On June 18, the Supreme Court issued its ruling in U.S. v. Skrmetti, affirming that anti-trans legislation banning gender-affirming care for minors is constitutional. The ruling allows laws banning this kind of evidence-based and medically necessary care in states like Tennessee (the state at the heart of the case) and Missouri to continue, meaning trans youth in these places cannot access gender-affirming treatments like puberty blockers and hormone therapy from in-state providers, depending on the details of their state's ban. According to the Movement Advancement Project, 25 states currently have laws banning gender-affirming care for trans youth, and two more states specifically ban gender-affirming surgeries for trans youth. The ruling also comes after President Trump attempted to effectively ban gender-affirming care for trans people under age 19 via Executive Order, which was later blocked by a federal judge.
According to the Williams Institute at UCLA School of Law, more than 100,000 trans youth live in states with gender-affirming care bans. For them, this ruling could mean an end to or a significant barrier to care that they, their parents, and their doctors have deemed medically necessary. This, Dallas Ducar, a registered nurse and nurse practitioner, currently the executive vice president for Donor Engagement and External Relations at Fenway Health, who served as the founding President and CEO of Transhealth, says, violates the “fundamental right” of bodily autonomy.
“There are core healthcare principals that we as clinicians really adhere to, and also clear values that many people across the country agree with. We want to be trusted with our own healthcare decisions,” Ducar tells Teen Vogue. “That is a fundamental right. Politicians and judges should not interfere with healthcare decisions that belong between patients and doctors.”
Ducar stresses that gender-affirming treatments like puberty blockers and hormone therapy are safe and effective, and have been long used as treatment for both trans and cisgender children. Major medical associations agree that gender-affirming care is both appropriate and necessary for trans youth.
In an interview with Teen Vogue politics editor Lex McMenamin in late 2024, L.W., the trans teen who brought the Skrmetti case, called the idea that the state could regulate her medical care “body horror.”
“It's a very terrifying thought that I could have to go off this medical care, because my dysphoria was horrible before [I started]. I was really isolated because of it, which tended to hurt my mental health,” she said. “Obviously, you're not yourself. It's real-life body horror, essentially: Body horror is a genre of horror that's particularly terrifying because it's about the lack of autonomy over your own body.”
If you're a trans teen and you're wondering exactly what this case may mean for you, Teen Vogue spoke to medical professionals to give you as much information as we can to navigate the days ahead.
What does this ruling mean for me?
If you live in a state where gender-affirming care is banned for trans youth (you can find a map here), you may face new challenges or continue to endure existing challenges in accessing the medical help you need. If you live in a state where a ban exists but has been blocked by a judge, those bans may now go into effect.
The first thing you should know, according to Ducar, is that your identity is valid. “Nothing can erase who you are, who we are,” she says. “Our existence is not up for debate. Young people specifically deserve bodily autonomy and the right to make decisions about their own lives.”
The second thing you should know is that you still have options. Trans-affirming providers that you previously worked with may still be able to advise you on options for care, or help you pursue alternate avenues to care.
“Continue working with qualified providers who understand gender-affirming care. Document your needs,” Ducar says. “Consider consulting with providers in other states, too, if local care becomes unavailable.”
Whether or not you can access care out of state is dependent on many things, not limited to your parents' willingness to drive you, your financial situation, your insurance, where you live, and your state's laws. Still, Ducar says there are mechanisms to help you access the care you need. Check to see if any states near you have shield laws that protect access to gender-affirming care (you can use this same map), and know your state's laws surrounding telehealth for gender-affirming care.
Think about financial planning and what you would need to access care in another state. If you do not have the funds for this, Ducar says there are grants and organizations that may be able to assist you, including the Trans Youth Emergency Project (where you can also find other resources to help you navigate this legal landscape). The Trans Lifeline also rounded up resources that can help you access care, which you can find here. If you need legal information, or help navigating your state's laws, you can reach out to your local ACLU, or you can use the Transgender Law Center's Legal Information Helpdesk.
You should never use hormones without a prescription from and the supervisory care of a doctor, Ducar says.
Ducar also stresses that mental health care remains legal and available. She advises connecting with a gender-affirming therapist, which you can find online. If there aren't any in your area, telehealth may be an option. Similarly, Ducar says community and peer support are particularly important in times like these. Reaching out to local groups or finding online spaces can be affirming.
What if I can't access the care I need?
First thing is first: you are not alone. “Your identity is valid regardless of medical access,” Ducar says. “Many trans people have lived authentically [without medical intervention]. Losing access is genuinely harmful and traumatic, but you are not alone.”
Still, it's important to acknowledge how scary and traumatic this can be. Dr. Kaiyti Duffy, MD, the Los Angeles LGBT Center’s Chief Medical Officer, compares the loss of gender-affirming care to a person with asthma losing access to their inhaler. “It's medically necessary, lifesaving care. I have asthma. If I wasn't able to get my inhaler, what could I do for my mental health in the moment of an asthma attack?” she says. “I would be panicking, rightfully.”
We know that denying trans youth access to gender-affirming care can have disastrous consequences, including suicidality. If you're experiencing suicidal ideation or considering harming yourself in any way, please reach out to a crisis line immediately. The Trans Lifeline and The Trevor Project both have LGBTQ-specific crisis services that can help you navigate. While Dr. Duffy says we need to mobilize as much mental health care as possible for trans people impacted by these bans, she also says that's not enough.
“I don't feel comfortable saying that just therapy will have to suffice in that moment,” she says. “We're creating medical crises by restricting this care to folks, and there's no substitute for it.”
If you're safe and able, Ducar says there are other steps you can take toward your transition that don't rely on medical care. Social affirmation is still available to you if you feel safe seeking it. Things like using your correct name and pronouns, dressing in an affirming way, voice training, and adjusting your physical movement and expression can all be means of supporting your gender identity.
Seeking supportive community is also crucial. Local LGBTQ youth groups, family support groups, and mentorship from older trans people are all great avenues, according to Ducar. Online spaces like Reddit and Discord can also help you build community, but Ducar cautions that social media can also be mentally distressing.
“Doom scrolling doesn’t help,” she says. “Stay informed about legal challenges but limit your social media access if you can.”
Ultimately, Ducar says you have a long life ahead of you to consider. This moment is certainly traumatic, but, she says, it won't last forever.
“Think about the longer term — family acceptance, longterm planning, researching states with protective laws. Some [physical] changes from delayed care can be addressed later. Focus on your mental health, build skills that support your identity,” Ducar says. “This landscape is temporary. Laws can change. The healthcare community will continue to support trans healthcare. Focus on staying safe.”
For parents of trans teens
For parents of transgender kids, the ruling means the loss of parental authority, says Dr. Duffy.
“No one is proposing that young people go on [puberty] blockers … without a very robust and informed consent process. That exists, and parents are the number one protector of a young person's wellbeing,” Duffy says, noting that parental consent is required for this kind of gender-affirming care. “So if we're saying that consent no longer holds water, that's quite powerful. I think regardless of people's take on gender-affirming care or trans youth, for parents to lose the right to consent and have the government be able to restrict that should scare everybody, should scare parents.”
So, what should you do for your trans teen? Duffy says you might strongly consider moving to a state with a shield law that protects access to gender-affirming care.
“I'm a parent. I have two kids. If I was in a state and I affirmed my child's ability and supported them pursuing their gender journey, and I was told by my state government that I wasn't allowed to do so as a parent, I would leave. And I don't say that flippantly,” she says, underscoring the very real barriers to leaving your home state. Still, the risks are enough to warrant it. “The suicide rates for young people who live in a place in which, not only is their trans identity not affirmed, but that they're restricted in accessing care, [those rates] are going to increase. And that's something that none of us can feel comfortable with.”
If moving isn't an option, Duffy says leaning into your local LGBTQ community is crucial.
“We're just going to have to do everything we can to send messages and to be in connection so that we save these young people's lives,” she says.
