美国最高法院正在考虑田纳西州的参议院法案1是否符合宪法，该法案禁止对被诊断患有性别焦虑的未成年人进行某些类型的医学治疗。周三，在华盛顿特区的法院外，辩论双方的数十名抗议者为他们的事业集会。
一名抗议者，西弗吉尼亚州居民和跨性别活动家Ash Orr，在最高法院的台阶外服用了规定剂量的睾丸激素，法官们听取了支持和反对田纳西州禁止对跨性别未成年人进行性别确认护理的口头辩论。
34岁的奥尔在谈到他抗议禁令的行为时说:“尽管在那栋大楼里，我们的身体自主性正在被讨论，但在那个时刻，我们处于控制之中。”。“我们可以控制自己的决定，控制自己的身体，做对我们跨性别者最有利的事情。”
当法院决定是支持还是阻止该禁令时，奥尔反思了年轻时的自己，以及获得他所谓的“救命”护理的重要性。奥尔说，他年轻时没有出柜，他说，成年后获得性别肯定的照顾，并得到包容和肯定的社区的支持，让他“茁壮成长”。
“我年轻的时候非常想自杀，因为我觉得被困在自己的身体里，”奥尔说。“我没有术语或资源来解释我的感受和我需要的帮助，以及我在很小的时候就试图结束自己的生命。我确实觉得，如果我有机会获得这种医疗保健，我在成长过程中就会少经历一些挣扎。...我认为人们不明白我们都应该有决定什么对我们的生活最好的自由。”
针对田纳西州的诉讼是由司法部提起的，但一直由一名15岁的纳什维尔变性女孩及其父母牵头。该法律限制获得青春期阻滞剂、激素疗法和性别转换手术。然而，它允许非变性未成年人获得相同或类似的医疗程序。
DOJ和纳什维尔家庭表示，田纳西州对性别确认护理的限制违反了第14修正案的平等保护条款，因为它特别歧视变性儿童。
田纳西州官员认为，宪法保证各州“有权利和责任保护儿童，监管医疗行业，并独立评估要监管的做法的风险和收益的证据，”田纳西州司法部长乔纳森·斯科尔梅蒂在一份关于最高法院论点的在线声明中说。
“我们的争论最终是关于宪法的明确性和常识，”司法部长斯科尔梅蒂说。“我们不能让意识形态凌驾于医学证据之上，以牺牲我们的自治权和保护儿童的责任为代价。”
青春期阻滞剂延迟某些身体特征的发育，包括乳房和面部毛发的生长以及一个人声音的变化。一旦阻断药被停用，健康专家告诉ABC新闻青春期持续很少或没有被证实的副作用。
接受激素治疗的青少年根据他们的性别身份服用雌激素或睾酮。专家解释说，激素治疗的变化发生缓慢，并且部分可逆，例如声音和体毛的变化。
健康专家告诉美国广播公司新闻，为18岁以下的人做手术是非常罕见的，只是在个案的基础上考虑。
跨性别者——据统计，在13岁以上的美国人中，跨性别者不到1%加州大学洛杉矶分校的研究机构，威廉姆斯学院已经成为全国几十个州共和党支持的立法的主题。
几十个禁令已经出现，限制身份证上性别标记的变化，变性浴室使用，性别确认护理禁令，等等。
根据性少数群体立法追踪系统，目前至少有24个州全面禁止对未成年人进行几种形式的医学性别确认护理运动推进项目。另外两个州完全禁止变性青年接受手术。
包括美国儿科学会、美国医学协会、美国儿童和青少年精神病学学会在内的医学组织和其他组织表示，性别确认护理是安全、有效、有益的，并且对一些跨性别青年来说可能是医学上必要的。
他们认为，限制个性化、适合年龄的性别确认护理的禁令侵犯了家庭与医生一起做出医疗决定的权利。
对性别肯定的青少年保健的批评者说，家庭应该等到他们的孩子长大后再做这些决定。田纳西州在最高法院前辩称，该法律是在“保护儿童”免受“不可逆转和未经证实的性别转换程序”的影响。
“田纳西州的大会审查了医学证据，以及欧洲国家限制这些程序的循证决定，并最终通过了这项禁止不可逆医学干预的两党法律，”Skrmetti说。“本案的原告要求法院从人民选出的代表手中夺走规范医疗实践的权力，并将其赋予不负责任的法官。”
蒙大拿州众议员佐伊·泽法，第一个公开的跨性别立法者在最高法院抗议田纳西州的禁令。
身处最高法院之外，她说这让她想起了争取性少数群体民权的漫长历史——从石墙起义到支持婚姻平等的抗议。
“你有像石墙这样艰难的时刻，但也有社区团结起来的时刻。如果你关注第二天的石墙骚乱，你会看到性少数群体人手挽手站在一起，微笑着，为他们一直站在一起，为彼此挺身而出而自豪，”泽法说。
她说:“参加集会的人知道利害关系，他们知道审理这个案件的法院是什么类型，但我昨天在那里看到的人也在为彼此开拓空间，让自己和其他同性恋者在一起，并在那个社区中找到快乐。”
泽法在她的第一个任期内受到指责，并被禁止进入众议院，因为她在州众议院恳求立法者投票反对他们最终通过的变性青年性别确认护理禁令。她说她最近与共和党议员合作在她的州拒绝了州众议院和参议院的跨性别浴室禁令。
她认为，反变性人的言论和立法分散了普通美国人面临的问题:“别管变性人，让我们过自己的生活，让我们的代表回去努力让我们的州成为我们所有人更好的地方。”
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 professionalshave told ABC Newsthat 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 toUCLA'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 trackerMovement 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 firstopenly 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 recentlyworked with Republican legislatorsin 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."
