Protests outside of Supreme Court capture growing fears for transgender Americans

The U.S. Supreme Court is considering whether Tennessee's Senate Bill 1 -- which prohibits certain types of medical treatments for minors with diagnosed gender dysphoria -- is constitutional. Outside the courthouse in Washington, D.C., Wednesday, dozens of protesters on both sides of the debate rallied for their cause.

One protester, West Virginia resident and trans activist Ash Orr, took his prescribed dose of testosterone outside the steps of the Supreme Court, as the justices heard oral arguments for and against Tennessee's ban on gender-affirming care for transgender minors.

"Even though inside that building, our bodily autonomy was being up for discussion, at that moment in time, we were in control," said Orr, 34, about his act in protest of the ban. "We were in control of our decisions, of our body, of doing what's best for us as trans individuals."

As the court decides whether to uphold or block the ban, Orr reflected on his younger self and the importance of having access to what he calls “lifesaving” care. Orr, who says he was closeted in his youth, said that access to gender-affirming care as an adult and being supported by an inclusive and affirming community has allowed him to "thrive."

"I was very suicidal when I was younger because I felt trapped in my body," said Orr. "I did not have the terminology or the resources to explain how I was feeling and the help that I needed and that to me trying to take my life at a very early age. And I do feel that had I had access to this health care, I would have seen less struggles growing up. ... I don't think folks understand that we all should have the freedom to decide what's best for our lives."

The lawsuit against Tennessee was brought by the Department of Justice, but has been led by a 15-year-old Nashville transgender girl and her parents. The law restricts access to puberty blockers, hormone therapies and surgeries for gender transitioning. However, it allows non-transgender minors access to the same or similar medical procedures.

The DOJ and the Nashville family say Tennessee's restrictions on gender-affirming care violate the equal protection clause of the 14th Amendment because it discriminates against transgender kids specifically.

Tennessee officials argue that the constitution guarantees states "the right and responsibility to protect children, regulate the medical profession, and independently evaluate the evidence of the risks and benefits of practices to be regulated," Tennessee Attorney General Jonathan Skrmetti said in an online statement about the Supreme Court arguments.

"Our arguments were ultimately about constitutional clarity and common sense," said Attorney General Skrmetti. "We cannot allow ideology to override medical evidence at the expense of our right to self-government and our duty to protect our children."

Puberty blockers delay the development of certain physical characteristics, including the growth of breasts and facial hair as well as changes in a person's voice. Once blockers are stopped, health professionals have told ABC News that puberty continues with little to no proven side effects.

Teens who receive hormone therapy take either estrogen or testosterone based on their gender identity. Changes from hormone therapy occur slowly and are partially reversible, experts explain, such as changes in voice and body hair.

Health professionals have told ABC News that surgeries for people under 18 are quite rare and only considered on a case-by-case basis.

Transgender people -- who make up less than 1% of Americans over the age of 13, according to UCLA's research organization, the Williams Institute -- have been the subjects of Republican-backed legislation in dozens of states across the country.

Dozens of bans have popped up restricting changes in gender markers on IDs, transgender bathroom use, gender-affirming care bans, and more.

Right now, at least 24 states have general bans on several forms of medical gender-affirming care for minors, according to LGBTQ legislation tracker Movement Advancement Project. Two other states solely ban surgeries for transgender youth.

Medical organizations including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and others say gender-affirming care is safe, effective, beneficial, and may be medically necessary for some transgender youth.

They argue bans that restrict individualized, age-appropriate gender-affirming care infringe on a family's right to make medical decisions with their doctors.

Critics of access to gender-affirming youth care say that families should wait until their children are older to make these decisions. Tennessee argued before the Supreme Court that the law is "protecting children" from what are "irreversible and unproven gender transition procedures."

“Tennessee’s General Assembly reviewed the medical evidence, as well as the evidence-based decisions of European countries that restricted these procedures, and ultimately passed this bipartisan law prohibiting irreversible medical interventions," said Skrmetti. "The plaintiffs in this case are asking the Court to take the power to regulate the practice of medicine away from the people’s elected representatives and vest it in unaccountable judges."

Montana State Rep. Zooey Zephyr, the first openly trans lawmaker in the state, was at the Supreme Court protesting in opposition to Tennessee's ban.

Being outside of the Supreme Court, she said it reminded her of the long history of the fight for LGBTQ civil rights -- from the Stonewall Uprisings to protests in favor of marriage equality.

"You have moments of hardship like Stonewall, but you also have moments where the community has come together. If you look after the Stonewall Riots the day after, you see photos of LGBTQ people standing arm in arm, smiling, being proud that they have stood by and stood up for one another," said Zephyr.

She said: "the people at that rally know what's at stake, and they know the type of court that is hearing this case, but the people I saw down there yesterday were also carving out space for one another and surrounding ourselves with other queer people and finding joy in that community."

Zephyr was censured and barred from the House floor in her first term for encouraging protesters after pleading on the state House floor for legislators to vote against a gender-affirming care ban for transgender youth that they ultimately passed. She said she recently worked with Republican legislators in her state to reject a transgender bathroom ban in the state House and Senate.

She argues that anti-transgender rhetoric and legislation have been a distraction from the issues facing average Americans: "Leave trans people alone, let us live our lives and let our representatives get back to trying to make our states better places for all of us."

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