The Supreme Court will hear arguments over Tennessee's ban on gender-affirming care for minors

WASHINGTON — Advocates for transgender rights are turning to a conservative-dominated Supreme Court after a presidential election in which Donald Trump and his allies promised to roll back protections for transgender people.

The justices on Wednesday are taking up the issue of gender-affirming care for transgender minors, which has been banned by Tennessee and 25 other Republican-led states.

The fight over whether transgender adolescents can access puberty blockers and hormonal treatments is part of a broader effort to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use.

Trump backed a national ban on such care as part of his 2024 campaign in which he demeaned and mocked transgender people.

In its waning days, the Biden administration, along with families of transgender adolescents, will appeal to the justices to strike down the Tennessee ban as unlawful sex discrimination and protect the constitutional rights of vulnerable Americans.

''The stakes are high, of course, for transgender adolescents, but also for the parents who are watching their children suffer, who are just trying to do right by their kids,'' Chase Strangio, who represents the families at the Supreme Court, said in an interview. Strangio, a lawyer for the American Civil Liberties Union, will be the first openly transgender person to argue before the high court.

A lawyer for Tennessee will argue that the ''life-altering gender-transition procedures'' are risky and unproven and that it's the state's role to protect children.

Trump nominated three justices in his first term who pushed the court in a more conservative direction that included the decision in 2022 overturning the landmark Roe v. Wade ruling, which had protected abortion rights for nearly 50 years.

Yet one of Trump's appointees, Justice Neil Gorsuch, also authored a ruling in 2020 that protected LGBTQ people from discrimination in the workplace under federal civil rights law.

The administration and transgender families both rely on that decision to bolster their arguments.

After Trump takes office on Jan. 20, 2025, it's possible the new administration could weigh in on the case, which is not expected to be decided until the spring.

There are about 300,000 people between age 13 and 17, and 1.3 million adults who identify as transgender in the United States, according to the Williams Institute at the UCLA School of Law. The Williams Institute is a think tank that researches sexual orientation and gender identity demographics to inform laws and public policy decisions.

Most Republican-controlled states have adopted a ban similar to the one in Tennessee, and those laws mostly are in effect, despite legal challenges. The Tennessee case is the first time the nation's top court will consider the constitutionality of the bans.

Sivan Kotler-Berkowitz, a 20-year-old college student in Massachusetts who is transgender, said his life would have been very different if he were just a few years younger and living in one of the states.

''These bans are denying people the opportunity to live and excel,'' he said in an interview. ''There are thousands of transgender youth across the country that are thriving just like me because we've had the love and understanding of our families and because we've had access to proper care.''

The bans in Tennessee and elsewhere have put families in the position of deciding whether to travel for ongoing health care, go without or wait until their children turn 18.

Erin Friday, a leader of Our Duty, an international group that supports the bans on gender-affirming care for minors, said the case is going to be as important as Roe v. Wade. She said upholding the Tennessee law would bolster the cases for the laws restricting sports participation and bathroom use.

Among the arguments advanced by defenders of the state laws is that many children who initially say they are transgender eventually change their mind. Friday said her daughter was 11 when she said she was transgender, which Friday attributed to the child having been ''indoctrinated'' at school. But after receiving psychiatric treatment, her daughter changed her mind, Friday said. If laws like Tennessee's are struck down, ''more children would be irreversibly harmed and live a life of deep regret,'' Friday said in a Supreme Court filing.

Guidelines from the World Professional Association for Transgender Health that were revised in 2022 say evidence of regret about transitioning is scant but also that patients should be told about the possibility during psychological counseling.

Some doctors who work with transgender minors said a state should not come between doctors, their patients and parents. ''From a medical standpoint, I think it's really frightening and dangerous to think that legislators could pass a law that basically judges or controls what people could do with a medication based on a diagnosis,'' Dr. Susan Lacy of Memphis, Tennessee, who joined with the families in suing the state, said in an interview.

Michelle Quist Ryder, CEO of the American Psychological Foundation, said the laws, if left in place, are damaging for the physical and mental health of transgender people and their supporters. Gender dysphoria — the unease a person may have when their assigned sex and gender identity don't match — has been linked to depression and suicidal thoughts.

''The more we lessen the sense of safety in this community, trans youth will look out and say, ‘Who else is going to come after me?''' she said.

There are prominent names in some of the 83 briefs, an unusually high number, filed on both sides of the case. Actors Elliot Page and Nicole Maines, and Sarah McBride of Delaware, who in November became the first openly transgender person to win election to Congress, have joined more than five dozen people in urging the court to strike down the Tennessee law.

Tennis legend Martina Navratilova and Olympic swimming gold medalists Donna de Varona and Summer Sanders are among 135 athletes, coaches, officials and parents who want the justices to uphold the ban on gender-affirming care for transgender minors.

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Mulvihill reported from Cherry Hill, New Jersey. AP Medical Writer Carla K. Johnson in Seattle and Associated Press writer Lindsay Whitehurst contributed to this article.