On a mild February evening in Nashville, a curly-haired teenager and her dad climbed the steps to the public gallery of the Tennessee Senate, where a group of lawmakers in the wood-paneled chamber below would, after a brief debate and the bang of a gavel, seize control of her family’s medical decisions.
As they watched over the Senate’s gilded railing last year, Tennessee Republicans voted to make it illegal for transgender minors to be prescribed certain medications and treatments for gender dysphoria.
L Williams is, in many ways, a typical teenager. She loves video games, brownies and hanging out with her friends. She is, at turns, annoyed and interested by her 11th grade classes. She takes out the recycling − upon gentle suggestion from her mom.
But on Dec. 4, she will climb another set of steps.
This time they lead to the U.S. Supreme Court, where her story sits at the center of a watershed legal case that could affect transgender medical treatment for young people across the U.S.
The teen, identified as L in court documents, and her parents, Brian and Samantha Williams, sued Tennessee in 2023 over the gender-affirming-care ban they watched pass. The ban forced Tennessee doctors to stop treating transgender patients like L with treatments like puberty blockers and hormone therapies by March 2024.
The ruling threatened to disrupt her medical treatment and endanger her mental health.
Two other Tennessee families with transgender children and a Memphis-based doctor joined the lawsuit.
Tennessee’s law sent the Williams family scrambling to find out-of-state doctors. Some Tennessee families affected by the law left a state they felt was dangerously hostile to their family circumstances.
But Brian and Samantha Williams don’t want to leave the place where they have deep family connections, or the home where their children’s growth milestones are proudly carved into the dining room doorway.
The Williamses saw the lawsuit as a line in the sand staking their claim to a home in Tennessee, their own Tennessee values and their right to make private medical decisions for their children.
“I don’t even want to think about having to go back to the dark place I was in before I was able to come out and access the care that my doctors have prescribed for me,” L said last year after filing the lawsuit.
The Tennessean, part of the USA TODAY Network, agreed not to identify L, still a minor, by full name or photograph her in an identifiable way because of safety concerns. Samantha and Brian Williams are named plaintiffs in the lawsuit.
Lawyers for the Justice Department and the ACLU will argue on Dec. 4 that the Tennessee law unconstitutionally violates the equal-protection clause on sex discrimination.
The same treatments and medications Tennessee Republicans said are too dangerous for L are still available to L’s classmates and other young people in Tennessee – as long as they are not transgender or being treated for gender dysphoria.
“Never in a million years did I think we were going to be going to the Supreme Court,” Samantha said in July, sitting with Brian and L at their dining room table, marveling at the “trajectory” of L’s journey over the past four years.
But why wouldn’t they push back, Samantha asked, for themselves and for other Tennesseans like them?
Navigating life as case barrels toward high court
Though the case has attracted national attention, it sometimes faded to the background for the Williams family this fall.
They tracked updates on the case with interest, but their warm and busy Nashville home often buzzed with the everyday activities of two working parents who are raising two teenagers.
Their backyard is peppered with Nerf darts, courtesy of a PVC-pipe air cannon Brian constructed with the kids, and they brought home a mischievous kitten dubbed Mushroom to join the family this fall.
On a recent October evening, the family flitted around the kitchen island, the wood countertop handcrafted by Brian from reclaimed rafters. L grabbed a snack while her parents discussed what they could rustle up for dinner.
A handwritten list hung nearby, outlining the Williams’ family rules that prioritize kindness and community, including “love your friends and neighbors,” “own your achievements and mistakes,” and “apologize when you hurt others.” A cheeky addition included “know how to throw a party.”
As lawyers in the case filed lengthy briefs through the summer, L began the 11th grade, juggling several Advanced Placement courses.
L has always been a crafty kid, Samantha said when picking up a pipe cleaner toy discarded by Mushroom, and used to build “fleets” of aircraft out of pipe cleaners. She still wants to be a pilot.
She spent last summer designing her first video game via self-taught computer programming and has for years produced electronic music with her friends. By October, she had picked up a new deck for DJing just in time to hold court at a Halloween party the family hosted for L’s friends. Brian helped her drape her DJ table with spider webbing and hang skeletons on the walls.
L is proud to challenge Tennessee’s law, though she acknowledges some anxiety about the potential results. What effect could their lawsuit have on transgender rights across the country? What influence could Donald Trump’s reelection have on the case as transgender Americans across the country are on edge regarding federal access to care?
At the family’s dining room table in July, L considered a question about the impact of such a rapidly shifting landscape.
“It’s stressful,” L said, carefully picking her way through her next statement.
Everyone, she said, should do their best to be involved in politics – “because it’s important, and it affects people.”
“But, you know, I really wish I could take breaks from politics, and I didn’t have to be worrying about that all the time,” she said. “But it’s something I have to constantly worry about. And, you know, I feel like I have to constantly develop arguments and arm myself with the knowledge to defend this to any particular person who decides to confront me on that.”
It’s something Samantha worries about, too.
On Feb. 15, 2023, days after L and her father watched the Tennessee Senate pass the upper chamber’s version of the care ban, Samantha testified before a House committee to oppose the bill.
It was days before L’s 15th birthday party, and Samantha’s voice began to break as she described the party plans – pizza and brownies, of course – that every kid should have, juxtaposed with what she characterized as a violation of parental rights.
“She is a happy, healthy kid who is not hurting anyone. Her joy, her smile, her confidence would not be what they are if it were not for the blockers she’s been on for a year and a half,” Samantha said.
Williams and another mother of a trans teen spoke before a group of lawmakers who at times aggressively interrogated the women.
“It was super-frustrating, just because they they wouldn’t even take that one moment to acknowledge our story. I really tried to personalize it as much as possible,” Samantha said. “She should be worried about pizza with her friends. She should not be worried about you guys taking away her care.”
Watching lawmakers debate the details of her everyday reality frustrated and angered L sometimes, she said, but through the process she just wanted to talk to the lawmakers considering the bill.
“They tend to infantilize a lot of transgender teenagers, especially when they’re talking about this legislation,” L said. “I think they’re going to be faced with a lot of cognitive dissonance, and I think they’re either going to have to come to terms with the fact that their opinions on the matter are at least somewhat fallacious. Or they’re going to have to show their true colors and reveal that they don’t actually believe any of the things that they say, and what they really believe is something much worse.”
Asking questions
When Tennessee lawmakers returned to work in 2023, banning gender transition treatments for minors was the Republican supermajority’s top priority.
Supporters of the bill testified that medications like puberty blockers, which suppress puberty and its physical changes, can cause long-term concerns like decreased bone density, sexual dysfunction and infertility problems. Long-term psychological effects of gender transition treatments for transgender minors are understudied, supporters argued, and teens are too immature to consent to such treatments.
“These treatments and procedures have a lifetime of negative consequences that are irreversible,” bill sponsor Rep. William Lamberth, R-Portland, said last year. He argued transgender teens needed mental health support until they could make medical decisions as an adult.
In the bill, Republicans banned specific medical treatments used for a specific purpose, but they did not ban the medications outright. Despite their stated concerns about lingering consequences for adolescents, lawmakers still allowed Tennessee teenagers to access these medications for conditions like hormone disorders or early puberty − as long as they are not transgender.
Leading U.S. medical organizations disagree with those assertions, stating the care is safe, effective and can be lifesaving for trans adolescents who experience higher rates of depression and suicidal ideation.
The Tennessee Chapter of the American Academy of Pediatrics urged Republican Gov. Bill Lee last year to quash the bill, arguing doctors should be free to “follow evidence-based medicine and clinical practice guidelines rather than politics.” No doctor with experience treating transgender people testified in support of the bill.
“People who disagree with Tennessee’s law can advocate for a different law through the democratic process,” Attorney General Jonathan Skrmetti, whose office will defend the bill in December, said in an op-ed in The Hill recently. “While the federal government is free to favor its transition-first, ask-questions-later approach, the Constitution does not bind Tennessee to that same choice.”
But the “ask-questions-later approach” could not be further from the Williamses’ journey, they said when describing L’s decision to come out as transgender.
“We did a lot of work trying to figure this out, ask a lot of questions and talk to our doctors and talk to therapists,” Brian said. “We did our due diligence, and then all of a sudden, somebody else is telling me that I can’t do this, and that it’s wrong?”
As L grew into adolescence, she began experiencing intense anxiety and discomfort. She felt as if she were “drowning and trapped” in the wrong body, and she couldn’t focus at school or connect with friends.
L said she felt “heavily emotionally distressed” as she faced going through male puberty. The experience would come with physical changes that, even if she pursued gender transition when she turned 18, could not be reversed. She felt so uncomfortable using the boys’ bathroom at school she developed urinary tract infections, according to the lawsuit.
“You’re at a point where not only are you going through puberty, but you’re also going through nightmare puberty,” L said. “I mean, obviously, nobody’s 100% comfortable with (the changes,) but you’re immensely uncomfortable with them.”
She first came out to a friend in 2019 but wouldn’t tell her mother until late 2020.
Samantha and Brian soon found L a therapist, whom she began seeing regularly after she was diagnosed with gender dysphoria. After six months and conversations with her pediatrician, the Williamses met with a medical team at Vanderbilt University Medical Center about starting puberty blockers to delay male puberty.
There were also long, drawn-out conversations and debates in the Williamses’ home, often up in Samantha and Brian’s room. Brian sometimes played devil’s advocate, to her chagrin, Samantha wryly told lawmakers last year. Her parents sometimes pushed back in ways L disagreed with.
“We had to keep saying, ‘We wouldn’t be good parents if we weren’t taking our time and asking questions,’” Samantha said.
“Your job as a parent is to take care of your kid, and do your best by them,” Brian chimed in.
In 2021, the Williamses decided puberty blockers were the choice for L, to her great relief. By January 2022, she had come out to extended family, classmates and teachers. More than a year after starting puberty blockers, L’s medical team and parents decided hormone therapy, which would suppress testosterone and increase estrogen in her body, was the next best step.
“I was not comfortable with where I was, and I personally felt like it was urgent to have that happen,” she said, adding it is “not fun to be the first trans person someone meets.”
“It’s difficult to deal with that, and school and puberty and all that at once. That’s why I oppose the law, obviously, because you’re going to significantly impact the lives of a lot of these kids because they have to deal with the stress of school compounding with a lot of the dysphoria they feel.”
Racing to find new doctors
In 2023, Samantha and Brian at first thought they might be exempt from incoming restrictions. L was already taking the medications, and they had done considerable due diligence with their medical team, Brian said. The state couldn’t just stop her from continuing medical treatment.
But they soon realized Tennessee could. As they lobbied the Legislature to block the law, Samantha began trying to find an out-of-state clinic that could take L as a patient before her medication became illegal in Tennessee in March 2024. It felt like a race against time as the treatment landscape shifted rapidly under their feet.
Before 2023, just three states had gender transition bans on the books. By the time Tennessee’s law took effect in June 2023, 20 states had banned the medical treatments for young people in some form, including a ring of states almost completely surrounding Tennessee and choking access to the treatments L had been prescribed for years.
For the Williamses, it was like a falling set of dominoes. Samantha scrambled to stay ahead. After at least a dozen inquiries with clinics across the country, she found a match in Cincinnati. Samantha, eyeing the wave of bans cascading into place across the country, decided to make another appointment in North Carolina as a backup plan.
The state would enact its own ban by August. But there was a catch.
Unlike Tennessee’s law, North Carolina’s would grandfather in any teens already receiving care in the state. The Williamses made an appointment in Asheville that summer, though they continued L’s treatment in Ohio through winter 2023. Ohio’s ban would come down in January 2024.
The treatment scramble led to monthlong delays in L’s care because each new clinic had to follow a careful procedure to admit L as a new patient.
“It’s not like you go in there and they’re immediately giving you prescriptions,” Brian Williams said. “There’s a lot of steps you’ve got to take.”
Anger and frustration over legislative debate
Meanwhile, L watched legislative discussions that sometimes sparked anger and frustration. She said she saw similar arguments and opinions she had already seen circulate online emerge within the halls of the state Legislature. The frequent vitriol directed at transgender people was also apparent to her.
“Puberty has a lot of irreversible damage that comes with it. So, I think to say that you should wait to make the decision until you’re 18 has a lot of consequences and permanent aspects to it. To say that, you’re robbing them of one of the choices they can make, at the very least,” L said. “I think that is a little bit hypocritical, unless you outright believe that someone who is transgender is inherently inferior. I know a lot of them won’t say it, but that’s oftentimes what they believe.”
The subtext surrounding the bill often cut even deeper than what was said in committee: The original version of the bill would have essentially codified gender-affirming care as an actionable form of abuse, suggesting lawmakers considered parents like Samantha and Brian a danger to their children.
Supporters of the bill threw out terms like “mutilation.” Meanwhile, a related rally in 2022 attracted members of the white nationalist group the Proud Boys as a national anti-trans movement emerged as a focus of the extremist right in recent years.
“It does make you a little nervous,” Brian acknowledged of challenging the state on an issue that has sparked considerable vitriol. “But it does feel a little punk rock. I don’t like what these people are doing, and I want to tell them that.”
A few months after the Williamses sued, a Trump-appointed judge in Nashville’s federal district court temporarily blocked Tennessee from enforcing the law. The ruling found the state lacked medical evidence and had likely run afoul of constitutional concerns. Months later, the 6th U.S. Circuit Court of Appeals reversed that decision, siding with Tennessee.
The Supreme Court arguments in December will center on that appellate ruling. Tennessee plans to argue the state has a compelling interest in blocking medication from kids who wish to treat their gender dysphoria.
Though Justice Department and ACLU lawyers will argue the state’s inconsistent ban amounts to sex discrimination, Tennessee argues that the state is allowed to set “age and use-based limits” and that the law does not differentiate between males and females but rather specific usage limits.
In December, between her 11th grade classes and social calendar, L will travel to Washington with her family to once again watch a chamber debate her access to medical care.
“I’m definitely proud of myself for it, but I’m nervous that it’s not going to go well. I’m a little nervous that I will feel some responsibility for this case going in front of the Supreme Court,” L said. She acknowledged that a ruling in the case could make or break gender-affirming care access for the entire country.
“I’m not too worried because, well, you’ve got to be optimistic about these things.”
