Tennessee's transgender health care law: What to know about latest legal wrangling

A federal appeals court last week reinstated a new Tennessee law than bans gender-affirming treatments for transgender youth, leading to some legal whiplash for Tennesseans as the law was first blocked from full enforcement and is now in total effect.

The ruling was a temporary one, though, and the case is likely to continue to make headlines in the coming months in the ongoing struggle over LGBTQ rights in Tennessee.

Here's what to know about the case and the legal proceedings so far.

What is the case?

In April, a trio of transgender youth and their families sued Tennessee over the new law, which legislative Republicans passed earlier this year. The lawsuit, L.W. v. Skrmetti, was filed in federal court.

The suit was filed on behalf of three Tennessee families — Nashville residents Samantha and Brian Williams and their 15-year-old transgender daughter L.W.; Rebecca Roe and her 15-year-old son Ryan; and anonymous parents of a 12-year-old son. The plaintiffs also include Memphis-based Dr. Susan Lacy, who provides gender-affirming care for her patients.

The law bans medications such as puberty blockers and hormone treatments for children who identify as transgender or nonbinary. Gender-affirming surgeries, which were very rare in Tennessee but at the center of the trans youth care controversy, were also banned under the law. The law went into effect on July 1, while children who currently take medications have until March 31, 2024 to cycle off the treatment.

How are the families challenging the law?

The lawsuit argues the law is unconstitutionally discriminatory, as a child could be prescribed a puberty blocker or hormone medication for any diagnosis other than gender dysphoria under the law. Families describe the treatments, taken after a series of tests and medical advisement, as life-saving treatment.

“I don’t even want to think about having to go back to the dark place I was in before I was able to come out and access the care that my doctors have prescribed for me,” L.W. said in a statement this spring.

Republican lawmakers, and now Attorney General Jonathan Skrmetti, have argued the treatments are in some cases irreversible and cause harm to minors who aren't yet mature enough to make their own medical decisions.

"The Tennessee General Assembly passed a law to protect Tennessee children from the lifelong consequences of these interventions, and we will vigorously defend that law," a Skrmetti spokesperson said in April.

Who are the judges in L.W. v. Skrmetti?

The lawsuit, filed in Tennessee's Middle District, is before U.S. District Court Judge Eli Richardson. Richardson was appointed to the bench by then-President Donald Trump in 2017.

When Skrmetti appealed Richardson's preliminary ruling that blocked Tennessee from enforcing part of its law last month, a three-judge panel from the 6th U.S. Circuit Court of Appeals issued a ruling. The court has jurisdiction over Tennessee.

Chief U.S. Circuit Judge Jeffrey Sutton, a George W. Bush appointee, and Judge Amul Thapur, a Trump appointee, found in favor of the state.

Judge Helene White, another George W. Bush appointee, dissented in part from the panel's opinion, finding Tennessee's law is likely unconstitutional on the basis of sex discrimination.

While the 6th Circuit is now expected to issue a final ruling on Tennessee's appeal of the preliminary injunction, Richardson will still preside over a full trial on the lawsuit.

What are the judges saying?

In an early ruling, Richardson said Tennessee's evidence to prove the alleged harm of gender-affirming treatment was "minimally persuasive."

Richardson found Tennessee's medical experts had never diagnosed or treated a minor with gender dysphoria, while the plaintiff's medical experts have treated "hundreds" of cases.

Richardson found the law likely infringes on Tennesseans' constitutional rights, namely the Equal Protection clause, as treating someone disparately based on transgender status is inherently discriminating based on sex. Richardson leans on a legal precedent from a 2020 U.S. Supreme Court case, Bostock v. Clayton County, in which a conservative-leaning court sided with three Georgia employees fired because of their sexual orientation or gender identity.

More: How a Supreme Court decision last year is reshaping the legal battle over LGBTQ discrimination

In the 6th Circuit, though, Sutton dismissed the Bostock ruling as inapplicable and instead relies on a court precedent set in the Dobbs decision, the landmark ruling striking down the constitutional right to an abortion. The Supreme Court's conservative majority rejected an argument in Dobbs that anti-abortion laws discriminate based on sex.

"If a law restricting a medical procedure that applies only to women does not trigger heightened scrutiny, as in Dobbs, a law equally applicable to all minors, no matter their sex at birth, does not require such scrutiny either," Sutton said in his ruling on an emergency stay.

What does the future of the case look like?

The 6th Circuit's decision is the latest legal whiplash in the case, but it may not be the last.

The ruling was on Tennessee's emergency request for a stay, meaning the ruling allowed Tennessee to fully enforce its law without fully overturning Richardson's injunction against the law.

"These initial views, we must acknowledge, are just that: initial. We may be wrong. It may be that the one week we have had to resolve this motion does not suffice to see our own mistakes." Sutton wrote in the ruling.

Sutton said the court will expedite considering a full appeal, promising a ruling by Sept. 30 at the latest. The ruling could either strike down Richardson's preliminary injunction or uphold it, which would block Tennessee from enforcing part of its law.

Meanwhile, the main case is still advancing toward a full trial early next year.

This article originally appeared on Nashville Tennessean: What is the Tennessee law at the center of a trans rights legal battle