Skirmetti vs. US (and the World): The Supreme Court, Transgender Rights, and the 14th Amendment

Part 2

The Supreme Court Line

Then, we left the warmth of the cozy restaurant to go to the Supreme Court building to check out the line. Winter temperatures in DC were about 15 degrees Celsius at 10 p.m., and there were already 50 people in line. We were the last of those fifty. Getting into a Supreme Court case hearing is rare, and this is the most prominent case heard perhaps since the gay marriage bill.

I learned what an activist life is like. Sitting next to us was a group of women praying; on the other side, a group of trans-identifying supporting men and women. The dichotomy reminded me of Faith vs. Activism, with the prayer group representing conservative social values and, on the other side, an active, visible advocacy focusing on the rights of transgenderism.

With the cold temperatures, we went to Walgreens and purchased gear and food to stay on the course. We agreed to rotate and take turns with at least one or two of us in the line at all times. I laid out blankets and wrapped myself up in the cold night about to become even colder. I actually managed to sleep a little, but I am keenly aware of how homeless people sleep on sidewalks. My brother helps homeless men and nurtures them back into society his – his podcast about being homeless is profound.

Abruptly, at 3:30 a.m., the DC Supreme Court workers set up a line of barricades on each side of us, as they anticipated protests and rallies in the morning. Some people slept soundly, while others stayed up talking all night long.

And for all this effort, we weren’t guaranteed a ticket. By 4 a.m., there were over a hundred people in the line. I warmed up in the back of the car while we rotated to avoid losing our place in line. The Supreme Court line is a ritual of sorts. It was obvious that for some, this was not their first rodeo. They had come with sleeping mats, heaters, sleeping bags, everything one would need. It was also evident that some were paid “line-holders.” This is a prominent practice in politics. One can pay someone per hour to wait in onerous lines, and they can claim their spot in the morning.

0630

The Supreme Court officer came out and handed out tickets for entry into the Supreme Court. I remember seeing the disgust on the people’s faces waiting behind us. One guy looked really upset and started calling the police, saying people were cutting the line and making a ruckus. He was experienced at this as he knew how to call and what to say to get the police to come. After that bit of commotion, we could grab a coffee, return to the Air BnB to freshen up, but we had to be back in line by 830 a.m. Talking about burning the midnight candle.

Rush hour prevented us from returning to the hotel, so we settled for coffee at Starbucks and used the bathroom there. Again, this is reminiscent of how homeless people function: sleeping outdoors, using a coffee shop to get warm coffee, and use the bathroom to clean up. Given our lack of sleep, we became slightly annoyed with one another, but it was all good; we all remembered what we were here for. But I still thought this was a hell of an effort only to have “a chance” to see the Supreme Court ordeal.

The Rising sun and the Morning Debate

Back in the line, we went, a crew of seven. As we stood in line for the Supreme Court case, a young woman, a student from Georgetown University, approached us. She politely asked if she could pose a question, setting the tone for a thought-provoking conversation.

“Excuse me, sir, can I ask you a question?”

She was genuine in her presentation and asked, “Why do you believe in the way you do?” She continued, “I believe in the trans movement very much; obviously, that’s why I’m here.”

She spoke of having concerns about the possibility of injuring kids as well but asked, “Why are you against this?”

First, she asked Sarah Penn, the Wyoming representative, and her husband, Nate.

Nate stated the obvious: kids aren’t ready to make those kinds of decisions, and that he had personal experiences with transgenderism, having seen the difficulties it placed on families and children themselves.

The student answered, “That may be true in some cases, but some desperately need this treatment.”

Nate continued talking to the young girl, and I listened intently. After all the usual questions, I joined the conversation.

I asked her if she’d ever witnessed or knew what happened in a transgender surgery. She answered me with a quizzical look and answered, “No.”

I continued saying, “Yes, I understand that you are nervous that this could affect the rights of both kids and trans rights. But kids can’t judge their gender on a whim. They’ve barely gone through five years or so of consciousness themselves.”

She rebutted, “Yes, I am concerned about the children and surgery as well, and I have a hard time knowing where to stand on that.” She kept repeating this in different ways. Thank you for the discussion,” she said. “Of course, I don’t agree with you, but I’m happy we are talking about it.”

Then she asked, “Well, what do you think about an adult being able to be transgender?”

“Good question,” I said. For me, it’s like this: I’m happy that an adult has the right to go through with these surgeries, and they should have the right to do it. Even more, I will fight to my absolute death to ensure that an adult has the right and the choice to have these surgeries and follow their happiness, wherever that leads them.”

I further explained what actually happens in these surgeries. They are harsh, intense, and require a lot of anesthetics. The surgeon’s goal is to scrape the chest wall with a tool called a rongeur in the operating room. A rongeur is a French term referring to gnawing; it’s a surgical instrument surgeons use in the operating room for cutting or biting away bone and tough tissues like cartilage. It’s a heavy-duty tool with a design that typically includes a handle, a lever, and a working end with sharp jaws or blades. In gender-affirming surgeries, it is used to scrape all breast tissue down the chest wall, and the anesthetic requirement is enormous. I don’t think the inventors ever imagined that these tools they were inventing would be used for changing normal little boys’ and girls’ anatomy when they had no disease.

The student was speechless at this point, only a blank stare.

Then, I went into the identity discussion.

I asked her, “How can a child even know their identity? At that age, you can’t even follow through with something you told yourself to do, let alone name your identity.”

I explained why identity is complex. It sits at the core of who we are, is transcendental, and goes so deep that our consciousness becomes involved. Identity is complex that it goes through developmental stages forming identity over time through experiences, relationships, and maturation. There’s a cultural influence and societal norms influence identity. I said it is unimaginable to allow children to change their identities on a whim and that we must allow people to mature before making such life-changing decisions.

Again, she was speechless but kept listening.

Then, I continued with the question about the costs. Who pays for these surgeries, for both minors and adults?

The student asked, “So how we pay for it?”

“With our taxpayer money, that’s how we know that there’s been over 12,000 trans surgeries on kids and adolescents since 2019.”

It must have been surreal for Travis Morrel, one of the doctors behind the Do No Harm and Principled Physicians organization, to hear these numbers used right in front of him, in a transgender debate, in front of the Supreme Court, while waiting to see the case to be argued in person.

I asked her, “Who should pay for these surgeries.”

“The government,” she responded.

I then asked, “Should pay for these surgeries, especially given the possibility that they may regret it later. Should it be the taxpayers or the person wanting to change their gender themselves?”

She said, “Then how is a trans person was going to get the money for surgeries if the government didn’t pay for it?”

That’s when I said, I’ve seen this firsthand: when these trans people want these surgeries, they will find the money. They will go to countries like Spain, where they do a lot of this type of surgery. When people want surgery, they always find the money, just like men and women motivated for cosmetic surgery.

Then I asked, “What happens when these kids, or even adults, decide five or ten years later that now they are, in fact, the gender they’re born with, and they want a reversal, assuming it can be done. What then? Who pays for that? How do we go about this?”

The young student had no answers for any of this. She was under the notion that the government should be paying for us all, Marxist, socialistic view for sure.

So, how far do we go? Do we just tell the trans person that you have one shot? Don’t ever change your mind. What then? Even worse, when this is a kid, what then? We didn’t even get into the failure of bottom surgeries, which has been a total disaster.

All she could come back with was a more positive affirmation that the subject of trans surgeries in kids is controversial and that maybe we aren’t there yet. She reiterated her fear that this would affect adults all the same. It was a nice way to agree to disagree.

I explained that I don’t see the surgeries being banned for adults. Maybe it will drive some of the medical therapies into cash pay and less insurance, but an adult will always have the right to seek these types of surgeries if they want them.

This student was a very nice person. She said thank you and returned to her place in line.

The Officer Returns

The officers came out and let the first 30 people in, and we were all concerned. The Supreme Court police officers give you hints or any information if you will be allowed entry; you just have to line up and wait. Even leaving to relieve yourself was a big risk as you never know when they would allow more. The Notre Dame Catholic students seemed pretty confident about the deal as they had done it before; they said that everyone would get in. Well, not so fast. This is a highly charged court hearing. And there were a lot of groups that had ties to the case, and they were let in first.

At ten AM, the courts were in session. We figured that we were toast; there was no way they would let anyone else in. Just as we were about to throw in the towel, the officer let another ten of us in. “It worked,” I said to myself. Still, about half of our group needs to get in by this point. They eventually got in as well, and we were all relieved.

Inside the Supreme Court

We entered the Supreme Court, went through the regular security checks, and were shown to our seats. This is a once-in-a-lifetime experience, so I was happy just being there to take it all in. As I was seated inside the Supreme Court, I saw the nine justices in front of me. It was quite surreal seeing the people, hearing their stories, and knowing the history of what’s transpired in this room.

They were there, all nine of them: Barret, Gorsuch, Sotomayor, Thomas, Roberts, Alito, Kagan, Kavanaugh, and Brown are all seated in their black robes with the edges of their chairs rising above their heads.

The ACLU lawyers were at the heart of their arguments. Of course, they sounded well-rehearsed; this is what the ACLU does. Three ACLU lawyers argued that this is a right-to-access issue and, according to the law, discriminatory.

These lawyers are well-versed. They spoke with a confident narrative so that when they stated something with little evidence or even a little misleading, that little part would still hold in their arguments.

The ACLU case was about whether or not Tennessee law has the right to infringe on the rights of minors who identify as transgender. They kept repeating that it’s up to the “good parents and doctors” to make these life-changing decisions for their children if they want to be the opposite sex and become their “true selves.” In truth, the ban in Tennessee is banning doctors from prescribing these medications and performing these surgeries.

“Excuse me?” I said to myself. The way the trans deal goes, the child goes into the office and says I am depressed and transgender. Then, minutes later, the prescription for puberty blockers and hormones is given.

Never once did anyone suggest that maybe some intense therapy would be the best way before ever considering these surgeries. It was as if once the doctor said that the child had a diagnosis of being transgender, that was the end of the story. Move forward with therapy. This was the little piece they kept saying, assuming that the state of Tennessee was doing a great job at diagnosing these little ones, and now they are ready for hormone therapy and surgery. The reality of this lies so far from the truth. All of the women who detransitioned explained how they were literally pushed through the system as rapidly as possible, with little time to explore the risks, benefits, or alternatives of the treatments they were receiving.

One of the things I appreciated was that ACLU lawyer Chase Strangio, a woman who identifies as a man, admitted that the data on suicide and transgender procedures wasn’t as clear as pro-transgender activists have previously claimed. Proponents of transgender ideology have long acclaimed that so-called “gender-affirming care” is lifesaving, telling parents that they can either have a living child with the treatments or a dead child without it. We now know this to be outright false. Suicide actually goes up after having transgender surgery, and it’s much more complex than that. Basically, we’ve put a Band-Aid on the real problem instead of addressing the root cause. Justice Samuel Alito pressed Strangio on the link to suicide and what the available data showed. Strangio first claimed that it was “clearly established in the science” that the medications reduced the risk of suicide. In response, Alito pointed to research from the Cass Review produced by the NHS in the United Kingdom that said that “there is no evidence that gender-affirming treatments reduce suicide.”

Strangio backtracked, saying that “there is no evidence in the studies that this treatment reduces completed suicide”, but claimed that the procedures would reduce suicidal thoughts. Again, I thought to myself, as a physician, no good studies are showing that, at least in any capacity, to be able to make constitutional decisions affecting whether a child should receive gender-affirming care or surgery. Recent research has shown that contrary to these claims, transgender procedures can increase the likelihood that minors will attempt suicide.

What struck me again was the lack of medical direction and the place for therapy in all this. Why aren’t we advocating better therapy, changing environments, and even the use of psychedelics like ketamine in conjunction with therapy?

I spoke with Chloe Cole about this exact topic, and she agreed that it could have changed her situation if she was offered therapy and psychedelics. Chloe Cole, who was put on cross-sex hormones and puberty blockers and had a double mastectomy as a minor, has become one of the most outspoken advocates against transgender procedures on women. She mentioned that all she was given was the antidepressant Wellbutrin, which merely numbed her thoughts about her gender confusion. After I explained how ketamine might work in a situation where a minor is gender confused, she thought it might be a great idea for others. It’s important to highlight that psychedelics are something to consider and a decision not to be taken lightly. They may or may not work in the case of gender dysphoria, but given the desperate situations families find themselves in, it’s worth trying. Please consider reading more in my book, The Revolutionary Ketamine.

Sotomayor’s now-famous statement

Counselor Mathew Rice posited, “How many minors have to have their bodies irreparably harmed for unproven benefits?” Justice Sotomayor responded, “Every medical treatment has a risk. Even taking aspirin.” I later read the exact wording: “I'm sorry, counselor,” Sotomayor interrupted then, her tone exaggerated. “Every medical treatment has a risk. Even taking aspirin.”

As a medical professional, I was just floored by this statement. It’s difficult to know where to start. I understand that Justice Sotomayor is an intelligent woman, but this statement, and what she said afterward was beyond comprehension. Implying that removing healthy organs like breasts, ovaries, and testicles is akin to the risks of taking certain medications like aspirin shows the profound lack of consideration of what’s actually happening here. For example, giving testosterone for life to a female is wrought with high risks and fraught with complications. The adverse effect rate of removing healthy organs and lifetime hormone replacement is a hundred percent, just as when a person receives a lobotomy, the adverse effect of that procedure is one hundred percent. I wonder if Sotomayor still agrees with the concept of lobotomies for depression.

Sotomayor’s response seems laughable until you realize that thousands of people are in places of authority like education boards, insurance companies, and political committees funded by NPOs. Then, it becomes overtly dangerous.

Finally, I was startled to hear Justice Jackson’s comparison of the law in question and irreversible medical interventions on minors to the laws against interracial marriage and civil rights. I felt like she was drawing straws at this point. I’m not a legal analyst, but these were my observations. I was impressed with how she used “the structure of the law” and other keywords. At first, you think it’s clever until she says, “It’s sort of the same thing.” Sort of the same thing? Transgender surgeries are nothing of the sort. She also pinned Rice on sticking to the law and not referring to other laws and situations, being legally rigid to produce a specific result. I understand these are legal strategies and gestures used in court, so I had to appreciate the complexities of what was happening.

One of the highlights of the experience was hearing Counselor Rice quoting the portion of the Amicus brief I wrote about “Healthcare is inherently discriminatory based on sex for good medical reasons.” He mentioned the outcome of the Dobbs decision and there are at least 6500 gene expressions that manifest differently between males and females. This led to one of the justices asking if he believed the genes that control sex are inherently immutable. Legally, this was a “drop-mic” moment in the court room as everyone remained silents for some minutes. Again, the Amicus can be found here.

Never once did Neil Gorsuch speak. That was puzzling, yet interesting. Then, the whole thing was over, and we adjourned.

All in all, I saw this case about the question of whether or not we should protect kids from doctors and healthcare workers who promote transgenderism. It’s looking like the Supreme Court is leaning towards upholding the ban on minor transgender surgeries and treatments for now. One can only hope and pray for the people to do the right thing. Someone asked me why I was here in DC, supporting this cause. I answered it’s about the children and I referred to Mathew 18:6: "If anyone causes one of these little ones—those who believe in me—to stumble, it would be better for them to have a large millstone hung around their neck and to be drowned in the depths of the sea."

As the plane took off from DC, I felt temporary relief after a whirlwind effort. Upon returning to Florida, my 13-year-old niece asked me, “Did you win in DC Uncle John?” I had to reflect for a moment and said, “No, I didn’t win. It was the kids who won. No, it was the kids all over the world who won.”

A special thanks to counselors Diana Lutfi JD who worked tirelessly to make all this happen and wrote the Amicus Brief. And to Terry Fowler JD, who is a former nurse, ethicists, disability rights advocate, and healthcare administrator. He also volunteered so much of his time and resources in taking this on. He is a published author and a prolific writer.