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How SCOTUS case is likely to impact Kentucky’s ban on transgender health care

An image of the outside of the U.S. Supreme Court building is shown, with a blue sky and white clouds behind it.
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The nation's highest court is getting involved in a legal battle over restrictions on gender-affirming medical care.

The Kentucky Legislature outlawed gender-affirming medical treatments for transgender children last year. Now, the U.S. Supreme Court will scrutinize a ruling that has kept that law in effect.

The U.S. Supreme Court accepted a case Monday that potentially could restore transgender kids’ access to gender-affirming hormone therapy in Kentucky.

A broad range of major medical associations say trans youth shouldn’t be barred from gender-affirming care, including medication that delays puberty as well as estrogen or testosterone treatments. However, Kentucky and 24 other states passed laws that restrict such treatments for minors in recent years, amid a surge in anti-trans statements by Republican politicians.

The Supreme Court agreed to take up a case that focuses on one such law passed in Tennessee. That is welcome news to the ACLU of Kentucky, which represents plaintiffs in a separate lawsuit challenging the legality of the Bluegrass State’s own ban on gender-affirming care.

“We are very, very happy that the Supreme Court will be reviewing a decision and considering a decision that we believe was incorrectly decided,” said Corey Shapiro, the ACLU’s legal director.

The decision in question is a September 2023 ruling by the 6th U.S. Circuit Court of Appeals. That ruling rejected legal injunctions that briefly blocked both Tennessee and Kentucky’s bans on gender-affirming care for minors, and instead allowed the laws to stay in effect while lawsuits challenging them make their way through the judicial system.

Because of that ruling, trans Kentuckians under 18 years old can’t access gender-affirming hormone therapy in their home state.

The Supreme Court could change that. If it finds fault with the 6th Circuit’s decision, Shapiro said that would reinstate the temporary injunction against Kentucky’s law approved by a U.S. district judge last June.

If that happens, trans youth could start receiving gender-affirming hormone therapy again, at least while the broader lawsuit over the ban continues.

“If the Supreme Court reverses the 6th Circuit decision, that puts the preliminary injunction back in place, and the law cannot be enforced,” he said.

It’s also possible the Supreme Court’s eventual decision in the Tennessee case could have further-reaching impacts, depending on how narrowly or broadly it’s written, according to Abigail Moncrieff, the co-director of Cleveland State University's Center for Health Law and Policy.

The Supreme Court sits at the top of the U.S. judiciary, so its decisions affect how judges in the lower courts decide future lawsuits on similar subjects.

A question at the center of the case the Supreme Court has accepted is: Does Tennessee’s ban on gender-affirming medical treatments for trans kids violate a clause in the U.S. Constitution’s 14th Amendment that says states can’t deny people equal protection under the law?

That question is pivotal to various lawsuits challenging similar bans in other states, including Kentucky.

“It certainly will have some impact,” Moncrieff said of the Supreme Court’s eventual decision in this case, which is expected by next summer. “Whether it definitively answers the question of which laws are permissible and which are not will depend somewhat on how the justices write the opinion, and which way they come out.”

“These things are very hard to predict,” she said.

Morgan is LPM's health & environment reporter. Email Morgan at mwatkins@lpm.org.

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