As I noted a month ago, the Supreme Court has granted the Solicitor General’s certiorari petition in United States v. Skrmetti. At issue is a Tennessee law that bars health-care providers from administering certain medical procedures for children with gender dysphoria. The procedures that are prohibited are surgically removing or modifying tissues, cavities, or organs (e.g., chopping off breasts or genitals) and administering puberty blockers or cross-sex hormones. Solicitor General Elizabeth Prelogar contends that the Tennessee law violates the Equal Protection Clause of the Fourteenth Amendment.
SG Prelogar’s argument rests heavily on her contention that “overwhelming evidence establishes that appropriate gender-affirming treatment with puberty blockers and hormones directly and substantially improves the physical and psychological wellbeing of transgender adolescents with gender dysphoria.” (Emphasis added.) But that contention was not true when the SG filed her certiorari petition last November. And developments since then make it crystal clear that Prelogar would be lying to the Court if she dares to repeat that contention in her merits brief.
Let’s start with some of those recent developments:
1. In April 2024, Dr. Hilary Cass published the Cass Review, a comprehensive 388-page report commissioned by England’s National Health Service. Over the course of four years, Dr. Cass commissioned nine systematic evidence reviews, assessed clinical guidelines, and reviewed data from NHS’s (now terminated) Tavistock Centre on pediatric gender care.
The Cass Review bluntly concludes that there is “remarkably weak evidence” that might weigh in favor of medical interventions on children and young people: “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.” (Emphasis added.)
Among its many findings:
- “The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes, and relatively weak evidence for any effect in adolescence.”
- On puberty blockers: “[N]o changes in gender dysphoria or body satisfaction were demonstrated. There was insufficient/inconsistent evidence about the effects of puberty suppression on psychological or psychosocial wellbeing, cognitive development, cardio-metabolic risk or fertility.”
- On cross-sex hormones: “There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents with gender dysphoria/incongruence, and few studies that undertake long-term follow-up. No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility. Uncertainty remains about the outcomes for height/growth, cardiometabolic and bone health. There is suggestive evidence from mainly pre-post studies that hormone treatment may improve psychological health, although robust research with long-term follow-up is needed.” (Quoting University of York “systematic review.”)
2. WPATH (the World Professional Association for Transgender Health)—the organization that has aggressively promoted transgender medical interventions on children and that has been treated as a reliable authority by many judges—has been exposed and discredited as thoroughly politicized. As journalist Jesse Singal explains in “Unsealed Court Documents Show That Admiral Rachel Levine Pressured WPATH To Remove Age Guidelines From The Latest Standards Of Care,” there is strong evidence that WPATH eliminated its minimum age requirements for various medical interventions in response to pressure from a Biden administration official (and transgender activist). More broadly, discovery in a case in Alabama has revealed (as Alabama’s motion for summary judgment states and extensively supports) that WPATH:
- violated multiple international standards for the creation of clinical guidelines that WPATH itself claimed to follow in Standards of Care 8 (“SOC-8”);
- restricted the ability of SOC-8’s evidence review team to publish the systematic evidence reviews finding scant evidence for transitioning treatments;
- intentionally used SOC-8 as a political and legal document to increase coverage for transitioning treatments and advance WPATH’s political goals;
- caved to outside political pressure by Admiral Rachel Levine and others to remove age minimums for hormones and surgeries in SOC-8; and
- “muzzle[d]” WPATH members who tried to inform the public of their concerns over pediatric transitioning treatments.
But even at the time she filed her certiorari petition, SG Prelogar had ample reason to know that her assertion of “overwhelming evidence” was untrue. Dr. Cass’s interim report, published in March 2022, “highlighted major gaps and weaknesses in the research base underpinning the clinical management of children and young people with gender incongruence and gender dysphoria, including the appropriate approaches to assessment and treatment.” That interim report “highlighted that little is known about the medium- and longer-term outcomes for children and young people receiving NHS support and/or treatment” for gender dysphoria. (I’m quoting what the Cass Review says about the interim report.)
Further, way back in 2020, the head of the John Hopkins evidence review team that WPATH itself commissioned reported to HHS that it “found little to no evidence about children and adolescents.” HHS wrote back: “Knowing that there is little/no evidence about children and adolescents is helpful.” (See Alabama’s motion for summary judgment, p. 16.)
The SG’s petition is remarkably shoddy in its supposed support for its assertion of “overwhelming evidence.” SG Prelogar cites three pages (Pet. App. 194a-197a) from the district judge’s opinion, but in those pages the district judge offers evidence that is far from “overwhelming” and is generally very hedged: one doctor’s testimony about her own patients, another doctor’s testimony about what “the available evidence indicates,” the judge’s own assertion that the second doctor’s testimony “is consistent with” WPATH Guidelines as to what studies “suggest” about how some symptoms “tend to” improve, and an assertion of mere correlation (“was associated with”).
Perhaps most strikingly, SG Prelogar purports to quote the district judge as flatly declaring that administering puberty blockers and cross-sex hormones to children with gender dysphoria “lowers rates of depression, suicide, and additional mental health issues” when in fact the judge says only that “the weight of evidence in the record suggests” such effects.
We shall see if SG Prelogar does a much better job of living up to her responsibilities to the Court when she files her merits brief or if she will instead continue to deceive the Court in service of the Biden administration’s ideological agenda.