More on United States v. Skrmetti, the big case on the Supreme Court’s docket next term in which the Biden administration is arguing that a Tennessee law that bars health-care providers from administering certain medical procedures for children with gender dysphoria violates the Equal Protection Clause.
In my Part 1 post, I examined Solicitor General Elizabeth Prelogar’s claim in her certiorari petition 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.) As I showed, that claim wasn’t 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.
Prelogar uses the adjective “overwhelming” on two other occasions in her certiorari petition and once in her reply brief. In all three instances, she claims that treating minors with puberty blockers and cross-sex hormones is supported by “the overwhelming consensus of the medical community.” Once again, her claim is overwhelming nonsense—false when she made it and in direct contradiction of what is instead a strong and clear international consensus developing against such treatments.
1. As Dr. James M. Cantor spells out in this declaration, there is a “growing international trend against the medicalized transition of minors”:
- Twenty years ago, Sweden permitted minors to receive puberty blockers at age 14 and cross-sex hormones at age 16. In 2019, a Swedish health agency conducted a systematic review of the evidence and found that its review “suggests that long-term effects of hormone therapy on psychosocial and somatic health are unknown.” In 2021, the leading Swedish pediatric gender clinic stated that treatments of puberty blockers and cross-sex hormones “are potentially fraught with extensive and irreversible adverse consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis.” In a dramatic reversal, it decided that it would no longer administer puberty blockers and cross-sex hormones to patients under the age of 16 and that patients ages 16 to 18 would receive such treatments only in research settings.” In 2022, the Swedish National Board of Health and Welfare concluded that, “[f]or adolescents with gender incongruence, the . . . risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits.”
- In 2020, Finland’s health-care service “greatly restricted access to puberty-blocking and cross-sex hormonal treatments, explicating that they may be considered for minors ‘only if it can be ascertained that their identity as the other sex is of a permanent nature and causes severe dysphoria,’ and only ‘if the need for it continues after [any] other psychiatric symptoms have ceased and adolescent development is progressing normally.’” (Dr. Cantor’s italics.) Any such procedures may take place only in “centralized research clinics.” Finland’s health-care service also emphasized the “need for more information on the disadvantages of procedures and on people who regret them.”
- In 2022, France’s Académie Nationale de Médecine warned that cross-sex hormones have “many undesirable effects, and even serious complications, …such as impact on growth, bone fragility, risk of sterility, emotional and intellectual consequences and, for girls, symptoms reminiscent of menopause.” It concluded that “the greatest reserve is required in their use.”
- In 2023, Norway’s Health Investigation Board concluded that “The knowledge base, especially research-based knowledge for gender-affirming treatment (hormonal and surgical), is insufficient and the long-term effects are little known” and that “This applies particularly to the teenage population.”
- On May 29, 2024, consistent with the Cass Review that I highlighted in my Part 1 post, the UK government issued an “emergency ban” on all new prescriptions of puberty blockers to minors by any physician, public or private, across England, Scotland, and Wales. A month earlier, a house editorial in the British Medical Journal (among the most respected medical journals in the world) bluntly declared that the “evidence base for interventions in gender medicine is threadbare” and that “[o]ffering treatments without an adequate understanding of benefits and harms is unethical.”
2. Any contention that there might be a “consensus” of the American medical community in support of puberty blockers and cross-sex hormones for minors raises a host of troubling questions. Why would such a consensus exist in the face of the contrary evolving international consensus and of the “remarkably weak evidence” (per Cass Review) for such treatments? Isn’t it troubling that WPATH, the organization that has aggressively promoted transgender medical interventions on children and that has been treated as a reliable authority by American medical associations, has been exposed and discredited as thoroughly politicized? (See point 2 of Part 1 post.) What reason is there to believe that the positions set forth by medical associations in group amicus briefs (rather than in formal policy statements adopted after review of the evidence) reflect the considered scientific assessment of those associations rather than the bullying of political activists?