In yesterday's decision in United States v. Skrmetti , the Supreme Court upheld Tennessee’s ban on gender-affirming care for minors. This decision means that transgender youth in Tennessee and 24 other states will continue to go without needed health care, and is a step towards wider bans on gender-affirming care. Because so many autistic people are transgender, and because this fact is often used in state legislatures to justify bans on gender-affirming care, this case is deeply important to the autistic community. Yesterday’s decision allows states to strip lifesaving health care from transgender youth, many of them autistic.
Gender-affirming care is health care that helps someone feel more like their gender, and more comfortable in their body (to learn more, read our toolkit on gender-affirming care [[link removed]]). Recently, gender-affirming care has become a “culture war” issue as extremist politicians have attacked the transgender community’s right to health care (to learn more, read our toolkit on barriers to gender-affirming care [[link removed]]), with children losing vital health care as a result. Yesterday’s ruling upholds Tennessee’s ban on gender-affirming care for minors, but Tennessee is one of 25 states [[link removed]] with such a ban. When states ban gender-affirming care for those under 18, trans youth are forced to travel to other states for the care they need, or go without care — leading to increased suicidality [[link removed]]. This is why every major medical, pediatric, and psychological association in the US [[link removed]] describes gender-affirming care as essential treatment for transgender people of all ages.
Autistic people are more likely to be transgender [[link removed]]. State governments have used this fact to make ableist arguments against gender-affirming care [[link removed]]. They say or imply that autistic people cannot really know if we are transgender; that we are being misled or are just confused, and so we should not be allowed to get gender-affirming care.
There is a long history of policymakers trying to keep disabled people from making decisions about our own care. When transphobes attack gender-affirming care by arguing that disabled people should not make our own choices about our medical care, these attacks threaten the autonomy of all autistic people, even those who are cisgender. Autistic people, like everyone else, should make medical decisions in concert with our doctors, our chosen support people, and, when we are children, our parents or guardians. We do not need politicians to make our medical decisions for us.
These attacks on health care for trans youth are happening in a larger context of transphobic policies. Under the Trump administration and extremist state governments, transgender people are facing attacks on their rights in the workplace, in health care, in education and sports, and their right to carry accurate identification documents. We fear that yesterday’s decision paves the way for states to ban gender-affirming care for transgender people of all ages. This could lead to transgender people being forced to move states or else go without care, and cause suicides as people are denied lifesaving health care. It could also put transgender people’s health at risk, since people who have had certain surgeries as part of their gender-affirming care need continued access to hormone therapy to stay healthy.
Bans on gender-affirming care disproportionately affect disabled trans people, trans people of color, and other marginalized communities that often live in poverty. For people living in poverty or relying on state benefits like Medicaid, moving states is not simply disruptive. It may be impossible. The same is true of traveling out of state for care.
This case is a devastating setback, but there are more legal arguments we can try. There are other ways that transgender communities and allies can argue for bans on gender-affirming care to be struck down in the future. Meanwhile, it’s important to know that yesterday’s decision is not a federal ban on gender-affirming care for minors. The decision allows states to ban gender-affirming care for minors, but in the states without bans, trans youth can still get the health care they need. In the wake of this case, state advocacy is more crucial than ever, as we fight to overturn state bans on gender-affirming care and to prevent more states from passing laws that ban it.
We need everyone in this fight. To take action this week, check out Lambda Legal’s list of actions to find rallies near you [[link removed]]. This page will be updated throughout the week. For the long haul, consider getting involved with advocacy for transgender rights in your state — your local LGBTQ+ center or ACLU chapter may know where you can start. You can also donate to groups on the front lines of this fight, like Advocates 4 Transgender Equality [[link removed]], Transgender Law Center [[link removed]], Lambda Legal [[link removed]], and the ACLU [[link removed]].
To our transgender community members, we are here for you. You do not deserve the persecution, scapegoating and discrimination that you are facing. You deserve to be treated equally in school, at work, in family life, in public places, and by your government. You deserve to get the health care you need without legal, financial, or social barriers. Our communities’ struggles are connected, and all of us fighting for the justice and equality that we deserve stand with you in this moment. ASAN will continue to fight for the rights of autistic transgender people until we all are free.
If you are in crisis or thinking about trying suicide, you can call or text Trans Lifeline [[link removed]] at (877) 565-8860.
Autistic Self Advocacy Network
PO Box 66122
Washington, DC 20035
United States
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