Last week, the justices at the United States Supreme Court (SCOTUS) made headlines with their most anticipated ruling of their 2024-25 term: United States v. Skrmetti. SCOTUS ruled 6-3 that banning puberty blockers and hormone replacement therapy (HRT) for adolescents dealing with gender dysphoria does not violate the 14th Amendment's Equal Protection clause. The Tennessee law (SB1) does not classify on sex because it bans the practice regardless of sex. This law was ruled to not have violated the 14th Amendment because it does not discriminate on such clear-cut examples as race, biological sex, religion, or sexual orientation. The only distinctions the Tennessee law makes are based on age and on medical use, neither of which are reviewed under heightened scrutiny. Tennessee is one of twenty-seven states that prevents such medical interventions for minors, which means that the bans are by and large upheld in other states, as well.
As I brought up a couple of months ago with a UK ruling on biological sex, the concept of gender identity is incoherent. It is claimed to based on objective truth, but it can be changed on one's subjective whim. Gender identity is supposed to be a societal construct, but somehow is simultaneously biological and internal. Gender identity is identified as independent of biological sex but is also identified in reference to biological sex. It is designated based on self-expression but also as a product of socialization. Human rights and legal protections cannot be based on something as unintelligible, muddled, and disjointed as gender identity. It would also undermine protecting same-sex attraction if we cannot define the material reality of biological sex, as it would undermine women's rights.
Coherence within the legal system is not the only reason I was happy to see the Supreme Court rule in favor of common sense. As a long-term Dutch study pointed out last year (Rawee et al., 2024), 78 percent of those dealing with gender non-contentedness overcame whatever dysphoria they were dealing with by the time they became adults without any interventions. An additional 19 percent had decreased gender non-contentedness. This means that vast majority of adolescents dealing with gender dysphoria do not need to go to the extremes of gender reassignment surgery, puberty blockers, or HRT.
Then there is the argument of "having a living daughter is better than having a dead son." This argument assumes that without these treatments, children dealing with gender dysphoria will resort to suicide. Forgetting what we covered in the previous paragraph about most adolescents with gender dysphoria overcoming it without intervention, there has only been one main study conducted to directly assess whether sex-change hormones reduce suicide rates among trans individuals (Ruuska et al., 2024). The study concluded that no such association exists, a finding that was also detailed in the Cass Review. The Cass Review, which is the most comprehensive research on the topic to date, also shows the evidence shows that these interventions do not manage gender-related stress long-term.
Arguing that banning these procedures will increase suicide is a tactic to silence dissent and obscure another issue, which is that these treatments cause considerable harm. As I documented last year, gender affirming "care" lacks the evidence base, not to mention that puberty blockers are shown to have multiple side effects, including decreased bone density, deteriorating mental health, and lower IQ. Keep in mind that it was such European nations as the United Kingdom, Sweden, and Finland that were the trailblazers in providing these interventions a decade before it became trendy in the United States. These European countries have conducted systematic reviews and have concluded that the evidence is lacking. It is no coincidence that these nations recommend that these treatments are offered as a last resort and only offered in a clinical setting.
It is one thing if an adult wants to undergo such a procedure with informed consent, even though the evidence base shows a lack of benefit for the vast majority of patients and shows considerable risk and harm. I personally do not agree with such activities as having children before getting married, using preferred pronouns, taking out student loans for something as useless as a gender studies degree, eating fast food every day, not exercising, smoking cigarettes, or entering in a polygamous marriage. But as long as you are not harming anyone else, you can do whatever stupid, unhealthy, or disagreeable things you want.
Because children do not have the maturity, understanding (mens rae), or capacity to fully make their own decisions, how society treats children's rights is different. There are a myriad of activities and decisions from which children are legally restricted that adults are not restricted, whether it is voting, owning property, entering into most contracts, purchasing alcohol or tobacco, or working in hazardous occupations. Gender reassignment surgery, hormone replacement therapy, or using puberty blockers should not be an exception, especially given everything I have highlighted above.
Although the Supreme Court was asking a constitutional question about the 14th Amendment, the Supreme Court came with the correct ruling in terms of outcome. Gender-affirming "care" is not an evidence-based practice. There is evidence showing the harm that such practices cause, especially ones that life-altering and essentially irreversible. This lack of evidence base is also augmented by the fact that the vast majority of adolescents overcome their gender dysphoria, thereby making these treatments unnecessary for the vast majority of those dealing with gender dysphoria in the first place. Socially progressive European nations understand this reality. I hope that those in the United States who believe otherwise can actually follow the science instead of adherence to ideological compliance for its own sake.
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