Mother Jones illustration; Getty

In 2016, when Tennessee OBGYN Susan Lacy learned she would be providing gender-affirming care to transgender patients in her new job at a reproductive health clinic in Memphis, she felt out of her depth. But it didn’t take long to realize that hormone treatments for trans folks weren’t so different from those she’d been providing for years to cisgender patients. She already knew how to use pills, patches, gels, and injections, with their different formulations and side effects, to reduce menopausal night sweats, hot flashes, and brain fog. Patients who took hormones for gender dysphoria told her they felt a similar sense of relief. “It didn’t matter about socioeconomics, age, race, feminizing or masculinizing hormone therapy,” Lacy says. Often the first reaction was, “I finally feel like I can think straight.”

Now a gynecologist in solo practice, Lacy has more than 300 adult trans patients. At one time, her patient list also included trans teenagers with the consent of their parents. But last year, Tennessee prohibited the prescription of certain medications to minors to treat the distress many trans people feel when their bodies do not align with their gender identity. Under the law, cisgender kids could keep receiving the meds: puberty blockers for those who start puberty too early, for instance, or testosterone or estrogen for teens who enter puberty late. But if the purpose was to treat gender dysphoria, those same medications were forbidden.

On Wednesday, the US Supreme Court will hear oral arguments in a landmark lawsuit challenging the Tennessee ban, brought by the Biden administration’s Department of Justice, Lacy, and three trans minors and their families. United States v. Skrmetti is one of the biggest cases of the term and the first major trans-rights case to be heard by the court since far-right lawmakers and policy groups launched a coordinated campaign inundating statehouses with hundreds of anti-trans bills a few years ago. Legal experts say the Skrmetti case could shape the landscape for trans rights for years to come, while testing how far the Court’s conservative supermajority is willing to extend its 2022 decision allowing states to ban abortion: Will the justices give states free reign to outlaw yet another form of healthcare?

“Before treatment, I hid,” one plaintiff, 15-year-old Ryan Roe, wrote in a declaration asking a federal judge to put the ban on hold. But with hormone therapy, “I am raising my hand in class again and participating in all aspects of school. I feel stronger—physically, mentally and emotionally. I feel so happy with myself and that makes me feel like I can do and be more.”

That changed, he added, when Tennessee lawmakers began debating the gender-affirming care ban. “Hopelessness creeped in again.”

The Skrmetti arguments are happening at a time of intense fear and vulnerability for the trans community. President-elect Donald Trump and his allies bet on transphobia to take back the White House and Congress, pouring millions into anti-trans campaign ads and vowing a broad crackdown on what Trump refers to as “left-wing gender insanity” (though the extent to which trans issues swayed the electorate remains unclear). Supported by groups like the Heritage Foundation, the think tank behind Project 2025, and Alliance Defending Freedom, a religious-right legal behemoth, states have made particular targets of trans young people, restricting their use of school bathrooms and locker rooms, their participation in sports, and discussion of LGBTQ-related topics in classrooms and libraries.

They have also targeted medical care, with nearly half of states outlawing gender-affirming treatments for people under 18,........

© Mother Jones