In 2023, in the wake of a mental health crisis among America’s youth and an exponential rise in gender clinics pushing medical interventions to alter children’s bodies in response to gender dysphoria,[1] Idaho enacted the Vulnerable Child Protection Act.[2] As its name suggests, the law aims to protect children who feel uncomfortable with their sex from drugs and procedures that disrupt the body’s natural development  causing lifelong harm.

Since the law was passed, there have been significant changes in the world’s understanding of the science and medicine surrounding so-called “gender-affirming care.” As will be discussed below, countries that pioneered medicalized gender interventions have reversed course and the interest groups that vouched for its safety have been discredited.[3] It is now clear that the widely touted “Standards of Care” were infected by political pressure and conflicts of interest.[4]

There have also been changes on the legal and policy front in the United States. The 2024 election ushered in a reversal of federal policy on gender issues.[5] And on June 18, 2025, the U.S. Supreme Court upheld the constitutionality of a Tennessee law protecting children from medicalized gender interventions.[6] Together, these changes reflect a turning of the tide on gender interventions for kids in the United States.

This article gives a brief description of Idaho’s law and the medical context. Next, it explains the politicization that drove the alleged medical consensus around treating children with gender dysphoria and the recent course reversal. Then it addresses the country’s changing political and popular culture. Finally, it explains the recent U.S. Supreme Court ruling in United States v. Skrmetti, which upheld laws, like Idaho’s, as constitutional.

Idaho’s Common-Sense Law

The Vulnerable Child Protection Act prohibits medical providers from administering puberty-blocking drugs or giving cross-sex hormones to kids under the age of 18 as a treatment for gender dysphoria.[7] It also prevents medical providers from performing surgeries on children that would remove healthy body parts and sterilize the child to affirm the child’s perception of his or her gender identity.[8] According to the Mayo Clinic, “gender-affirming surgery” can include “top surgery” (e.g., mastectomies) and “bottom surgery” (removal of healthy genitals and “surgical creation” of a penis or vagina), and cosmetic procedures.[9]

Idaho’s law clarifies that it is never medically necessary to perform surgery or intervene medically with a child’s body based on the child’s subjective perception that his or her body is the wrong sex.[10] More than half of the states have now passed similar laws.[11]

Proponents of these laws, including me, believe they reflect common sense and sound medicine. As described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (“DSM 5”), gender dysphoria is a mental disorder.[12] Children experiencing discomfort with their biological sex or who believe they were “born in the wrong body” should be treated not with experimental drugs and surgeries, but with counseling that helps them align their perception with reality. Doctors and counselors should not “affirm” this misperception by treating a healthy body as the problem; they should treat the unhealthy perception to restore the mind to health.

Litigation Over Idaho’s Law

Idaho’s law protecting children from medicalized gender interventions was challenged by the American Civil Liberties Union (“ACLU”), which represented two teenagers and their parents in Poe v. Labrador.[13] The federal district court enjoined the entire law,[14] and the Ninth Circuit declined to stay the injunction during the appeal.[15] Idaho then appealed to the U.S. Supreme Court. On April 15, 2024, the Supreme Court granted Idaho’s emergency motion and narrowed the injunction, permitting Idaho to enforce its law except as to the specific plaintiffs in Poe and the medical services they were requesting.[16] This restored Idaho’s ability to otherwise enforce the law while litigation continued. The Ninth Circuit heard oral arguments in August 2024 but then stayed the case in light of the Supreme Court’s decision to hear a challenge to a similar state law in United States v. Skrmetti (discussed below).[17] On June 17, 2025, the parties in the Ninth Circuit litigation agreed to dismiss the appeal, leaving Idaho free to enforce its law.[18]

Updates Since Law Was Passed and Challenged

There have been major developments since Idaho’s law protecting children from medicalized gender interventions was passed and challenged. As the next section will explain, the leading advocacy organization for the interventions has been thoroughly discredited.[19] European countries that were years ahead of the United States in performing these interventions have dramatically reversed course based on the lack of evidence and risk of harm to children.[20] The U.S. Supreme Court upheld the constitutionality of state laws like Idaho’s in a case about Tennessee’s law regulating the procedures for children.[21] Also, the 2024 election ushered in a dramatic reversal of federal policy on transgender issues.[22]

The Discredited Standards of Care

Opponents of laws like Idaho’s Vulnerable Child Protection Act insist that medicalized gender interventions are “medically necessary treatment” for children with gender dysphoria.[23] They rely primarily on statements from medical interest groups pointing to “evidence-based clinical guidelines” from the World Professional Association of Transgender Health (“WPATH”).[24] But as internal WPATH emails reveal,[25] these groups and their “standards” are ideologically driven.[26]

WPATH, a self-proclaimed “advocacy organization,”[27] promulgates “Standards of Care” for “transgender healthcare.”[28] The most recent version is SOC-8, which came out in 2022.[29] While claiming to be “based on the best available science and expert professional consensus,”[30] WPATH’s standards were influenced by U.S. politics, ACLU lawyers, and pre-determined outcomes.[31]

For example, WPATH loosened its guidelines after receiving pressure from the Biden Administration.[32] Originally, SOC-8 suggested age minimums for gender interventions for kids—14 for cross-sex hormones, 15 for mastectomies, and 17 for surgeries removing healthy reproductive organs.[33] Before publication, WPATH consulted Admiral Rachel Levine­­, the former Assistant Secretary for Health at the U.S. Department for Health and Human Services who identifies as a transgender woman and is a longtime LGBTQ activist.[34] As the New York Times reported, Levine’s staff “urged [WPATH] to drop the proposed limits from the group’s guidelines and apparently succeeded.”[35] Internal WPATH emails show that although some members expressed concern “about allowing US politics to dictate international professional clinical guidelines,”[36] WPATH ultimately removed the age minimums from the guidelines.[37]

In addition to taking content out for political reasons, WPATH also added certain phrases to make the standards “a tool for our attorneys to use in defending access to care.”[38] WPATH consulted with an ACLU lawyer in creating the guidelines, writing SOC-8 with an eye toward litigation.[39] SOC-8 repeats throughout that “gender-affirming” treatments are “medically necessary.”[40] Ironically, the ACLU now cites WPATH’s guidelines, which it helped shape, “to argue that its legal position is grounded in medical science.”[41]

Even putting politics aside, many of the doctors and researchers who helped create SOC-8 had undeclared conflicts of interest. While the guidelines state that “[n]o conflicts of interest were deemed significant or consequential,”[42] the chair of WPATH’s Standards of Care agreed that “most participants in the SOC-8 process had financial and/or non-financial conflicts of interest.”[43] Rather than seek out neutral experts, the president of WPATH believed it was “important for someone to be an advocate for [transitioning treatments] before the guidelines were created.”[44] WPATH members stood to profit financially from the procedures they were asserting were “medically necessary.” WPATH’s President did not think that making “more than a million dollars” the previous year from performing transitioning surgeries needed to be disclosed as a conflict.[45] As far as non-financial conflicts, WPATH members did not approach the guidelines with a spirit of open inquiry. Instead, they suppressed research that did not align with their pre-determined agenda.[46] WPATH commissioned systematic reviews of the medical evidence from Johns Hopkins University.[47] But when Johns Hopkins came back with results WPATH did not like, those reviews were not published.[48]

Europe Pumps the Brakes on Gender Interventions for Kids

America is not the only country that is now seeing the serious problems with gender experimentation on children. Europe was ahead of the United States in giving children puberty blockers, cross-sex hormones, and life-altering surgeries. But now many countries in Europe have reversed course.[49] The national healthcare systems of several countries have recognized that the benefits of gender transition interventions are speculative and far outweighed by the risks.[50]

England’s National Health Service commissioned an independent review of the research around gender interventions for children.[51] The review was led by the former president of the Royal College of Pediatrics and Child Health, Dr. Hilary Cass. Her final report was released in April 2024. The Cass Review concluded: “This is an area of remarkably weak evidence.”[52] Specifically, it found that “we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”[53] Moreover, it found that the systematic reviews “have demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to base clinical decisions.”[54] Now, the United Kingdom’s government has banned all new prescriptions of puberty blockers to minors by any physician, public or private, based on the “lack of evidence for these medical treatments.”[55]

The United Kingdom is not the only country to reverse course. In 2020, Finland’s health care service ended the surgical transition of minors and greatly restricted access to puberty blockers and cross-sex hormones by restricting the procedures to their centralized research clinics.[56] All of the Scandinavian health authorities have now severely restricted the medical transition of minors or have commissioned studies that have recommended policy changes in that direction.[57] The issue is less partisan in Europe than it is in the United States. Finland and Sweden’s restrictions were put in place by left-leaning governments.[58] And the UK ban was initiated by the conservative Tory government and later confirmed by the liberal Labour government.[59]

The 2024 Election and President Trump’s Indictment of Gender Ideology

The 2024 Presidential election has brought even more change on transgender issues. While the Biden Administration aggressively promoted gender theory,[60] President Trump’s victory in the 2024 election has been interpreted by some as an indictment of the Biden Administration’s promotion of gender theory over biological reality.[61] One of Trump’s first actions as President was to make it an official policy of the United States that there are only two sexes, male and female, and they are “not changeable and are grounded in fundamental and incontrovertible reality.”[62]

Just over a week after taking office, President Trump issued an executive order entitled “Protecting Children from Chemical and Surgical Mutilation” which announced the federal government’s strong opposition to medicalized gender interventions for children.[63] The order condemned the “blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity, spurred by guidance from the World Professional Association for Transgender Health (“WPATH”), which lacks scientific integrity.”[64]

The order also directed the Secretary of Health and Human Services to “publish a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria” and work “to increase the quality of data to guide practices” for treating these children.[65] Hopefully these actions will lead to better policy and medicine in the United States for children suffering from gender dysphoria.

SCOTUS Upholds Tennessee’s Law

In June of 2024, the Supreme Court granted review in United States v. Skrmetti to address whether Tennessee’s law prohibiting medical gender interventions for children violated the Equal Protection clause.[66] The United States under the Biden Administration briefed and argued the case, and the Court heard oral argument in December 2024. The Court issued its opinion on June 18, 2025, upholding Tennessee’s law as constitutional.[67] The decision was 6-3, with Justices Sotomayor, Jackson, and Kagan dissenting.

The Court, in an opinion written by Chief Justice Roberts, held that the law at issue was subject only to rational basis review, which it easily met.[68] It rejected the argument that the law was subject to heightened scrutiny since it classified only based on age and medical purpose.[69] Under the law, “[h]ealthcare providers may administer certain medical treatments to individuals ages 18 and older but not to minors” and “to treat certain conditions but not to treat gender dysphoria.”[70] And the state “clearly” met the deferential rational-basis standard.[71] It was reasonable for Tennessee to act to protect vulnerable children’s health and welfare in the face of legislative findings of the “experimental [ ] nature” and “life-altering consequences of such procedures.”[72] The Court referenced the “[r]ecent developments” in medicine and policy discussed above, like the Cass Review and England’s National Health Service reversal on gender treatments for children, as “underscor[ing] the need for legislative flexibility in this area.”[73]

In a concurrence, Justice Thomas wrote extensively about the dubious “medical consensus” for these treatments.[74] He noted that “recent revelations suggest that leading voices in this area have relied on questionable evidence, and have allowed ideology to influence their medical guidance.”[75] Specifically, he recounted troubling evidence discussed above that “WPATH bases its guidance on insufficient evidence and allows politics to influence its medical conclusions.”[76] Justice Thomas also referenced how other countries have reversed course on their policies, the ethical issue of whether children have the capacity to consent to these interventions, and the testimony of detransitioners–people who underwent these treatments and now regret them.[77] Although no other justices joined this concurrence, it echoed concerns raised by several other justices at oral argument.[78]

Conclusion

Idaho was right to step out to protect its children from experimental medical gender interventions. In my view, the procedures are a scam that will go down in history, with disgust, similar to frontal lobotomies. Increasingly, the world is waking up to the dangers caused by the rush to “affirm” children in gender identities contrary to their sex. The risks—as Justice Thomas cited in his Skrmetti concurrence[79]— include infertility,[80] sexual dysfunction,[81] and heart problems, to name a few.[82]

The heartbreaking stories of detransitioners who regret the irreversible changes made to their bodies as children are a stark reminder of the reason for regulating medical providers providing gender interventions to kids.[83] Thankfully, the U.S. Supreme Court has now clarified that it is within the states’ authority to legislate in this area.

Representative Bruce D. Skaug is currently the Chairman of the Idaho House Judiciary & Rules Committee, serving as a legislator since 2021. He is a recently retired attorney and a member of the Idaho Bar since 1988. Bruce is married to his wife, Debbie, of 39 years and they have six children and 12 grandchildren. They reside in Canyon County.

[1] Jennifer Block, Gender Dysphoria in Young People Is Rising—And So Is Professional Disagreement, BMJ (Feb. 23, 2023), https://www.bmj.com/content/380/bmj.p382.

[2] H.B. 71, 67th Leg., 1st Reg. Sess. (Idaho 2023), codified at Idaho Code § 18-1506C. 

[3] Joshua P. Cohen, Europe and U.S. Diverge Sharply on Treatment of Gender Incongruence in Minors, Forbes (updated Dec. 2, 2023); Azeen Ghorayshi, Youth Gender Medications Limited in England, Part of Big Shift in Europe, N.Y. Times (Apr. 9, 2024); Hannah Barnes, Why Disturbing Leaks from US Gender Group WPATH Ring Alarm Bells in the NHS, Guardian (Mar. 9, 2024).

[4] Azeen Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, N.Y. Times (June 25, 2024); Barnes, supra note 3.

[5] Exec. Order 14168, Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, 90 Fed. Reg. 8615, 2025 WL 327882 (Jan. 20, 2025); Exec. Order 14187, Protecting Children from Chemical and Surgical Mutilation, 90 Fed. Reg. 8771, 2025 WL 358731 (Jan. 28, 2025).

[6] United States v. Skrmetti, 145 S.Ct. 1816, 605 U.S. __ (2025).

[7] Idaho Code § 18-1506C (2)(a), (3)(c).

[8] Idaho Code § 18-1506C (3)(a), (3)(d). The American Psychological Association (APA) defines “gender identity” as “[a]n internal sense of being male, female or something else.” APA, A Glossary: Defining Transgender Terms, 49(8) Monitor on Psych. 32 (2018).

[9] See MayoClinic.org, “Feminizing Surgery” (Sept. 26, 2024), https://www.mayoclinic.org/tests-procedures/feminizing-surgery/about/pac-20385102; MayoClinic.org, “Masculinizing Surgery” (Oct. 1, 2024), https://www.mayoclinic.org/tests-procedures/masculinizing-surgery/about/pac-20385105.

[10] Idaho Code § 18-1506C (4)(a).

[11] See Celine Castronuovo, Future of Transgender Care Rests With Elections, Supreme Court, Bloomberg Law (Sept. 3, 2024).

[12] APA, Diagnostic and Statistical Manual of Mental Disorders 829 (5th ed. 2013).

[13] Case No. 1:23-cv-00269 (D. Idaho).

[14] Memorandum Decision and Order, Poe v. Labrador, No. 23-269 (D. Idaho Dec. 26, 2023).

[15] Poe v. Labrador, No. 24-142 (9th Cir. Jan. 30, 2024).

[16] Labrador v. Poe, No. 23A763, 01 U.S. ____, 144 S.Ct. 921 (Mem) (2024).

[17] Oral Argument, Poe v. Labrador, No. 24-142 (9th Cir. Aug. 21, 2024); Order (9th Cir. Sept. 16, 2024). United States v. Skrmetti, No. 23-477 (U.S. June 24, 2024).

[18] Stipulated Motion to Voluntarily Dismiss Appeal, Poe v. Labrador, No. 24-142 (9th Cir. June 17, 2025).

[19] Barnes, supra note 3; Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4.

[20] Cohen, supra note 3; Ghorayshi, Youth Gender Medications Limited in England, Part of Big Shift in Europe, supra note 3.

[21] United States v. Skrmetti, 145 S.Ct. 1816, 605 U.S. __ (2025).

[22] See, e.g., Exec. Orders, supra note 5.

[23] See, e.g., Jennifer S. Dempsey, HB 71: The State’s Attempt to Ban Gender Affirming Medical Care for Transgender Minors, 67 Advocate 14 (2024) (citing Amicus Brief of American Academy of Pediatrics (AAP) et al., Poe v. Labrador, No. 24-142 (9th Cir. Mar. 12, 2024)).

[24] Id.

[25] In litigation defending its law protecting children from medicalized gender interventions, Alabama was able to obtain internal emails from WPATH. See generally Boe v. Marshall, 2:22-cv-00184 (M.D. Ala.), https://www.alabamaag.gov/boe-v-marshall/. The discovery was reported on by the New York Times and City Journal. See Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4; Leor Sapir, A Consensus No Longer, City J. (Aug. 12, 2024).

[26] See Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4; Sapir, A Consensus No Longer, supra note 25.

[27] Mot. to Quash 3, Boe v. Marshall, No. 22-00184 (M.D. Ala. Dec. 27, 2022), Doc. 208.

[28] WPATH, Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 S5, 23 Int’l J. Transgender Health S1 (2022) [SOC-8].

[29] Id.

[30] Id. at S3.

[31] See Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4; Sapir, A Consensus No Longer, supra note 25.

[32] See Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4.

[33] Id.

[34] Id.; see also Mariana Brandman, National Women’s History Museum: Rachel Levine, Womenshistory.org, https://www.womenshistory.org/education-resources/biographies/rachel-levine.

[35] See Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4.

[36] Boe v. Marshall, No. 22-184, Doc. 700-15, Page 33, https://www.alabamaag.gov/wp-content/uploads/2024/10/SJ.DX186-700-15-WPATH-13-REDACTED-560-36.pdf (Aug. 1, 2022 Email, “feedback regarding the age statement in Adolescent SOC8 chapter”).

[37] See SOC-8, supra note 28; Ghorayshi, Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show, supra note 4. Internal WPATH emails discuss “removing the age criteria” because “[i]t led to [the American Academy of Pediatrics] formally not opposing the SOC,” adding “this is highly confidential.” See Boe v. Marshall, No. 22-184, Doc. 700-17, Page 153 (Oct. 3, 2022 Email, “Re: New York Post article”), https://www.alabamaag.gov/wp-content/uploads/2024/10/SJ.DX188-700-17-WPATH-15-REDACTED-560-38.pdf.

[38] Boe v. Marshall, No. 22-184, Doc. 700-10, Page 34 (Jan. 6, 2022 Email), https://www.alabamaag.gov/wp-content/uploads/2024/10/SJ.DX181-700-10-WPATH-8-REDACTED-560-31.pdf.

[39] Sapir, A Consensus No Longer, supra note 25.

[40] See, e.g., SOC-8, supra note 28, at S16. The phrase “medically necessary” is used 56 times in the document.

[41] Sapir, A Consensus No Longer, supra note 25.  

[42] SOC-8, supra note 28.

[43] See Leor Sapir, The Deposition of Eli Coleman, City J. (Dec. 13, 2024).  

[44] Boe v. Marshall, No. 22-184, Doc. 564-8, Unsealed Marci Bowers Dep., 121:7-10, May 3, 2024, https://www.alabamaag.gov/wp-content/uploads/2025/02/SJ.DX18-564-8-Bowers-Depo-Tr.-UNSEALED.pdf.

[45] Id. Bowers Dep., 37:1-13; 185:25 – 186:1-9.

[46] See Research into Trans Medicine Has Been Manipulated, Economist (June 27, 2024).

[47] Id.

[48] Id. See also Jennifer Block, Dispute Arises over World Professional Association for Transgender

Health’s Involvement in WHO’s Trans Health Guideline, BMJ (Oct. 30, 2024), https://www.bmj.com/content/bmj/387/bmj.q2227.full.pdf.

[49] Cohen, supra note 3.

[50] Cohen, supra note 3; Ghorayshi, Youth Gender Medications Limited in England, Part of Big Shift in Europe, supra note 3.

[51] The Cass Review, Final Report, https://cass.independent-review.uk/home/publications/final-report/.

[52] The Cass Review, Independent Review of Gender Identity Services for Children and Young People 13 (Apr. 2024).

[53] Id.

[54] Id. at 385.

[55] U.K. Department of Health and Social Care, Press Release, Ban on Puberty Blockers To Be Made Indefinite on Experts’ Advice (Dec. 11, 2024), https://www.gov.uk/government/news/ban-on-puberty-blockers-to-be-made-indefinite-on-experts-advice.

[56] Ghorayshi, Youth Gender Medications Limited in England, Part of Big Shift in Europe, supra note 3; Council for Choices in Health Care in Finland, Medical Treatment Methods for Dysphoria Associated with Variations in Gender Identity in Minors—Summary of a Recommendation (June 16, 2020), https://palveluvalikoima.fi/documents/1237350/22895008/Summary_minors_en+(1).pdf/.

[57] Cohen, supra note 3; Ghorayshi, Youth Gender Medications Limited in England, Part of Big Shift in Europe, supra note 3.

[58] Sapir, A Consensus No Longer, supra note 25.

[59] Id.

[60] Gender theory “distinguishe[s] sex (being female or male) from gender (being a woman or a man),” understanding gender as something socially constructed. See generally Mari Mikkola, Feminist Perspectives on Sex and Gender, The Stanford Encyclopedia of Philosophy(Edward N. Zalta & Uri Nodelman, eds., Summer 2024), https://plato.stanford.edu/archives/sum2024/entries/feminism-gender/.

[61] See Bill Barrow & Marc Levy, Trump hammered Democrats on transgender issues. Now the party is at odds on a response, AP News (Nov. 14, 2024); Shane Goldmacher et al., How Trump Won, and How Harris Lost, N.Y. Times (Nov. 7, 2024, updated Nov. 16, 2024) (discussing polling effect of Trump ads portraying Kamala Harris as “dangerously liberal” and out of step with voters on transgender issues).

[62] Exec. Order 14168, supra note 5.

[63] Exec. Order 14187, supra note 5.

[64] Id. § 3.

[65] Id. § 3(a)(ii), (b).

[66] United States v. Skrmetti, No. 23-477 (U.S. June 24, 2024). The Court did not take up the Due Process issue, which was raised by the private plaintiffs.

[67] United States v. Skrmetti, 145 S.Ct. 1816, 605 U.S. __ (2025).

[68] Id. at 1835 (“SB1 clearly meets this standard.”).

[69] Id. at 1829.

[70] Id.

[71] Id. at 1835.

[72] Id. at 1835-36.

[73] Id. at 1836-37.

[74] Id. at 1839-40 (Thomas, J., concurring).

[75] Id. at 1840.

[76] Id. at 1847.

[77] Id. at 1844.

[78] See United States v. Skrmetti, No. 23-477, Oral Argument Transcript (U.S. Dec. 4, 2024). Chief Justice Roberts noted the issue of “how extensive any evolution or increase in uncertainty in Europe has been and elsewhere” on the medical issues. Id. at 12-14. Justice Kavanaugh raised the fact that Europe is “pumping the brakes on this kind of treatment because of concerns about the risks” and highlighted the experience of detransitioners. Id. at 50:6-16, 49:11-16. Justice Alito asked about “the state of medical evidence” and quoted the assessment of Sweden’s National Board of Health and Welfare “that the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits of these treatments.” Id. at 14:12-13; 14:22-25 – 15:1-2. See also Swedish National Board of Health and Welfare, Updated Recommendations for Hormone Therapy for Gender Dysphoria in Young People (Feb. 22, 2022), https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/.

[79] United States v. Skrmetti, 145 S.Ct. 1816, 1842-43 (Thomas, J., concurring).

[80] Removal of reproductive organs means a person will not be able to generate or bear children. See MayoClinic.org, “Feminizing Surgery” (Sept. 26, 2024); MayoClinic.org, “Masculinizing Surgery” (Oct. 1, 2024), supra note 9. “The risk of permanent infertility increases with long-term use of hormones. That is particularly true if hormone therapy is started before puberty begins.” MayoClinic.org, “Feminizing Hormone Therapy” (July 12, 2024), https://www.mayoclinic.org/tests-procedures/feminizing-hormone-therapy/about/pac-20385096; MayoClinic.org, “Masculinizing Hormone Therapy” (July 12, 2024), https://www.mayoclinic.org/tests-procedures/masculinizing-hormone-therapy/about/pac-20385099).

[81] Barnes, supra note 3 (“WPATH’s president, Dr Marci Bowers, comments on the impact of early blocking of puberty on sexual function in adulthood. ‘To date,’ she writes, ‘I’m unaware of an individual claiming ability to orgasm when they were blocked at Tanner 2.’”).

[82] See MayoClinic.org, “Feminizing Hormone Therapy,” supra note 89 (risks include blood clots in a deep vein or in the lungs, heart problems, high blood pressure, and Type 2 diabetes, among other things); “Masculinizing Hormone Therapy,” supra note 89 (risks also include those).

[83] See, e.g., Robin Respaut et al., Why Detransitioners are Crucial to the Science of Gender Care, Reuters (Dec. 22, 2022); Pamela Paul, Opinion, As Kids, They Thought They Were Trans. They No Longer Do., N.Y. Times (Feb. 2, 2024).