The US Supreme Court Joins the Debate Over Gender Dysphoria

US v. Skrmetti is a legal case currently pending before the US Supreme Court that addresses the constitutionality of a Tennessee statute that prohibits gender-affirming medical care for transgender individuals who have not yet reached the legal age of adulthood, and who are diagnosed with gender dysphoria. Twenty-five other states have similar bans that apply to adolescents diagnosed with gender dysphoria, who are seeking treatment recommended by a physician and who are supported by their parents. Treatment involves gonadotropin-releasing hormone agonists, such as leuprolide or histrelin, which are approved by the Food and Drug Administration for use in children with central precocious puberty and are commonly prescribed off-label for adolescents. The purpose of puberty-blocking drugs is to suppress the onset of hormonal changes of puberty to facilitate the youth's anticipated transgender transition when the youth does reach the legal age of adulthood. Certainty about the time available for a youth to consider their gender identity, with the guidance of a professional support team, minimizes the risk of disruptive anxiety that's associated with near-term onset of sexual maturation involving development of irreversible secondary sex characteristics. This Commentary presents the legal arguments in the case and discusses relevant medical literature on this important issue in anticipation of the US Supreme Court's decision on the Tennessee law.