When Tennessee imposed a ban on gender-affirming care for transgender youth last year, Sarah found herself taking time off work to drive long distances to a North Carolina clinic. Just a month later, a similar ban took effect in North Carolina, leaving her in a panic. She realized the closest state with available treatment would be Ohio, over 400 miles away. Thankfully, the North Carolina law had exceptions for those already receiving treatment. "I should be able to take my child to a nearby clinic and get the care they need easily," Sarah told CNN, using a pseudonym for her family's safety.

Parents and Transgender Communities on Edge

Parents like Sarah and the transgender community across the US are closely watching as the US Supreme Court hears arguments in US v. Skrmetti. This case could determine whether states can ban certain forms of gender-affirming care for trans children and teens. The Biden administration brought the case on behalf of trans youth families, challenging the constitutionality of Tennessee's ban, which restricts puberty blockers and hormone therapy and imposes penalties on doctors. Tennessee Attorney General Jonathan Skrmetti argues the law ensures minors understand the consequences, but plaintiffs' attorneys point to medical organizations that support the safety and necessity of the treatments.Since the state law was enacted, parents have gone to great lengths to seek out-of-state treatment, sometimes dipping into savings and taking on debt. The court's decision will have a significant impact on both sides and the transgender community nationwide. A win for the plaintiffs could protect trans people under the equal protection clause and combat anti-trans laws. A win for the state could lead to more restrictions on trans health care.

What If the Ban Is Struck Down

If the court rules Tennessee's ban unconstitutional, it would be a major victory for transgender rights advocates. Similar state laws would be invalidated, and trans youth would have greater access to gender-affirming care. Dr. Maurice Garcia, director of the Cedars-Sinai Transgender Surgery and Health Program, says gender-affirming care helps transgender people live in accordance with their gender identity and eases anxiety and depression. Currently, 26 states have passed laws restricting this care, but some bans have been blocked. The court's decision would only affect bans similar to Tennessee's, and it could be sent back to the appeals court for "heightened scrutiny."Sarah's son experienced a significant change after receiving testosterone therapy. Before, he was withdrawn and frustrated, but after, he became confident and at peace. However, a ruling in favor of the plaintiffs wouldn't end the fight. Elana Redfield, federal policy director at the Williams Institute, expects states to continue to find ways to ban access to gender-affirming care. In Arkansas, for example, a ban has been blocked, but a new law allows patients to file malpractice lawsuits against their doctors for up to 20 years after turning 18.

What If the Ban Is Upheld

A ruling upholding the Tennessee law would strengthen the patchwork of trans health care bans in the country, making it more difficult for minors to access gender-affirming care and potentially opening the door to wider restrictions for trans people. Transgender advocates fear this lack of access could worsen mental illness among trans minors and lead some families to leave the state. Research shows that transgender youth face significant mental health issues, with high rates of considering and attempting suicide.As families grow desperate, they are taking extreme measures. Some are splitting up their households to ensure their trans child can receive care. Nearly half of transgender and nonbinary people surveyed said they or their family have considered moving due to LGBTQ+-related politics and laws. Sarah has already considered uprooting her family to a state where her son can get treatment.

Implications Beyond the Case

By ruling that Tennessee is not discriminating against trans youth, the court could give the green light for conservative lawmakers to extend health care restrictions to trans adults. Lawyers for the plaintiffs also worry about the implications for other healthcare issues like abortion, IVF, and birth control. They point to the Dobbs v. Jackson decision, where Justice Samuel Alito wrote that abortion regulations do not require heightened scrutiny. Tennessee has used this argument to defend its ban.However, attorneys for the plaintiffs argue that the law clearly discriminates based on sex. No matter the outcome of Skrmetti, transgender communities will continue to fight for their rights in other legal avenues. "We'll always be here, fighting and surviving," said Shawn Meerkamper.