As transgender activism continues to ratchet up across the country, the U.S. Supreme Court is preparing to weigh in on a Tennessee law that prohibits puberty blockers, cross-sex hormones, and sex reassignment surgeries for minors. The question before the court is whether the law, SB1, violates the Equal Protection Clause of the 14th Amendment to the U.S. Constitution, and the outcome could have a profound impact on similar laws or policies in progress or already on the books in 26 states.

Ratified in 1868, the Equal Protection Clause was intended to prevent post-Civil War discrimination against African Americans. But as the Constitution Center points out, “the text of the Clause is worded very broadly and it has come a long way from its original purpose.”

Nonetheless, the Washington Examiner observed that, during oral arguments on December 4, there appeared to be “enough justices on the nine-member court who seemed skeptical of the Biden Administration’s contention that Tennessee’s law marked a violation of the 14th Amendment’s equal protection clause.”

The lawsuit was originally filed against Tennessee Attorney General Jonathan Skrmetti and others by the ACLU and several law firms claiming to represent “families with transgender adolescents.” In September 2023, Reuters reported that the U.S. Court of Appeals for the 6th Circuit found that Tennessee and Kentucky “could enforce laws banning gender-affirming medical care for minors, such as puberty blockers, hormones and surgery.” The Biden Justice Department then intervened in the case, “asking the Supreme Court to take up the dispute.”

Last July, the same Appeals Court for the 6th Circuit upheld a Tennessee policy prohibiting citizens from changing their sex on their birth certificates. As reported by The Tennessean, the court ruled that “there is no fundamental right to a birth certificate recording gender identity instead of biological sex,” and called the policy, “a nondiscriminatory form of government speech embraced by some States about an undeniable historical fact.”

More than ‘The Dirty Dozen’

Over the past several years, many experts have sounded the alarm about the physical and emotional destructiveness of transgender medical interventions. For example, practicing child and adolescent psychiatrist and author, Dr. Miriam Grossman, told The Washington Stand that such “experimental” procedures “have proliferated, in part because of money, but also because the American Academy of Pediatrics and the American Psychiatric Association for many years have been taken over by a small group of activists who simply push their agendas forward and stifle debate. And too many of my colleagues are simply spineless and not willing to speak up against it.”

Grossman was referring to the recently released Stop The Harm Database, compiled by the non-profit health advocacy organization Do No Harm. The data shows that nearly 14,000 minors underwent “transgender surgeries, puberty blockers, or cross-sex hormone injections between 2019 and 2023, generating nearly $120 million in revenue.” (The October Education Reporter briefly described this data.)

Do No Harm’s Data-Gathering-and-Analysis-Methodology further showed that 5,747 minor patients underwent sex-change surgeries and, 8,579 received cross-sex hormones and puberty blockers during the four-year time frame. As chairman Dr. Stanley Goldfarb explained in National Review: “We’ve really been meticulous in trying to make sure that the data are as clear as possible and are as accurate as possible.”

The database lists what Do No Harm calls “The Dirty Dozen Hospitals, or the worst-offending children’s hospitals promoting sex change treatments for minors.” (See sidebar for the list.) But it is important to note that these institutions are not the only ones harming kids. Approximately 225 hospitals nationwide, including some religious-affiliated hospitals, have been found by Do No Harm to be performing transgender procedures.

The database shows that from 2019-2023, “170 children were subjected to ‘transgender’ surgeries and 508 children were prescribed cross-sex hormone or puberty blocker drugs at various Catholic hospitals in the nation.” The organization CatholicVote.org posted a response to these findings by a spokesperson for the U.S. Conference of Catholic Bishops (USCCB). The response reiterated church teaching “about the inherent dignity of each person as created in the image and likeness of God,” and restated that the bishops “have been clear as to what’s morally acceptable when it comes to procedures or interventions related to ‘gender transition.’”

Bishop Robert Barron of the Winona-Rochester, Minnesota diocese, which had no reported violations of USCCB policy at its Catholic hospitals, was more direct. “The surgical mutilation and chemical castration of young kids under the rubric of ‘gender-affirming care’ is a moral outrage,” the bishop wrote in an email to CatholicVote. “That any of it takes place within the confines of a Catholic hospital is appalling.”

CatholicVote’s Accountability Project director, Tommy Valentine, said: “I know a lot of people in and around Catholic healthcare, and it’s clear that most of our Catholic hospitals provide care that respects human dignity. But a minority of them have lost the plot.... We’re all on the same team here, including the bishops, and we need to work together to prevent this madness from ever happening again within our hospitals.”

Unfortunately, many Catholic hospitals operate outside the auspices of the dioceses in which they are located, and “have their own boards of directors that oversee them.” While they are expected to follow church teaching, this obviously does not always happen in practice, and some observers believe transgender activists find ways to advance their agenda while keeping a low-profile. (See Education Reporter, August 2024.) It should perhaps be no surprise that the highest number of procedures that took place in Catholic hospitals were located in either blue or purple states, including “Oregon, California, Washington, New Mexico, New York, Wisconsin, Minnesota, Pennsylvania, and Virginia.”

Serious concerns

The release of Do No Harm’s data prompted a response from the American Society of Plastic Surgeons (ASPS). Manhattan Institute Fellow, Leor Sapir, Ph.D., posted an email on X from ASPS, which reads in part:

• ASPS has not endorsed any organization’s practices recommendations for the treatment of adolescents with gender dysphoria. ASPS currently understands that there is considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions for the treatment of adolescents with gender dysphoria, and the existing evidence base is viewed as low quality/low certainty. This patient population requires specific considerations.

The email further acknowledges that “plastic surgeons have a responsibility to provide comprehensive patient education and maintain a robust and evidence-based informed consent process, so patients and their families can set realistic expectations in the shared decision-making process.”

Do No Harm’s external relations manager and registered nurse, Beth Serio, told the The Daily Signal News Foundation (DCNF): “Its a common lie in the trans industry in America that these procedures are very highly reversible, that there’s no long-term effects. We know that’s simply not the case....”

She added that so-called “’gender-affirming surgery’ is significantly associated with elevated suicide-attempt risks, underlining the necessity for comprehensive post-procedure psychiatric support.” She further explained that many children suffering from gender dysphoria “have comorbidities with different mental health illnesses, and we know that medicalizing does not decrease the incidence of mental health problems. Instead, it increases, typically, the mental health problems that they have.... So, we really have to ask ourselves: ‘Why are we doing it?’”

Of course, there is no replacing the healthy body parts that have been removed from troubled young patients, which has resulted in a burgeoning number of desperate detransitioners whose lives have been permanently ruined by tragic and unnecessary procedures.

Biden-Harris influence

The Biden-Harris Administration has done its part to further the transgender agenda by enabling unelected bureaucrats to take gender-confused children from their “non-affirming” parents through a new federal rule. Inspired by Alex Roque, head of the Ali Forney Center for homeless LGBT kids in New York City, and a social services program in Cuyahoga County, Ohio, the new HHS rule instructs states to place foster children identifying as LGBT “in [gender] affirming homes.”

According to the DCNF, Roque appeared in a U.S. Department of Health and Human Services (HHS) webinar last year, where he stated: “Family rejection of a child’s gender identity cannot be dismissed as a personal view. Non-affirmation must be treated as abuse. If they were denying them food or denying them access to school or denying other things, there would be prosecution.” The DCNF opined that Roque’s opinions “cast a vision for completely transforming child protective systems nationwide.”

The Cuyahoga County program helped seal the deal. DCNF reviewed hundreds of documents and emails obtained through FOIA requests, and found that the program “strong arms parents into affirming whatever confused beliefs children express about their gender. Parents who decline risk losing a voice in their child’s life.” The program, which uses federal grants provided by HHS, proved “an ideal model for infusing gender ideology into foster care and social services.”

The final rule is scheduled for implementation by October 2026. While it specifies children in foster care, Rachel Morrison, director of the HHS Accountability Project for the Ethics and Public Policy Center (EPPC), called it “a dangerous premise [that] could extend outside the foster care context to adoption, custody disputes, and schools.”

Many observers say this is already happening, and that stories of children being taken from parents who resist affirming their child’s wishes are surfacing nationwide. Vernadette Broyles, president and general counsel of the The Child and Parental Rights Campaign, confirms that more families are being “investigated or disrupted” because they believe in “biological reality.”

In a video interview with Washington Watch, Broyles said her organization is currently representing six families whose children expressed “gender confusion” and who are in danger of being removed from their homes by overzealous school and child protective services activists. “Immediately [when a child expresses an interest in becoming the opposite sex],” Broyles said, “school officials begin to affirm and endorse this imagined identity, hide it from the parents, lie to the parents [and ignore] the objections of the parents, and then continue to socially transition the child.”

Broyles warned that the Biden Administration’s rule “creates an assumption that parents who have a scientific or religious belief that there are two genders are emotionally abusive — or worse, failing to provide for their child’s needs.”

Supreme Court to rule next year

During the December 4 oral arguments in United States v. Skrmetti, both pro-transgender activists and supporters of the Tennessee law rallied outside the Supreme Court. Do No Harm hosted a "Stop the Harm" Rally on the court steps, which organizers say “was an enormous success, even going viral on social media....” Supporters gathered to hear speakers that included producer, writer, and activist Matt Walsh, detransitioner and Do No Harm patient advocate, Chloe Cole, Tennessee lawmakers who sponsored their state’s pro-child law, and other prominent pro SB 1 voices.

Walsh later posted on X that Justice Samuel Alito cited “the Cass Report, a nearly 400-page report that examined ‘gender identity services for children and young people’ in the United Kingdom.” Walsh wrote: “Alito pulled up Page 195 of the Cass report, showing that child sex-changes don’t actually prevent suicide.” ACLU attorney Chase Strangio admits in response that there’s “no evidence that these procedures actually reduce suicides.”

A decision in the case is expected to be announced by late June or early July 2025.

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