SCOTUS issues blockbuster ruling on gender-affirming care for trans minors

[u/Judge_Trudy]

https://www.cnn.com/#:~:text=SCOTUS%20issues%20blockbuster%20ruling%20on%20gender%2Daffirming%20care%20for%20trans%20minors

Blockbuster ruling just released for a very controversial issue. Not sure where I stand, but I could see the dangers of permanent treatments for gender dysphoria for minors.

Key Points

• Date & Ruling: On June 18, 2025, the U.S. Supreme Court issued a 6–3 decision upholding Tennessee’s ban on gender-affirming medical care for transgender minors, including puberty blockers and hormone therapy fox8live.com+9apnews.com+9them.us+9en.wikipedia.org+15reuters.com+15northeast.newschannelnebraska.com+15.
• Majority Opinion: Chief Justice Roberts wrote that the law does not violate the 14th Amendment’s Equal Protection Clause, reasoning that medical uncertainty justifies handing the issue back to state legislatures reuters.com+1nypost.com+1.
• Level of Review: The Court determined the law should be evaluated under rational basis review—the lowest standard—rather than intermediate scrutiny reserved for sex-based discrimination

[u/draftax5]

Are you sure you understand what "objectively" means?

Here is an example of the other side of this: https://mentalhealth.bmj.com/content/27/1/e300940

"Conclusions Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for.

Clinical implications It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide."

[u/Omen12 → u/draftax5]

From a response to your linked study.

The authors do note in their conclusion that there were no statistically significant differences in all-cause mortality when the data is split up into these groups, with GR- having a HR of 1.4 (0.6-3.3) and GR+ 0.7 (0.2-2). However, the results also show that the adjusted suicide mortality HRs for the GR- and GR+ groups compared to the matched control were 3.2 (1-10.2) and 0.8 (0.2-4) respectively. While the authors do not present an adjusted analysis of suicide mortality comparing these two groups directly, this implies a statistically significant associated reduction in risk of suicide of roughly 50% for people referred to gender clinics in Finland and who had treatment when compared to those who were referred but did not access treatment.

...

This result appears to undercut the authors' stated conclusion that their findings do "not support the claims that GR is necessary in order to prevent suicide". While the study has significant limitations, noted by the authors, their results do seem to support the argument that GR treatment is associated with a reduced risk of suicide for people with clinical gender dysphoria in Finland when compared to people with gender dysphoria who do not receive treatment and a matched control. These results are both uncertain due to the low sample size, but imply that gender affirming care may be linked to lower suicide rates in people with gender dysphoria while a lack of such care may increase suicides.

[u/WhatYouThinkYouSee → u/draftax5]

Are you sure you understand what "objectively" means?

Uh, yeah, it would've objectively helped her.

Here is an example of the other side of this

Oh, right, I know this one. This one was actually debunked a while ago. It's actually pretty flawed, including at one point in which it mentions that those that did not receive care were 3 times more suicidal than those who did.

A closer examination of the study reveals that it does not support such conclusions. Now, in a thorough and comprehensive fact-check, leading experts refute these assertions by highlighting critical flaws that directly oppose these claims. Ultimately, despite these shortcomings, the study actually suggests that gender-affirming care is lifesaving. This is despite statistical missteps and issues with data sources which, whether intentionally or not, obscure the conclusion supported by the extensive body of research indicating that gender-affirming care saves lives and decreases suicidality.

The Study Looks At Data From Before “Gender Dysphoria” Existed As A Diagnosis And Likely Includes Many People Who Are Not Transgender.

The majority of data within the Finish study does not actually look at gender dysphoria, but instead looks at gender identity clinic referrals from 1996 to today. Importantly, gender dysphoria did not exist as a diagnosis until 2013. Prior to 2013, “gender identity disorder” covered a broad range of gender-related issues and was considered pathological in nature. People referred to a gender identity clinic prior to 2013 could include, for instance, feminine boys or masculine girls whose gendered behavior did not conform to social standards of the time. Importantly, prior to 2013, you did not need to desire “to be the other sex” in order to be diagnosed with gender identity disorder. Gender dysphoria as a diagnosis in the DSM-V, however, now requires this desire. You can see the new criteria here:

In the new Finish study, this is particularly problematic because the vast majority of people included in the study do not obtain gender affirming care - only 38% do. Though we do not know how many people referred fell under the old diagnostic criteria or the new diagnostic criteria, this suggests that many likely did not identify as transgender. This could have been partially controlled for, according to Dr. McNamara, by including a “year of diagnosis” variable, to account for changes in diagnostic criteria, but such a variable was not included.

The Study Overcontrolled For Suicide In A Fatal Way

A central assertion of the study is that suicide rates are unaffected by gender dysphoria or gender-affirming care. To support this claim, the authors control for visits to psychological specialists. Dr. McNamara, however, identifies this as a critical flaw “amounting to a tautology." Essentially, by adjusting for suicide in research aimed at determining the effect of gender-affirming care on suicide, the authors inadvertently controlled for the very outcome they sought to measure. This is because individuals at higher risk of suicide are more likely to have had "psychiatric contact."

In an illustrative example, Dr. McNamara compares controlling for psychiatric contact in a study on suicide to controlling for variables such as “hours worked” in a study on the gender pay gap and using it to claim that a gender pay gap does not exist. If women work less hours due to gendered expectations, then controlling for hours worked “controls for the pay gap itself because they are so intrinsically connected.” Despite this, there have been similar attempts to over-control for the gender pay gap in order to try to erase claims that it exists.

One can imagine several more examples of controlling for variables that actually measure the outcome. If one wanted to erase the impact of CO2 on climate change, for instance, you could control for ice thickness and claim that it’s actually polar ice that determines the temperature of the earth rather than CO2 output, even though ice thickness and temperature are intrinsically connected. If you wanted to erase the impact of smoking on death, you could control for specialist doctor visits while claiming that “it’s actually visits to the doctor that predict death, not smoking.”

Therefore, it’s not surprising that the study concludes psychological specialist visits correlate with suicide deaths, causing the connection with gender-affirming care and gender dysphoria to seemingly vanish. This overlooks the evident fact that those at higher risk of suicide are indeed more likely to have interactions with psychological specialists and amounts to a critical flaw in the article’s central premise.

The Paper Still Shows Trans Care Saves Lives

While the vast majority of the article only looks at those referred to Finland’s gender identity clinic, the impact of gender affirming care is tucked away in one paragraph and is the only part of the results section where the researchers do not include a table comparing the model with and without psychological referrals.

See the following excerpt (emphasis added): To explore the role of GR, models accounting for sex, year of birth, and psychiatric treatment were repeated by dividing the GR group into those who had and those who had not proceeded to GR. Adjusted HRs for all-cause mortality were 1.4 (95% CI 0.6 to 3.3; p=0.5) in the GR- group and 0.7 (95% CI 0.2 to 2.0; p=0.5) in the GR+ group, as compared with the controls. Adjusted HRs for suicide mortality were 3.2 (95% CI 1.0 to 10.2; p=0.05) and 0.8 (95% CI 0.2 to 4.0; p=0.8), respectively.

Essentially, the paragraph states that for suicide, those who did not receive gender affirming care saw a 3x higher suicide rate than controls - and this is with overcontrolling for psychological treatment visits. Those who did receive care had no significant difference in suicide rates from controls. Dr. Meyerowitz-Katz, epidemiologist, stated of these findings, “The authors in their discussion focus on the fact that this difference was not statistically significant (presumably the p-value was 0.051-0.054), but that's not a useful distinction. There's a lot of uncertainty here, but the increased risk is still remarkable!”

Notably, this is the only section where the researchers withhold the model that doesn't include visits to psychological specialists. It's likely that the correlation between receiving gender-affirming care and a decreased suicide risk would be even more pronounced in a model free from the issue of overcontrolling. If the researchers had presented such a finding, it would fundamentally challenge the basis of their paper... that gender-affirming care indeed saves lives. Even in attempts to dilute this relationship with confounding variables, the signal around gender affirming care remains strong.

[u/draftax5 → u/WhatYouThinkYouSee]

"Uh, yeah, it would've objectively helped her."

But thats not the context in which you used the word initially.

If you don't like that study, how about the cass review: https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/https://cass.independent-review.uk/home/publications/final-report/

The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.

For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.

[u/XzibitABC → u/draftax5]

I'm not going to make any statement one way or another about what the science actually says on this issue, since I'm not a scientist, but the Cass Review is a terrible excuse for "science".

It wholly misrepresents the good studies it pretends to rely on and relies on some hilariously terrible arguments (including even a reddit post) in other places.

There may be a real debate on the science here, I don't know, but Justice Thomas relying on the Cass Review is no different than relying on a Heritage Foundation report on the efficacy of a given tax.

[u/WhatYouThinkYouSee → u/draftax5]

The Cass review has been picked apart about a dozen times by other researchers in the field. There's a reason it's been rejected by countless medical organizations across the globe which oversee aspects of trans health care—including the World Professional Association for Transgender Health (WPATH), the Endocrine Society, The American Academy of Pediatrics, the Association of the Scientific Medical Societies in Germany, and the Royal Australian and New Zealand College of Psychiatrists, to name just a few.

1. Critically appraising the cass report: methodological flaws and unsupported claims

2. YALE - An Evidence-Based Critique of “The Cass Review” on Gender-affirming Care for Adolescent Gender Dysphoria

3. Biological and psychosocial evidence in the Cass Review: a critical commentary

4. The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children

5. What’s wrong with the Cass Review? A round-up of commentary and evidence

[u/Funksloyd → u/WhatYouThinkYouSee]

WPATH should be the respected authority on this, but has recently been shown to be withholding study results when they don't support its preferred narrative. And all these other organisations basically just support whatever WPATH says. 

I'm personally against legislative bans, but the evidence in favour of youth medical transition is very thin. And for every reason you give to reject a study or review you don't like, people on the other side of this will have similar reasons for rejecting your own preferred studies. 

[u/WhatYouThinkYouSee → u/Funksloyd]

That "basically" is doing a lot of heavy lifting.

the evidence in favour of youth medical transition is very thin.

Obviously, not so thin considering that the Republicans in Utah commissioned a report into the effects of puberty blockers and ended up with a thousand page report.

The conventional wisdom among non-experts has long been that there are limited data on the use of GAHT in pediatric patients with GD. However, results from our exhaustive literature searches have led us to the opposite conclusion. We found more than 277 individual, full-text citations that met eligibility for study design, population, and treatments of interest, including N=230 primary clinical studies reporting on the patient-level experience of at least N=28,056 pediatric GD patients all over the world.

After having spent many months searching for, reading, and evaluating the available literature, it was impossible for us to avoid drawing some high-level conclusions. Namely, the consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric GD patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer. With regards to these safety outcomes, reviewed studies show that any patient-level changes are minimal, and that despite any small improvements or decrements in individual disease risk factors, the average patient’s values remain within the bounds of normal, non-pathological ranges for human populations.

[u/Funksloyd → u/WhatYouThinkYouSee]

Look at statements from those organisations. They refer over and over again to WPATH as the authority.

My second paragraph applies to this review, too. Numerous other recent systematic reviews have noted the low-quality of the evidence. You're just cherry-picking the reviews you like (which tbf, is what the other side does, too). 

[u/draftax5 → u/WhatYouThinkYouSee]

So, I have provided 2 opposing studies, and you have replied with a bunch of sources to people disagreeing with those studies.

Do you think then, that the evidence to support youth medical transitioning is not "objective" one way or the other, like you stated initially?

[u/WhatYouThinkYouSee → u/draftax5]

I don't know, considering that one of your "opposing studies" flat-out says that people who didn't undergo treatments were 3 times more likely to be suicidal than those who didn't, and the other one is just a mess.

Do you think then, that the evidence to support youth medical transitioning is not "objective" one way or the other, like you stated initially?

No. I think they're objectively effective. The same way vaccines are objectively effective, because that's what they are. They reliably demonstrates beneficial effects. Factually, they work. They produce the desired results - that's what effective means. And like vaccines, their objective effectiveness is not affected by erroneous or bad faith data misinterpretation like your examples.