DOJ Joins Challenge to Tennessee Transgender Youth Healthcare Ban

The Department of Justice (DOJ) filed a complaint to join an existing lawsuit alleging that Tennessee's new law banning gender-affirming healthcare for minors is unconstitutional, and asked the court to issue an injunction on the state's Senate Bill 1 (SB 1).

"This lawsuit challenges a state statute that denies necessary medical care to children based solely on who they are," the new complaint read.

SB 1 specifically prohibits medical treatment using puberty blockers, hormones, and surgical procedures for minors with gender dysphoria. It does allow the use of these treatments for "congenital defects," including "abnormalities caused by a medically verifiable disorder of sex development."

The law calls such treatments "harmful, unethical, immoral, experimental, or unsupported by high-quality or long-term studies" which "might encourage minors to become disdainful of their sex."

However, these treatments are part of the standards of care published by the World Professional Association for Transgender Health, the Endocrine Society, and the American Academy of Pediatrics, and are widely accepted and part of a personalized, multidisciplinary approach, the complaint stated.

"The Ban does nothing to protect the health or well-being of minors. To the contrary, it gravely threatens the health and well-being of adolescents with gender dysphoria by denying them access to necessary care," the original lawsuit read, which was filed by the American Civil Liberties Union (ACLU), the Lambda Legal Defense and Education Fund, and the law firm Akin Gump Strauss Hauer & Feld LLP.

In a statement from Lambda Legal, Chase Strangio, JD, deputy director for transgender justice at the ACLU's LGBTQ & HIV Project, said, "Because this law discriminates on the basis of protected characteristics and infringes on the fundamental rights of transgender youth and their families, it demands a level of legal scrutiny that Tennessee will not be able to meet."

Similar bans on gender-affirming care in Alabama and Arkansas have been challenged in federal courts.

"Tennessee legislators seem hellbent on joining the growing roster of states determined to jeopardize the health and lives of transgender youth, in direct opposition to the overwhelming body of scientific and medical evidence supporting this care as appropriate and necessary," said Sruti Swaminathan, JD, Lambda Legal's staff attorney for youth, in the statement.

Tennessee's ban of various forms of medical care only for transgender minors, the DOJ noted, violates the Fourteenth Amendment to the U.S. Constitution, which guarantees equal protection of the law. SB 1 discriminates on the the basis of sex and transgender status, the DOJ added, because it allows other minors to access the same treatments.

A memorandum attached to the DOJ complaint stated, "If the purported health-driven concerns regarding the risks of the procedures undertaken as part of gender-affirming care were genuine, SB 1 would prohibit those same procedures for all minors, whether they are transgender or non-transgender."

Three families of transgender youths and a doctor are listed as plaintiffs in the complaint filed against Tennessee's Attorney General Jonathan Skrmetti, JD; Ralph Alvarado, MD, the commissioner of the Tennessee Department of Health; Melanie Blake, MD, president of the Tennessee Board of Medical Examiners; and other agency leaders.

One of the minor plaintiffs known as John Doe, age 12, had been diagnosed with gender dysphoria around the second grade. After transitioning socially, getting an official name change, attending years of therapy, and undergoing evaluation by Vanderbilt Children's Hospital, Doe was prescribed puberty-blocking medication.

"The idea of losing access to his medication is horrifying to John. He cannot imagine losing control of his life for the next six years and fears permanent changes to his body if he undergoes the wrong puberty," the original complaint stated. "His parents fear for John's safety as a transgender individual should he lose access to this important healthcare."

The physician plaintiff, Susan Lacy, MD, provides gender-affirming care to hundreds of transgender patients at her private practice, a portion of whom are minors. She is at risk of losing her license if she continues to treat her patients, and could be sued for $25,000 for violating SB 1.

According to the original complaint, "Dr. Lacy is deeply concerned for her young transgender patients because her experience leads her to believe that denying her patients access to gender-affirming hormone therapy can lead to depression, increased anxiety, and suicidal ideation."

A statement emailed to MedPage Today, attributed to Attorney General Skrmetti, read, "The federal government has joined the ACLU and an elite New York law firm in attacking a bipartisan law that protects children from irreversible harm. I welcome the opportunity to litigate these issues and vigorously defend Tennessee's law."

Tennessee Gov. Bill Lee (R), in a statement emailed to MedPage Today, said that "Tennessee is committed to protecting children from permanent, life-altering decisions. This is federal overreach at its worst, and we will work with Attorney General Skrmetti to push back in court and stand up for children."

The DOJ said it did not have additional comments beyond the filing.

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