US Supreme Court set to hear major transgender rights case

WASHINGTON (Reuters) -The U.S. Supreme Court began hearing arguments on Wednesday in a major transgender rights case testing the legality of a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors, one of 24 such policies enacted by conservative state lawmakers around the country.

Democratic President Joe Biden's administration appealed a lower court's decision upholding Tennessee's prohibition on medical treatments such as puberty blockers and hormones for people under age 18 experiencing gender dysphoria. That is the clinical diagnosis for significant distress that can result from an incongruence between a person's gender identity and the sex assigned at birth. 

The arguments were ongoing.

U.S. Solicitor General Elizabeth Prelogar, arguing for the administration, noted that the medications at issue in the case have been safely prescribed for decades to treat many conditions.

But under Tennessee's law, Prelogar said, "It doesn't matter what parents decide is best for their children. It doesn't matter what patients would choose for themselves. And it doesn't matter if doctors believe this treatment is essential for individual patients. (The law) categorically bans treatment when, and only when, it's inconsistent with the patient's birth sex."

The administration and other challengers have argued that the law discriminates against these adolescents based on sex and transgender status, violating the U.S. Constitution's 14th Amendment promise of equal protection. 

The case brings transgender rights, a major flashpoint in the U.S. culture wars, to the Supreme Court as Republican U.S. President-elect Donald Trump prepares to take office on Jan. 20. Trump vowed during his election campaign to restrict gender-affirming care and transgender sports participation.

Tennessee's law, passed in 2023, aims to encourage minors to "appreciate their sex" by prohibiting healthcare workers from prescribing puberty blockers and hormones to help them live as "a purported identity inconsistent with the minor's sex."

Providers can be sued and face fines and professional discipline for violations. The law allows these medications to be used for any other purpose, including to address congenital defects, precocious puberty or other conditions.

The state has said it is banning "risky, unproven gender-transition interventions," pointing to "scientific uncertainty," tightened restrictions in some European countries and "firsthand accounts of regret and harm" from people who discontinue or reverse treatments.

Medical associations, noting that gender dysphoria is associated with higher rates of suicide, have said gender-affirming care can be life-saving, and that long-term studies show its effectiveness.

Before the arguments, a few hundred demonstrators - both opponents and supporters of Tennessee's law - gathered outside the court on a chilly morning. One Connecticut man held a sign that read, "I love my trans son." A Republican Tennessee lawmaker, Jason Zachary, spoke to a crowd about the need for the law, flanked by signs that read, "Stop the Harm" and "Kids' Health Matters."

Several plaintiffs - including two transgender boys, a transgender girl and their parents, as well as a doctor who provides the type of care at issue - sued to challenge the law's legality. They are represented by the American Civil Liberties Union and LGBT rights group Lambda Legal.

The U.S. Justice Department subsequently intervened in the lawsuit.

ACLU lawyer Chase Strangio, representing the original plaintiffs, is set on Wednesday to become the first openly transgender attorney to argue before the Supreme Court. 

A federal judge blocked the law as likely violating the 14th Amendment but the Cincinnati-based 6th U.S. Circuit Court of Appeals later reversed the judge's preliminary injunction. The ruling by the Supreme Court, which has a 6-3 conservative majority, is expected by the end of June.

In a major case involving transgender rights, the Supreme Court ruled in 2020 that a landmark federal law forbidding workplace discrimination protects gay and transgender employees. 

(Reporting by Andrew Chung and John Kruzel; Editing by Will Dunham)