One of the most critical decisions from the U.S. Supreme Court in 2025 involves a case argued before the justices in early December—U.S. v. Skrmetti. The high court will decide whether the state of Tennessee may protect minors from experimental, life-altering transgender medical protocols such as puberty blockers, cross-sex hormone injections and surgical manipulation. For many, transgender medicine is the largest medical scandal in our nation’s history, resulting in heart-wrenching stories of wrecked lives.

To be completely upfront, the reason for this article is a call to get on our knees and pray for a clear and decisive victory to protect children and youth in Tennessee and across the country from reckless, unsubstantiated, harmful and often irreversible medical experiments. 

This case has massive implications for at least two reasons. First, if you have ever listened to the testimony of a sterile, regretful, broken 20-year-old detransitioning woman, and tears don’t pour from your eyes, you don’t have a heart. Young lives are permanently damaged, and no one warned them. Affirming parents, teachers, counselors and medical professionals drank the ideological potion, seemingly oblivious to the irreversible, life-altering consequences such as sterility. This in itself is enough reason to petition our Lord for mercy, goodness and righteousness to prevail in the Supreme Court’s decision, which is expected by July. The questions posed during the hearing by the conservative majority point to the likelihood of a favorable ruling, the Wall Street Journal reported, but there are no guarantees.  

Will the court understand the plight of detransitioners whose lives are forever changed, abandoned by the “progressive” medical establishment that failed to warn them? Will the justices consider that children struggling with gender dysphoria will conform to their actual body 85% of the time by the end of puberty and over 90% of the time by adulthood? These factors alone show that Tennessee acted reasonably, honorably and wisely to protect minors from dubious hormone and surgical interventions with no good science showing helpful long-term outcomes. 

Undeniably, this is a case of historical consequence for our nation. Tennessee desires to protect children and youth from medicalized transitions that have lifelong effects and hold reckless medical practitioners accountable. State lawmakers’ duty to love, care for and protect minors should never be trumped by elevating gender identity to a special, untouchable constitutional status. States should be free to legislate by the medical reality that biological sex matters and that medicalized transition does real, lasting harm. 

Romans 13 says the purpose of government is to stand against evil for the good of the people. Over 20 states have had the fortitude and vigilance to protect minors from transgender medical practices. Never forget that it took nearly 50 years of advocacy, three Supreme Court appointments and a bold strategy to set states free to protect vulnerable preborn children by erasing the millstone of Roe v. Wade. This is reason to pray for the state of Tennessee in their fight for all states courageously standing against the medical atrocity of “gender-affirming care.”

Defying nature and nature’s God never ends well. Evidence-based findings in countries such as Norway, the United Kingdom, Sweden, Denmark, France and Finland have caused medical officials to put the brakes on medicalized transitions for children and youth. Leaks from the World Professional Association for Transgender Health (WPATH) show that behind closed doors, even some “gender-affirming care” activists express concerns and doubts about the practice. One documented concern was that youth are not mature enough to make a decision about long-term fertility and the ability to have a family one day. 

A report resulting from WPATH’s public leak concluded that although the organization is often treated as authoritative on standards of care for treatment of gender dysphoria, it actually is “a fringe group of activist clinicians and researchers masquerading as a medical group, advocating for a reckless hormonal and surgical experiment to be performed on some of the most vulnerable members of society.” 

Recently the Cass Review,  a nearly 400-page report commissioned by England’s National Health Service, concluded that there is “remarkably weak evidence” supporting transgender medical interventions, with “no good evidence” on favorable long-term outcomes. 

As biologist Colin Wright concisely captures it, the fight against the gender ideology agenda is “reality’s last stand.” A Supreme Court decision allowing medical professionals in Tennessee to continue dispensing puberty-killing toxins, cross-sex hormones and genital surgery on distressed youth may propel gender identity to a constitutional legal status where women’s shelters, dorms, locker rooms, prisons and sports become accessible to men pretending to be women. 

The world is recognizing that this offense against nature and rejection of God’s merciful, creative, male and female design is harmful. In the United States, the American Society of Plastic Surgeons recently expressed “considerable uncertainty” about the effectiveness of plastic surgery procedures on transgender minors. But the U.S. government and most other medical associations continue to endorse medical sex change procedures for minors, and as a result, lives are being ruined. 

Many states, including Tennessee, are courageously standing in the gap. Pray for favor, blessing and mercy with the Supreme Court justices and that this will not be “reality’s last stand” in an earthly sense. And keep hope: Ultimate victory comes in Revelation 21, where Jesus says, “Behold, I am making all things new” (Revelation 21:5).

In the meantime, let us commit ourselves to living out the words of Romans 12:12, “Rejoice in hope, be patient in tribulation, be constant in prayer.” ©2024 Todd Chasteen

Scripture quotations are taken from The Holy Bible, English Standard Version.

Todd Chasteen is vice president of public policy and general counsel for Samaritan’s Purse.

Photo: George Walker IV / ©2023 AP