Conservative lawmakers have been actively introducing numerous bills in recent years, specifically targeting transgender youth's access to medical care and their participation in public life. On Wednesday, the Supreme Court is set to hear oral arguments regarding one such legislative attack - Tennessee's ban on treatments for transgender minors, including puberty blockers, hormone therapy, and surgery. (It's important to note that cisgender youth are not prohibited from pursuing these same treatments.) This challenge holds significant implications nationwide.

Unveiling the Impact of Tennessee's Ban on Transgender Youth Care

Introduction to the Issue

In recent years, conservative lawmakers have been introducing a significant number of bills that directly affect transgender youth. Tennessee's ban on certain treatments for these minors is now before the Supreme Court, with potential consequences that extend far beyond the state. This ban has sparked a heated debate and raised concerns about the rights and well-being of transgender youth.

As of now, Tennessee and 25 other states have imposed restrictions on gender-affirming care for minors, despite protests from leading medical organizations. These laws have a profound impact on nearly 40 percent of all trans youth in the country. The plaintiffs in the Skrmetti case include a 16-year-old transgender girl, her parents, and two other families. Dr. Susan Lacy, a board-certified OB/GYN with decades of experience treating trans patients in Memphis, has been at the forefront of this issue.

The Journey of Providing Gender-Affirming Care

Dr. Lacy's decision to expand her practice to include gender-affirming care was a natural progression. After nearly 19 years in a private practice group, she joined a local nonprofit with a mission to provide transgender care. As a gynecologist, she found hormone management to be fascinating and was already familiar with the hormonal aspects of both masculinizing and feminizing care.

One patient's story stood out to her. They described feeling like a "Mac" operating with a "Windows system," with their brain and its functioning not aligning with their gender identity. Another patient, a 20-year-old from Alabama, had been misdiagnosed with multiple personality disorder but found relief through testosterone. These examples highlight the importance of understanding the complex relationship between brain chemistry and gender identity.

The Impact on Minors

Before the law was passed, Dr. Lacy had around 25 minors in her practice receiving gender-affirming care. She emphasizes that she never treated pre-pubertal children with puberty blockers, as that requires the input of a pediatric endocrinologist. She often worked in collaboration with a local endocrinologist, with the endocrinologist providing initial treatment and referring patients to Dr. Lacy for contraceptive management as they grew older.

When working with minors and their families, Dr. Lacy takes a comprehensive approach. She starts by asking about the patient's journey and their expectations. Parental consent and a psychological evaluation are required, with a letter from a psychologist. The process is not quick; it takes time for individuals to become aware of their gender identity and for parents to come to terms with it.

Addressing Concerns

One common concern is the perception that gender-affirming care is a rapid process. In reality, it is a gradual journey. Voice deepening is permanent, while breast growth is not reversible but also does not happen overnight. Other changes, such as facial hair growth, are reversible. Fertility is an open question as there is not enough data. Dr. Lacy uses analogies with her own family to help parents understand that the goal is to approximate the hormonal environment of the gender with which the child identifies.

The minors she treated were often eager to start the process. They were well-informed through online resources and were ready to take the next step. However, the ban on gender-affirming care has had a devastating impact on their mental health. Many feel bewildered and angry when their care is taken away, and they struggle to understand why. Dr. Lacy and her patients had to come up with a plan to continue care, often seeking resources outside of Tennessee.

The Role in the Lawsuit

Dr. Lacy decided to join the lawsuit for several reasons. As an independent practitioner with a trans child, she believes it is important to address these issues and bring them to the forefront. Her experience treating a large number of trans patients has given her a unique perspective that she feels needs to be heard.

She also feels that someone has to speak up for the minors. Their voices are compelling, and they deserve to have their rights protected. Many families with trans children are concerned about retaliation in the current political climate, and Dr. Lacy is aware of the risks. However, she is committed to standing up for her patients and ensuring that their voices are heard.

The Chilling Effect on Younger Patients

The ban on gender-affirming care not only affects minors but also has a chilling effect on younger post-adolescent patients. Those between 18 and 25 years old often rely on parental insurance and may not have the support of their families. While they are legally able to seek care, the lack of family support can make it difficult for them to access the treatment they need.

The high rates of suicidal thoughts and attempts among trans kids are a significant concern. The ban exacerbates these issues, as it limits the options available to these young people. Dr. Lacy is worried about the long-term consequences of this law and the impact it will have on the well-being of transgender youth.

In conclusion, the ban on gender-affirming care for transgender minors in Tennessee has had a profound impact on the lives of these young people. Dr. Lacy's story and the experiences of her patients highlight the importance of understanding and respecting the gender identities of transgender youth and the need to protect their rights.