The potential dangers in the SCOTUS’s trans-gender mutilation ruling

The June 18th Supreme Court ruling upholding Tennessee’s ban on gender mutilation of minors–United States v. Skrmetti–is generating criticism from the Left. But there is room for concerns from those who welcome the ruling.

In 2023, Tennessee banned procedures on minors, in the name of treating “gender dysphoria,” that rendered those young people temporarily or permanently sterile. The prohibitions included puberty blockers and surgery to alter genitalia and/or remove healthy female breasts. Gender ideologues immediately pounced on the Volunteer State and enjoyed the backing of the Biden Administration.

With the change of administrations, the Trump team took Tennessee’s position that the ban was constitutional. The Supreme Court, 6-3, agreed.

The ruling ultimately concluded that temporary or permanent medical interventions affecting a minor’s future fertility, done in the name of “gender healthcare”, are controversial and disputed issues about which there is substantial disagreement. In such a context, the Court chose to leave the question of how to address them “to the people, their elected representatives, and the democratic process.”

The immediate outcome of the case is that approximately 30 states will protect minors from temporary and/or permanent loss of fertility in the guise of “gender care.” But it also means that about 20 states will not.

Invocations of “states’ rights” and “states as laboratories of democracy” have appeal in some quarters, but we should soberly consider what they imply. They suggest that lopping off a teenage girl’s healthy breasts, reconfiguring genitalia so they become merely a simulacrum of “genitalia” (i.e., unable to generate anything), and/or chemically castrating children just might be “good” things, depending on whether you live in, say, Michigan versus Ohio.

Laurie Pohutsky, the Michigan state legislator who took to social media last January to tell the world she was getting sterilized in response to the inauguration of President Donald J. Trump, announced that Michigan would continue proudly to stand with teenagers seeking mastectomies of healthy breasts.

While I doubt that Gretchen Whitmer will ramp up tourism by changing signs at the Ohio border to “Welcome to Michigan–the Great Lake States–Mastectomies for Minors Always Protected!” we should keep our eyes on something else: these 20-something states proclaiming themselves “sanctuaries” for “gender-affirming care.”

We already saw that tactic with abortion. California, Illinois, Michigan, and–if Abigail Spanberger gets her way and is elected—Virginia, all regard themselves as “choice oases” amidst an America of handmaidens and Gilead states. Given the thrall with which Democrats find themselves to sexual libertinism masquerading as “choice,” expect something similar with “gender care.”

And it’s not mere rhetoric. Would “sanctuary states” only allow confused children and their more confused parents to mutilate themselves? Or would they go further, encouraging runaway children and declaring them temporarily emancipated for “gender care” purposes? Will they replicate the “non-extradition/non-cooperation” laws now being passed for abortionists that essentially immunize them against criminal or civil liability (e.g., malpractice) in the minor’s home state? Will such jurisdictions further split families by applying that immunity against, say, a father seeking redress for what a physician did to his child spirited to the “sanctuary state” by his or her mother? Will “non-affirming” parents find their parental rights temporarily or permanently cancelled by aggressively pro-trans “Child Protective Services?” Will such permissive states erect the kind of “judicial bypass” procedures that were used under Roe to subvert parental consent to a minor’s request for abortion? Will “the right to privacy” be invoked so that parents might not even know essential details of the “treatment?”

These are real questions involving parental rights. June 2025 marked the centennial of Pierce v. Society of Sisters, a 1925 ruling in which a unanimous Supreme Court gave full-throated affirmation to parents to direct “the education and upbringing of children.” It’s the basis behind Doe v. Uthmeier, a case working through the Florida courts, which challenges the constitutionality of judicial bypass procedures by which “mature” minors could obtain abortions. With Roe dead, there is no countervailing “right” to justify a state official (judge) interfering with the right of parents to raise their minor child without providing her with an abortion.

Getting rid of the bypass system will erase the aberration that, when it comes to medical care, the state needs parental consent to give a girl an aspirin but not an abortion. If Uthmeier prevails, then states that use “sanctuary” policies to subvert parental rights regarding “gender care” will legitimately be in the crosshairs of violating the real federal rights of parents to be parents.

Gender ideologues will push back, saying that Tennessee violated “parental rights” by deciding it, and not parents, would say whether a child might have access, say, to puberty blockers. Isn’t that a contradiction?

No. Part of what underlay the challenge against Tennessee was the idea that states should not be able to regulate standards of care in their jurisdictions, particularly in procedures involving the reproductive system. No one would deny that a state could prohibit amputations of what it judges healthy limbs just because a parent and child think them unhealthy and found some “doctor” to sign off. Parents cannot, for example, bind their daughter’s feet, even if they and their child want it, think it “culturally appropriate,” and can find a practitioner. They cannot engage in female genital mutilation for religious reasons (a still common practice in many Muslim countries). Would an anorexic child be allowed to continue that way because her parents might have anorexic biases, too? Indeed, there is ample precedent that states can protect life even against a parent’s and child’s objections, such as when a transfusion is required to save a child’s life, but the parents’ religious tenets forbid it.

“Parental rights” are extensive, but they are not “whatever a parent says they are,” especially when the consequences are permanent and irreversible. In “gender surgery,” that’s obvious. But as Ryan Anderson noted in When Harry Became Sally, we are at best ignorant of the consequences of “puberty blockers.” Advocates say they are reversible; that’s unproven. We do not know the long-term consequences of puberty onset at, say, 21 as opposed to 12; the only way to know is by experimenting on people, something considered unethical not too long ago.

But when “parents’ rights” are reduced to “whatever a parent says,” medicine (and reality) both become consumer-oriented wish fulfillment: I want it, it’s OK. Expect to hear something of that confusion when the Supreme Court rules this month in Mahmoud v. Taylor, the Maryland case where a local school district abridges parental opt-out for K-5 graders from its pro-gender ideology curriculum. The likely refrain will be: “parents’ rights count for parental transphobes, but not parents standing with ‘trans’ kids.”

That said, Tennessee’s law will not stop gender dysphoric kids and their approvingly confused parents from going, say, to Boston or New York for hormones, puberty blockers, and perhaps even “top” or “bottom surgery.” In that sense, the Supreme Court ruling made the protection of children “supported” by both parents from genital mutilation geography dependent. But that geographical diversity opens the door for much mischief, making where both parents are not in agreement, maybe even when both are in disagreement with their child. That’s where future controversies could arise.