On Wednesday, the Supreme Court is set to deliberate on a case regarding Tennessee’s prohibition on gender-affirming care for individuals under the age of 18.
This development follows a trend, as at least 26 states across the country have enacted legislation that either restricts or outright bans such medical interventions for minors, with many of these states currently embroiled in legal challenges.
Central to the legal arguments is whether Tennessee’s statute infringes upon the equal protection clause of the 14th Amendment, which mandates that people in comparable situations be treated equally under the law. Both parties involved in the case assert they are acting in the best interests of minors.

Gender-affirming care has garnered the endorsement of numerous medical organizations, including the American Medical Association and the American Academy of Pediatrics.
Typically, this care begins with an evaluation and diagnosis process. Young individuals who consistently identify with a gender different from the one assigned at birth may be referred to specialized clinics where multidisciplinary teams offer gender-affirming support.
The assessment generally involves consultations with a pediatrician and a mental health specialist, who evaluate any distress the young person may be experiencing.
Those who exhibit persistent and significant distress may be diagnosed with gender dysphoria.

Some families decide to pursue a social transition, which may involve changing hairstyles, clothing, names, or pronouns.
Many experts contend that allowing children to express their gender in alignment with their identity can be beneficial.
An 18-year-old from Chicago, Chazzie Grosshandler, shared her experience, noting that she expressed her true identity to her parents at the age of nine and received care starting at age eleven.
“The initial step of gender-affirming care for me was when I disclosed to my parents that I identified as a girl,” she recounted. “It’s crucial to understand that ‘care’ encompasses more than merely medical procedures; it embodies love and acceptance.”

For some youth, the next option might entail the use of puberty blockers, which serve to alleviate discomfort and allow time for exploration of gender identity.
These medications, classified as GnRH agonists, inhibit the secretion of essential hormones involved in the sexual maturation process.
Frequently employed for decades in treating precocious puberty, a condition where puberty commences abnormally early, these drugs are initiated when a young person exhibits early signs of puberty, typically between the ages of 8 and 13 for those assigned female at birth.
The treatment can be administered through injections or as arm implants that can last for up to two years, and the effects are generally reversible once the medication is discontinued.
Although ongoing research is investigating the impact of puberty blockers on bone development, no evidence has surfaced indicating an elevated risk of fractures associated with these treatments.

Transgender adolescents may also consider taking hormones after undergoing puberty blockers.
Many opt for hormone therapy to align their bodies with their gender identity, utilizing synthetic forms of either estrogen or testosterone, which spur sexual development during puberty.
Estrogen is available in various forms, including patches and pills, while testosterone can be administered through injections, implants, or gels.
Medical guidelines advocate for the initiation of hormone therapy when teens are deemed mature enough to make informed medical choices.
Some individuals may continue hormone treatment throughout their lives.
If hormone therapy is halted, certain physical changes may persist, such as a lower voice or facial hair from testosterone, and breast development from estrogen.
Research into the long-term effects of hormone treatment in transgender adults indicates possible health risks, including a slight risk of blood clots with estrogen and adverse cholesterol changes from testosterone.

Surgical procedures related to gender-affirmation are comparatively rare among teenagers.
When surgeries do occur in transgender youth, they most often involve breast reduction, predominantly for older transgender males.
Interestingly, the majority of such surgeries performed on minors are for individuals not identifying as transgender, typically addressing a condition known as gynecomastia, which is characterized by excessive breast tissue.
Analysis of millions of insurance claims in 2019 revealed that only 151 breast reduction surgeries were conducted on minors in the U.S., with a striking 97% occurring in non-transgender individuals.

Research indicates that transgender youth are at an elevated risk for stress, depression, and suicidal ideation.
Some studies suggest that interventions addressing gender dysphoria can enhance the well-being of affected youth, although the intricacies of these findings remain partially understood.
In one notable study, researchers assessed 315 transgender youth undergoing hormone therapy over two years, observing reductions in symptoms of depression and anxiety among those assigned female at birth, while no similar improvements were noted for those assigned male at birth.
Researchers hypothesized that societal pressures may heavily influence the latter group.
The study, published in the New England Journal of Medicine, documented two participants who tragically died by suicide during the study, highlighting the complexities involved in treatment outcomes.
Ongoing long-term research is expected to yield further insights into the efficacy of these treatments.