outside of the Supreme Court on Wednesday as the conservative-leaning bench heard more than two hours of arguments. Tennessee Solicitor General Matt Rice said the states law, which bans treatments like puberty blockers and hormone therapy, is intended to protect minors from risky, unproven medical interventions. "Its application turns entirely on medical purposes, not a patient's sex. That is not sex discrimination," Rice said.Solicitor General Elizabeth Prelogar, who argued on behalf of the Biden administration, said the law violates the 14th Amendments equal protection clause because it prohibits access to treatment depending on a patients sex.The law restricts medical care only when provided to induce physical effects inconsistent with birth sex. Someone assigned female at birth can't receive medication to live as a male, but someone assigned male can. If you change the individual sex, it changes the result, Prelogar said. Prelogar said Tennessees law doesnt leave room for transgender youth, parents and doctors to consider the benefits on an individual basis. She argued West Virginias law, which creates guardrails around gender-affirming care rather than banning it, is more likely to survive heightened legal scrutiny. Justice Sonia Sotomayor inquired about the risks of not providing gender-affirming care, such as substance abuse and suicide. One of the petitioners in this case described throwing up every day and going almost mute because of his, because of their inability to speak in a voice that they could live with, Sotomayor said. Organizations like the American Medical Association and the American Academy of Pediatrics have recognized the value of gender-affirming care for minors. However, conservative justices argued there is scientific uncertainty around the long-term risks, pointing to a recent report from the UK. They also said some transgender youth end up regretting these medical interventions. Justice Brett Kavanaugh suggested lawmakers, rather than judges, are better suited to make policy decisions. The difficulty of the issue is some people are going to be harmed and then the question becomes, how does the court choose which group? Why isn't that a choice for policymakers as best they can, Kavanaugh said. Its expected to take several months for the Supreme Court to make a decision. While justices deliberate, President-elect Donald Trump could potentially shake up policies at the federal level after he takes office next year. Trump has previously said he would support national restrictions on gender-affirming care for minors.

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On Wednesday, the Supreme Court will hear arguments in a case involving Tennessees 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 Tennessees 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. Heres a look at whats typically involved:Evaluation and diagnosis happen firstYoung 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 whats 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 not just a boy who likes girly things. She started receiving care two years later.The 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, she said. I think people get really confused when they hear the word care that it has to be something medical. But the truth is that its more than just medical. Its love and acceptance.Puberty blockers can be a next stepA 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. Theyve 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 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 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 hormonesAfter 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 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 Adams 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 rareGender-affirming surgery in transgender teens is far less common than hormone treatment. When it is done among transgender youth, its 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 97% were not transgender.Hormones and well-beingResearch suggests that transgender youth are prone to stress, depression and suicidal thoughts. Some studies suggest treatment for gender dysphoria can improve young peoples 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 one after six months and the other after a year.Longer term studies on treatment outcomes are underway.