Live updates: SCOTUS weighs gender-affirming care for minors, Tennessee transgender care ban | CNN Politics

SCOTUS conservative majority appears ready to endorse Tennessee law banning gender-affirming care for minors

Transgender rights supporters rally outside of the Supreme Court on Wednesday, December 4, 2024, in Washington, DC.
Legal analyst breaks down arguments made by SCOTUS justices in deciding transgender healthcare
03:51 - Source: CNN

What you need to know

• The conservative majority on the Supreme Court appeared ready to endorse a Tennessee law banning gender-affirming care for minors as it heard arguments Wednesday on US v. Skrmetti — a case that could determine whether states can ban this type of care for trans children and teens. A decision is expected by July 2025.

• During the arguments, Justice Ketanji Brown said she is “suddenly quite worried” and “nervous” about conservatives’ arguments in the controversy. The case, brought by the Biden administration on behalf of families of trans youth, challenges the constitutionality of Tennessee’s gender-affirming care ban, which restricts puberty blockers and hormone therapy for transgender minors and enacts civil penalties for doctors who violate the law.

• The Tennessee law is among a growing number of state laws enacted in recent years targeting transgender care. Republican lawmakers who support the ban say decisions about care should be made after an individual becomes an adult. Opponents argue that in addition to violating the civil rights of trans youth, the laws also run afoul of parents’ rights to make decisions about their child’s medical care.

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Our live coverage of Wednesday’s Supreme Court oral arguments has ended. Read more about the proceedings in the posts below.

Catch up on key takeaways from the historic transgender care arguments at the Supreme Court

The Supreme Court appeared likely to back a divisive Tennessee law that bans gender-affirming care for minors after more than two hours of oral arguments on Wednesday in which the court delved into a culture war battle that has become even more politically fraught since the election.

The transgender care case is the most significant matter to come before the Supreme Court this term – and it has become even more extraordinary since former President Donald Trump was elected to a second term, in part on a campaign to end the “transgender craziness.”

More than 110,000 teenagers live in states where restrictions on transgender care exist, according to the Williams Institute at UCLA School of Law.

Here are some key takeaways from Wednesday’s historic arguments:

Roberts, Kavanaugh wary of courts second-guessing legislatures: On multiple occasions, Chief Justice John Roberts and Justice Brett Kavanaugh, two of the court’s most important votes, suggested that the issue of gender-affirming medical treatments for minors should be left to legislatures to decide and that the courts shouldn’t play a role. Roberts’ skepticism toward courts getting involved was a particularly worrying sign for the challengers to the Tennessee ban, as Roberts had previously sided with federal transgender employees in a major 2020 case finding those employees are covered under the workplace discrimination protections of the Civil Rights Act.

Alito and other conservatives focus on “detransitioners”: Several of the court’s conservatives appeared heavily focused on so-called detransitioners – individuals who regret receiving gender-affirming treatments earlier in their lives – as they expressed skepticism toward arguments that transgender Americans should receive heightened protection under the law. Justice Samuel Alito, in particular, was interested in the question of whether transgender status is “immutable.” Historically, the court has considered immutability to be a key aspect of the characteristics of a group deserving of more protection.

Kavanaugh worried about girls’ sports: Kavanaugh repeatedly raised concerns about the impact the court’s decision may have on girls’ sports – an issue that has already worked its way up to the Supreme Court in several cases. “If you prevail here,” Kavanaugh pressed US Solicitor General Elizabeth Prelogar, “what would that mean for women’s and girls’ sports in particular?” It was notable that Kavanaugh was raising that question. The Trump nominee has discussed his efforts coaching basketball for his daughters’ teams, one of which even came to his confirmation hearing in 2018.

Gorsuch, a key vote in transgender case, remains silent: One of the most notable twists in the hours of speaking was a conservative justice who decided to say nothing at all: Neil Gorsuch. Gorsuch is considered a key vote in the case because he wrote the majority opinion in an unexpected decision four years ago in Bostock v. Clayton County that protected transgender employees from discrimination in the workplace. He was cheered by surprised LGBTQ+ advocates on the left and roundly criticized by conservatives – including several of his colleagues on the bench.

Read more key takeaways from the oral arguments.

Chase Strangio: The fight will not end at the Supreme Court

Chase Strangio, the first openly transgender person to argue in front of the US Supreme Court, speaks next to MC Peppermint outside the court following arguments over an appeal by President Joe Biden's administration of a lower court's decision upholding a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors, in Washington, DC, on Wednesday.

Cheers erupted outside the Supreme Court as the crowd welcomed Chase Strangio to the microphone following his historic arguments before the justices.

Strangio, the first openly transgender lawyer to argue before the Supreme Court, told the justices that Tennessee’s law took away “the only treatment that relieved years of suffering for each of the adolescent plaintiffs.”

Strangio, an attorney with the American Civil Liberties Union, represents three transgender youth and their parents who initially challenged the law.

Strangio thanked those who braved the frigid Washington, DC, weather to stand up for their rights and the rights of transgender people across the country. He said he felt emboldened by their support inside the courtroom.

“Whatever happens we are the defiance,” Strangio said. “We are collectively a refutation of everything they say about us. And our fight for justice did not begin today, it will not end in June – whatever the courts decide.”

Tennessee's attorney general says state is doing its "duty to protect our children"

Following oral arguments Wednesday, Tennessee Attorney General Jonathan Skrmetti defended the state’s gender-affirming care ban as common-sense medical regulation aimed at protecting minors.

The attorney general dismissed opponent’s claims that the Tennessee law discriminates based on sex and reiterated his stance that the policy falls within the state’s authority and should be kept out of the courts.

See courtroom sketches from today's oral arguments over gender-affirming care

The Supreme Court heard a challenge Wednesday on Tennessee’s ban on gender-affirming care for minors, the highest-profile case of the fall.

Cameras are not allowed inside the Supreme Court courtroom. See sketches below of key moments from the today’s proceedings:

Solicitor General of the United States Elizabeth Prelogar argues before the US Supreme Court on Wednesday, December 4, on US v. Skrmetti — a case that could determine whether states can ban this type of care for trans children and teens.
A person holds a court document during arguments before the US Supreme Court on Wednesday, December 4, on US v. Skrmetti — a case that could determine whether states can ban this type of care for trans children and teens.
Chase Strangio, the first openly transgender lawyer to argue before the Supreme Court, speaks before the US Supreme Court on Wednesday, December 4, on US v. Skrmetti — a case that could determine whether states can ban this type of care for trans children and teens.
The US Supreme Court justices listen to arguments on Wednesday.
Tennessee’s solicitor general J. Matthew Rice argues before the US Supreme Court on Wednesday, December 4, on US v. Skrmetti — a case that could determine whether states can ban gender affirming care for trans children and teens.

During arguments, SCOTUS conservative majority appears ready to endorse Tennessee law

Transgender rights supporters rally outside of the Supreme Court on Wednesday, December 4, 2024, in Washington, DC.

The Supreme Court’s conservative majority expressed deep skepticism Wednesday about a challenge to a Tennessee law banning gender-affirming care for minors, with several key justices repeatedly questioning whether the thorny issues should be left to elected lawmakers to decide.

Justice Brett Kavanaugh, another conservative who tends to be close to Roberts on high court, picked up on the concern that transgender care may not be a matter for courts to decide – a notion that would lean toward the Tennessee law being upheld.

“Why isn’t it best to leave it to the democratic process?” Kavanaugh asked.

The court’s three liberals indicated they strong support the Biden administration and trans youth that challenged Tennessee’s law banning puberty blockers and hormone therapy. Nearly half of the nation’s states have enacted similar bans on transgender care.

Justice Elena Kagan pushed back on the central argument made by Tennessee – and several of her conservative colleagues on the court – that Tennessee’s law is not based on sex. And Justice Ketanji Brown Jackson repeatedly said she was “nervous” that some of her colleagues seemed eager to hand the issue off to lawmakers.

One major question mark: Justice Neil Gorsuch. The conservative was closely watched as a key vote in the case. Gorsuch never asked a question, which is highly unusual and leaves his vote uncertain.

Gorsuch wrote the majority opinion in an unexpected decision four years ago in Bostock v. Clayton County that protected transgender employees from discrimination in the workplace.

A decision in the case is expected by July.

Gender equity advocates reflect on "pivotal moment" in trans rights movement

Trans journalist and advocate Imara Jones was in the packed Supreme Court courtroom Wednesday morning and described the arguments as a “pivotal moment” in the battle over trans rights.

Jones noted the case comes amid a wave of anti-trans bills being introduced in state legislatures and just weeks after the re-election of Donald Trump, who ran his campaign in part on a message to end “transgender craziness.”

She said she wished the court had heard more about the “visceral and real” impact of denying health care to trans people.

“There was not enough talk of what the benefits are of actually living your life as who you are,” Jones said. “There are all these people that can point to tremendous success (after treatment), how the treatments saved their lives, how it’s allowed them to be able to create families and do a whole host of things.”

Other gender equity advocates reacted to Wednesday’s oral arguments, arguing that eroding legal protections for transgender people could also impact other areas of American life, including reproductive care.

Kimberly Inez McGuire, the executive director of United for Reproductive & Gender Equity (URGE), said in a statement that “sexism and transphobia are two sides of the same coin.”

Prelogar warns of a nationwide ban on gender-affirming care like Tennessee law

US Solicitor General Elizabeth Prelogar said that if the Supreme Court embraced Tennessee’s arguments, it would open the door for a nationwide ban on gender-affirming treatment in minors. Previously in Wednesday’s arguments, Prelogar had noted that Tennessee’s arguments would also apply if the state sought to ban gender-affirming case for all residents, not just children.

The remark Prelogar made about a nationwide ban in her rebuttal remarks was aimed at Justice Brett Kavanaugh’s emphasis on how states can come to different conclusions when their policymakers are weighing the risks of treatments for minors against their benefits.

"The case is submitted": Oral arguments on transgender care case wrap

People hold rainbow-colored umbrellas and flags at a demonstration as the US Supreme Court hears arguments over an appeal by President Joe Biden's administration of a lower court's decision upholding a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors, outside the court in Washington, DC, on December 4.

At 12:29 p.m. ET, after roughly two and a half hours of oral arguments on the transgender care case, Chief Justice John Roberts gaveled the session closed.

A decision in US v. Skrmetti is expected by July 2025.

Rep. Marjorie Taylor Greene's speech outside Supreme Court met with boos

A sustained chorus of boos attempted to drown out a speech from GOP Rep. Marjorie Taylor Greene outside the Supreme Court.

Greene’s speech was barely audible over the return of music, sirens and boos.

“No child should ever take any type of hormones or chemical castration pills … before they’re ever old enough to vote or join the military,” the Georgia congresswoman tried to shout over the crowd.

Jackson grills Tennessee on who can and get hormone treatments under law

An exchange between Justice Ketanji Brown Jackson and Tennessee attorney Matthew Rice got testy as she grew frustrated with how he was depending on a law not before the court to answer her questions. Jackson was pressing on who can and cannot get hormonal treatment under the Tennessee ban in dispute in the case.

Jackson asked whether a boy who wanted hormones to deepen his voice in order to affirm his masculinity could get the treatments. Rice said the boy would not, because that was not a medical condition. But under more pressing by Jackson, he acknowledged that it was another law on Tennessee’s books barring the use of the drug for cosmetic reasons that would prevent that treatment. Jackson demanded that Rice set aside that statute, since that is not the law being challenged today, and focused on the specific statute in this case.

Eventually, Rice conceded that particular ban would not prevent the boy from receiving that treatment. Jackson then turned the hypothetical to a biological girl who wanted the treatment to deepen her voice.

“I think if it’s for the purpose of identifying inconsistent with their sex, she would be barred from doing that,” he said.

Kagan: Conservative arguments that case is only about health care are "a dodge"

Supreme Court Justice Elena Kagan sits on a panel at the 2024 Ninth Circuit Judicial Conference in Sacramento, California, in July.

Justice Elena Kagan pushed back on the central argument made by Tennessee – and several of her conservative colleagues on the court.

The whole case is tied up in the question of whether Tennessee’s law discriminates on the basis of sex. Kagan’s remarks were a clear signal that she opposes Tennessee’s law.

ACLU attorney points to historical anti-trans laws, rebutting Amy Coney Barrett

Chase Strangio speaks  on May 13 in New York City.

Chase Strangio countered claims by Justice Amy Coney Barrett that there was a historical absence of anti-transgender laws, with the ACLU attorney raising early in his arguments that that there were examples of government discrimination against transgender people in the form of bans on transgender service in the military and prohibitions on crossdressing.

Barrett later said that she had thought of the military example but had not thought of the cross-dressing ban, while asking Strangio for any other examples. Strangio said that there were other types of laws that lumped transgender and homosexuality together in their frameworks, but said the military and crossdressing policies were the most salient examples.

Barrett is interested in such laws because she had stressed that courts had previously deemed certain categories of people to be “suspect classes,” and it’s been after a pattern of state discrimination towards those classes.

Justice Jackson: "Suddenly quite worried" and "nervous" about conservatives' arguments

Ketanji Brown Jackson speaks on stage on September 20, 2024 in Washington, DC.

Justice Ketanji Brown Jackson said she was “suddenly quite nervous” that some of the conservatives seemed to be eager to bow out of the complicated issues involving transgender care just because the court doesn’t have medical expertise.

Jackson, after hearing several of her conservative colleagues make that point, noted that the court has historically weighed into those issues and she repeatedly called attention to a landmark 1967 decision that invalidated laws banning interracial marriage under the Constitution.

“I’m getting kind of nervous,” Jackson said at one point.

Kavanaugh: "Some people are going to be harmed," so who should SCOTUS choose?

Justice Brett Kavanaugh, always a key vote to watch, has repeatedly returned to the idea that some people might be harmed if the court sides with the trans youth. His focus on people who later regret transitioning suggests he has deep reservations the Biden administration’s position.

Kavanaugh pressed the attorney representing the transgender youth, on why that isn’t a question for elected officials to work out rather than courts.

J. Matthew Rice makes his pitch to the justices for Tennessee

Tennessee’s solicitor general, J. Matthew Rice, is making his debut argument at the Supreme Court to defend the state’s law. But it’s not Rice’s first time in the building: He clerked for conservative Justice Clarence Thomas during the 2019-2020 term.

Before Rice began his legal career, he played professional baseball with the Tampa Bay Rays organization. The All-American catcher played in the minor leagues for two seasons before attending law school.

Rice graduated from Western Kentucky University and the University of California, Berkeley School of Law. He also worked as an associate at the Williams & Connolly law firm. He clerked for Judge Sandra Ikuta on the 9th US Circuit Court of Appeals.

John Roberts knocks courts’ expertise, citing Covid cases

In one fascinating exchange, Chief Justice John Roberts appeared to argue that federal courts might want to stay away of the issue of gender-affirming care because the court isn’t adequately equipped to deal with fast-evolving medical and scientific issues.

“It seems to me that it’s something where we are extraordinary bereft of expertise,” Roberts said.

Roberts, a conservative, compared some of those fast-moving medical issues to the Covid-19 pandemic, during which the high court was frequently asked to wade into whether public health restrictions on churches and synagogues were constitutional.

Initially, the court deferred to public health authorities during Covid but it switched gears after conservative Justice Amy Coney Barrett was seated.

It’s a point that Chase Strangio, arguing on behalf of the trans youth, was quick to note.

“The court has not hesitated to suggest that heightened scrutiny applies in contexts that deal with medicine and science,” he said.

Alito warns of "endless litigation," an argument aimed at Roberts and Kavanaugh

After Chief Justice John Roberts and Justice Brett Kavanaugh raised concerns about courts deciding disputes about medical treatments that were best left to lawmakers, Justice Samuel Alito zeroed in on the issue and warned of “endless litigation” if the high court adopted the arguments made by Tennessee’s opponents.

In questions for ACLU attorney Chase Strangio, Alito said that if the justices agreed that courts should give greater scrutiny to laws concerning gender-affirming care, it would require courts not only to decide the constitutionality of blanket bans like Tennessee’s.

Courts would also have to confront legal questions about any limits that states put on those treatments, like consent requirements, counseling mandates and licensing rules, he said.

“Wouldn’t this be endless litigation … with the decisions based on determinations by lay judges regarding complicated medical issues?” Alito said.

Strangio makes history as first trans lawyer at Supreme Court

This March 2022 photo shows Chase Strangio, an American Civil Liberties Union lawyer, in New York.

Chase Strangio, the first openly transgender lawyer to argue before the Supreme Court, told the justices that Tennessee’s law took away “the only treatment that relieved years of suffering for each of the adolescent plaintiffs.”

Strangio, an attorney with the American Civil Liberties Union, represents three transgender youth and their parents who initially challenged the law.

Tennessee’s law, he said, “bans medical care only when it is inconsistent with a person’s birth sex. An adolescent can receive medical treatment to live and identify as a boy if his birth sex is male but not female.”

Hear more about him on today’s One Thing podcast.

Amy Coney Barrett raises historical absence of anti-trans laws as issue for Biden administration's arguments

US Supreme Court Associate Justice Amy Coney Barrett speaks at the Ronald Reagan Presidential Library Foundation in Simi Valley, California, on April 4, 2022.

Justice Amy Coney Barrett — who was not on the court when it decided the 2020 LGBT discrimination case that was the last major case bringing similar issues to the justices — asked Solicitor General Elizabeth Prelogar about what she perceived to be a historic absence of anti-transgender laws.

She asked whether a lack of those kinds of discriminatory state policies make the constitutional arguments the Biden administration is raising an “odd way” to approach the dispute.

Barrett stressed that she wasn’t questioning that there has been private discrimination against transgender individuals. But she said that when courts have deemed a category of people a “suspect class” worthy of certain legal protections, courts have done so when there has been a pattern of state laws and policies that discriminating against those categories of individuals.

Barrett said that the private discrimination that transgender people have faced did not seem “analogous” to government policies discriminating against people on the basis of religion or race, prompting courts to deem those categories of people “suspect” classes and requiring higher level of scrutiny of laws concerning those classes of people.

The Supreme Court has ruled that different groups of Americans receive different levels of protection under the equal protection clause. People who are discriminated against based on their race or religion are considered part of a “suspect class,” which means they receive the most protection.

The next level down, which cover people who face discrimination based on sex, are considered a “quasi-suspect class.” Discrimination based on sex receives a slightly less robust – but still considerable – protection in federal court.

Transgender Americans aren’t currently considered a quasi-suspect class, though the Biden administration is arguing in this case that the court should include them in this category. But the Supreme Court has for decades been reluctant to expand who is included in that class.