Freethought-Now

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It has been nine months since the Supreme Court announced its ruling in United States v. Skrmetti, holding that Tennessee’s ban on gender-affirming care for minors was constitutional. Since then, those of us who have been monitoring the growing anti-transgender movement in the United States have been watching carefully to see in what direction the law continues to develop.

As of early 2026, 27 states have imposed bans on best practice medical care for transgender youth, applying to an estimated 40 percent of transgender youth between the ages of 13 and 17. These laws not only ban surgeries, which prior to the rise of anti-trans hysteria were already extremely rare and only occurred in cases of severe gender dysphoria in older teens, but also medications such as puberty blockers for younger patients and hormone replacement therapy for teenagers. As always when talking about gender-affirming care, it is critical to note that these banned treatment models have been considered best practice medical care for decades by most mainstream medical organizations. These bans are not in reaction to legitimate scientific discoveries, but rather are a result of a coordinated effort by Christian nationalist organizations to make these health care bans a priority, supported by a large network of shared funding and staff focused on creating a wealth of anti-transgender pseudoscience masquerading as legitimate data. 

As of right now, I predict we will see a slow down in the number of laws passed that are specifically targeted at banning gender-affirming care for minors. The states where these laws can and have passed easily with very little political opposition have already done so, with the remaining states containing enough political opposition to hold such bans at bay, at least for now.

The focus on minors, though, has been a strategic one, both on the part of those who support the anti-trans movement as well as self-described “moderates” who are “just asking questions” about whether minors have the capacity to understand themselves, their bodies, and their identities. Defenders of gender-affirming care bans sometimes claim that they have no problem with adults seeking this health care if that is what they feel is best. As we rapidly approach the one-year anniversary of the Skrmetti decision, however, it is clear that the bans, or at least rapidly increasing barriers, on access to gender-affirming care for adults are going to be the next major upcoming battleground. In fact in February, Kevin Roberts, president of the Heritage Foundation (the organization behind Project 2025), stated on a podcast that the next goal post to its solution to transgender existence is to outlaw it completely. The path to that outcome is not in front of us — it is the one we are already on.

In mid-March, the 4th U.S. Circuit Court of Appeals ruled that states can ban Medicaid funding from being applied to gender-affirming surgeries for adults, explicitly calling gender-affirming care “dangerous” regardless of the age of the patient, and holding that states have a legitimate interest in “encourag[ing] citizens ‘to appreciate their sex’ and not ‘become disdainful of their sex.’” The decision cites Skrmetti over 70 times, disregarding the role that age played in the Supreme Court’s analysis, and instead focusing on the idea that the proper role of the state is to radically control the personal medical choices of consenting adults. This will be a case to watch closely in the coming months and years, as it will likely be one of the next big questions presented to the U.S. Supreme Court.

The increasing use of language encouraging trans people to “appreciate their sex” instead of seeking out gender-affirming care should unsettle anyone concerned about the rise of Christian nationalism and attempts at theocratic control over the individual right to bodily autonomy. This language has been essentially pulled directly out of the materials for Christian conversion therapy programs, and in particular “gender exploratory therapy” programs, designed to force patients to adhere to “God’s plan” for them based on their genital configuration. I wrote about these programs more in-depth back in June 2025, noting that these programs place patients at a significantly increased risk for substance abuse, suicidal ideation and other negative mental health outcomes.

This idea that trans people simply need to “appreciate their sex” and “the inherent biological differences between men and women” is also deeply tied to a strand of Christian theology known as “complimentarianism,” which claims that people are born with “God-given” inborn traits based on their genitals. Males, in this line of theology, are meant to be “leaders” and “providers,” a dominant force in their home second only to God. Females, on the other hand, are meant to be “submissive” and “nurturing,” devoted to following the will of their husbands, caring for the home, and producing and raising children. Often these gender exploratory therapies will operate by requiring that patients lean into conforming to these patriarchal stereotypes, encouraging patients to actively pursue activities more in line with their “God-given sex” and avoid activities that would place them outside of those stereotypes.

The fact is, there is no massive health crisis regarding “too many” people receiving gender-affirming care. Long-term studies, including 40-year follow-ups, indicate incredibly high rates of satisfaction among people who have received gender-affirming surgeries. Yes, of course, these are major surgeries, but contrary to what the Christian nationalist movement may have you believe, these surgeries are pursued with careful frameworks for consent, under the guidance of multiple medical professionals, and typically take years of transition care to access. The goal of these laws banning or making more difficult such surgery is not to ensure that people are “certain” before undergoing a major medical procedure, but instead to radically police bodies into conforming to a Christian understanding of sex and gender roles.

The fight is moving into the adult arena, and it is going to be up to each and every one of us to work with our legislatures and communities to prevent the damage of the Christian nationalist anti-transgender movement from spreading even further. Because once they are done with us, they will begin a new campaign of policing anyone who does not visibly comply with their theology — regardless of gender identity.

Disclaimer: The views in this column are of the author and do not necessarily reflect those of the Freedom From Religion Foundation.

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