Who’s Who in US v. Skrmetti

Drugged kids, a tacky gynecologist, and Miss Idaho

“Tennessee’s brief has literally nothing to say about L.W., John Doe, Ryan Roe, their families, and the countless other families with transgender adolescents whose lives Tennessee has ripped apart and whose critically needed health care the State has banned.”

–ACLU, 2024 (final brief in US v. Skrmetti)

American lawsuits aren’t about ideas. They’re about people.

You might think Skrmetti, the case that’s scheduled for oral argument before the Supreme Court on Wednesday, is about discrimination or pediatric gender medicine (PGM). But it’s actually about three kids who want to be the opposite sex, their eager moms, and a gynecologist whose YouTube channel is called Crotch Talk.

These plaintiffs are represented by the voluble trans activist Chase Strangio, who has joined forces with her friend Elizabeth Prelogar, the US Solicitor General, to battle the Attorney General of Tennessee, Jonathan Skrmetti, over whether his state’s ban on PGM violates the US Constitution.

In this post I’ll show you who Skrmetti is about. Then I’ll introduce the Supreme Court justices who will soon decide one of the legal issues in Skrmetti, before kicking the case back down to lower court judges to figure out the rest. Finally I’ll explain why I think the people of Skrmetti matter more to the future of trans litigation than any legal argument. (But if you want to learn the legal arguments anyway, I’ll drop some links at the bottom.)

Tennessee’s lawyers did not discuss the plaintiffs in their brief. Maybe they think it’s unseemly to publicly analyze children. I feel no compunction about doing that. You need to understand the kids in order to understand the case.

The legal documents I cite can be found here. Quotes of the plaintiffs come from written statements they filed with the trial court unless otherwise noted.

The Plaintiffs

The plaintiffs are represented by the ACLU, Lambda Legal, the ACLU of Tennessee, and biglaw firm Akin Gump. These attorneys had the resources and experience to scour Nashville, Knoxville, Memphis and Chattanooga for ideal faces to represent the PGM cause. They chose…

The Gynecologist

Susan Lacy received her MD from Johns Hopkins University, one of America’s premier med schools. In 2021 a GoFundMe was launched to support her struggling Memphis gynecology practice: “Help Dr. Susan Lacy provide Southern Trans Care.” In her video appeal she noted that her home had “very little water.” Maybe a natural disaster had just struck – she didn’t explain.

Lacy’s practice provides “comprehensive waxing services” and hormones for gender transition. Treating nonbinary patients with hormones, she says on her YouTube channel, is “sort of a matter of figuring out where you want to land.” That channel is called Crotch Talk. By April 2023 she had prescribed cross-sex hormones to three dozen minors.

Gender doctors fly to Washington, DC for the Skrmetti argument

The Boy

LW is autistic, according to his mother, and did not like to be hugged as a child. In his own words, when he was 10 he “did not like changing clothes in front of anyone[.]” He also struggled to relate to his peers:

“My guy friends at school were talking about wanting to grow mustaches and beards. I remember thinking that was something I did not want to happen to me. I knew that I was different from those friends, but I did not know what to do with that feeling.”

When LW was about 11, he had a revelation:

“In 2019, when my cousin told my family that she is transgender, I finally understood what ‘transgender’ meant. My cousin and I are very close, and when she started talking to me about the feelings she was having and her coming out process, I began to realize that she was describing the feelings I had been having too.”

LW came out to his mother on Thanksgiving during 7th grade, commenced therapy within weeks, had his puberty blocked the next summer, and started on estrogen at age 14.5:

“I don’t feel as scared or worried about my body changing in ways that would harm me because I know the medication is helping to stop those changes right now.”

LW’s mother is pleased:

“I noticed a huge change at her fourteenth birthday party in February of 2022, the first party we threw for her after she had come out. My daughter was the belle of the ball and was very outgoing and had a huge group of friends attend.”

LW is “terrified of being misgendered” but otherwise “thriving.” Also:

“If my care was taken away, I know that I would not be able to think about anything else in my life except when I could get my medication again.”

The Girls

The girl plaintiffs were both classic tomboys as children.

Ryan hated appearing female and in fifth grade “considered going mute to protect myself from the pain and anxiety that my voice caused.” Getting her period that year “felt awful.” In middle school her voice “caused me serious distress, and I stopped talking in public a lot of the time. I was a good student, but I never wanted to participate in class[.]”

After Ryan told her mother she was a boy, in fifth grade, her mother tried to learn more:

“I started to research everything I could about what it meant to be transgender. I googled it, ordered books on Amazon, and joined Facebook support groups for parents of transgender children.”

At age 13, a gender clinic prescribed Ryan meds to stop her period. She had to wait for T until age 14. Getting the shot made her feel “relief and joy.” She now participates in class and likes looking in the mirror. “I feel stronger – physically, mentally and emotionally. I feel so happy with myself and that makes me feel like I can do and be more.” (T, also known as steroids, causes euphoria.) She fears losing access to the drug:

“If I lost my testosterone and I couldn’t get it back, I really don’t know how I would survive. It would feel impossible.”

The other girl-plaintiff, John, told her parents that she wished she were a boy from a young age. At the end of first grade her parents sat her down and asked, in her mother’s recollection:

“‘What if you could be John, and just be a boy all the time?’ His eyes got as big as saucers—I could see he hadn’t even realized that it was a possibility and that he was imagining that kind of happiness in his life. It was as if a light came on for him.”

From then on, John’s parents pretended she was a boy. At age 9 John’s mother read her a book about puberty:

“[John] was absolutely mortified at the notion of his body undergoing the changes of a typical female puberty, and it became clear that we needed to explore the possibility of medical treatment to prevent that.”

John was put on Lupron (a chemical castration drug administered to sex offenders) at age 10.

The Plaintiffs’ Lawyers

“Counsel of record” for these kids, parents, and Lacy is the ACLU’s Chase Strangio. Activists are heralding her as the first openly-transgender lawyer to argue before the Supreme Court. Last month her colleagues reportedly thought about benching her because her behavior in preparing for argument was so immature. More recent media coverage suggests the ACLU still backs Strangio.

Strangio is a loose cannon. Recently she implied that the ACLU advanced Skrmetti to Supreme attention because it was at an early stage. Unlike other PGM lawsuits, it hasn’t gone to trial yet and its record lacks evidence. In other words, she seemed to acknowledge that the evidence about PGM is not on her side. (The ACLU might also be racing to the Supreme Court because it does not want rival trans-rights lawyers to get there first.)

The Defendants

Tennessee banned PGM in early 2023 following reports by Matt Walsh that Vanderbilt University Medical Center, in Nashville, was chemically castrating youth and performing gender surgeries on them. Video showed a VUMC clinician calling FTM genital surgeries “huge money-makers.”

Vanderbilt was the state’s major provider of PGM. One PGM doctor appears in media reports and all the plaintiffs’ declarations: VUMC’s Cassandra Brady, a pediatrician.

To block the law, the plaintiffs sued various state officials (as legally required), including Attorney General Jonathan Skrmetti, who is responsible for handling the officials’ defense. He’d been in the job about seven months.

Tennessee’s law regarding AGs is unique. Unlike most state attorneys general, Skrmetti is not a politician – he was appointed to the role by the state supreme court.

Red states like Tennessee tend to have leaner AG offices than blue states, and rely more on outside counsel. Skrmetti retained two firms to co-counsel with his office to defend the PGM ban: the elite conservative boutique Consovoy McCarthy at $400/hour, and Lawfair at a flat $10,000/month. Lawfair was founded by Adam Mortara, a conservative Supreme Court litigator. The only other lawyer associated with it is Christopher Roach, an unknown who was caught making dreadfully racist anonymous posts. It appears he’s now out.

Skrmetti has overseen a budget expansion and ramped up his office’s litigation capacity. Tennessee Democrats argue Skrmetti is wasting funds by fighting with the Biden administration and the liberal city of Nashville.

Skrmetti investigated VUMC’s PGM practice (outcome unclear; maybe ongoing). He did not join the multistate probe into the American Academy of Pediatrics before it issued its demand letter in September.

The Intervenor

The United States of America moved to intervene in Skrmetti within a week of its filing. In practical terms, that means the Biden administration wanted to step into the case and fight on the side of the ACLU.

The USA’s law firm is the US Department of Justice. As required for intervention, US Attorney General Merrick Garland (who leads DOJ) certified that the case had “general public importance.” The court granted the motion to intervene.

The USA is an active player in Skrmetti. It’s the reason the Supreme Court is hearing the case — the justices accepted its petition for review and rejected the plaintiffs’. That said, DOJ and the ACLU appear to be collaborating. DOJ requested that its half-hour of argument time be split with the ACLU and the Supremes granted the request.

The Alabama Attorney General has suggested DOJ strategically petitioned the Supreme Court in Skrmetti to freeze the Alabama lawsuit in which WPATH’s internal emails were being mined and revealed to the public.

Elizabeth Prelogar

On Wednesday, the DOJ’s top courtroom lawyer (and fourth-ranking official) will argue against the PGM ban: US Solicitor General Elizabeth Prelogar. As is typical of SGs, she has a flawless resume and everyone says she’s the best oral advocate ever. Less typically, she competed in beauty pageants throughout her youth and was crowned Miss Idaho in 2004. She once said of her unlikely trajectory:

“If you want to look at a through line here, I like to go in front of judges.”

That said, she’s known for fiery exchanges with arch-conservative Justice Samuel Alito.

As a Cooley (biglaw) partner in 2020, Prelogar teamed with Strangio to challenge Idaho’s law segregating school sports by sex. As far as I can tell, it’s the first ACLU lawsuit to argue the term biological sex is “imprecise” and therefore should be replaced with “sex assigned at birth” — meaning that this verbal erasure of sex could have been Prelogar’s idea.

When Prelogar found out Biden would nominate her to be SG, she called Strangio.

Merrick Garland

Considering the “general public importance” of PGM litigation (and all the media attention it receives), I assume Garland is looped in on the action.

Garland is also almost certainly aware of the prosecution of Eithan Haim in the Southern District of Texas – an arm of DOJ under Garland’s control. Haim is the young surgeon who exposed Texas Children’s Hospital (TCH) for practicing PGM after claiming publicly that it did not. DOJ’s conduct toward him has been shockingly unjust. It accuses him of violating HIPAA, a patient privacy statute, by looking at records he had lawful access to – a ridiculous charge.

The first prosecutor on the case, Tina Ansari, threatened Haim before she knew basic facts about the file; ignored evidence in her possession that exonerated him and sought an indictment anyway (she later removed the false charge); failed to pay bar dues and then practiced with a suspended law license; weirdly referred to TCH as Haim’s victim; and filed slipshod documents that typo’d the statute Haim allegedly violated. Ansari withdrew from the case only after Haim’s counsel exposed her family’s financial ties to TCH.

Garland’s DOJ is now seeking a gag order against Haim because his tweets about the case were liable to cause “bullying.”

Why hasn’t Garland kiboshed this political prosecution?

Why has Garland let his staff run wild on PGM litigation?

Garland’s pedigree is extraordinary: Harvard, Harvard Law, Supreme Court clerkship for liberal icon William Brennan, prosecutor of 90s supervillains like the Unabomber and Tim McVeigh at DOJ, appointed to the DC Circuit Court of Appeals by President Bill Clinton, nominated to the Supreme Court by President Barack Obama (blocked by the Senate as Republicans held out for Obama’s term to end), appointed to lead DOJ by President Joe Biden.

The ruling class cherishes Garland. This suggests he may not be a rebel. Plus, Garland probably has a strong relationship with Prelogar, who clerked for him when he served on the DC Circuit. So how could he say no to “transgender rights”?

When Donald Trump takes office in January he’ll appoint a new AG. That won’t affect Skrmetti. Once it’s argued on December 4, the lawyers’ work is done.

The Deciders

The Supreme Court’s approach to trans issues has been slothlike, as though it is doing as little as possible to conserve energy.

The Fourth Circuit declared in 2020 that trans people, vaguely defined, are a protected class – an extreme threat to the legal understanding of sex in the five states covered. The Supremes declined to hear an appeal.

This year, the justices have reviewed trans-related cases while only discussing their technical aspects. (Poe v Labrador, Dept. of Education v. Louisiana.)

In the one decision they issued that was squarely about trans issues – Bostock in 2020, about employment discrimination – Justice Neil Gorsuch’s controlling opinion avoided the key phrase “gender identity,” dubiously declared “Few facts are needed to appreciate the legal question we face,” and insisted his logic did not apply to any other contexts, even ones that were obviously implicated, like employee bathroom use. It answered almost zero questions about what trans meant under law.

Skrmetti is underdeveloped. The parties haven’t conducted discovery or cross-examination yet. By plucking this early-stage PGM lawsuit instead of waiting for a post-trial appeal from another state’s litigation, I’m afraid the Supreme Court is trying to make another decision based on “few facts.”

It’s actually possible to reach a correct decision on PGM without grasping all the facts. You don’t need to know, for example, why the regret rate studies are unreliable. But if you’re going the “few facts” route then it’s even more important to understand the ACLU’s magic trick. The briefs that expose the foundational trickery of gender medicine were submitted by TERF amici: WDI International and WoLF. Will the justices read them?

None of the six conservatives are known to engage with feminism, and the Court’s three liberals appear to be basic Dems. When Justice Ketanji Brown Jackson was asked to define “woman” at her 2022 confirmation hearings, she said she couldn’t because “I’m not a biologist.” Trans intellectuals probably laughed at that answer since they think sex is a construct and would never consult a biologist, but you get the idea.

The justices are also unlikely to learn about the plaintiffs as people. The parties’ briefs don’t mention the boy’s autism or older trans cousin, or anything about anyone’s sexual orientation. The ACLU paints its two clients on cross-sex hormones with the same brush: they are both “thriving” and “outgoing.”

When Will America Meet These People?

Most commentators predict the Court will rule for Tennessee. I agree, but I fear they will do so in a way that frustrates the movement to expose gender fraud.

The justices could rule, for example, that laws relating to “transgender people” are subject to rational basis review because they are not a protected class. Sounds good. But if they discuss gender identity in the course of reaching that conclusion – as they should, since all the Skrmetti parties agree it’s part of the definition of a trans person – they will entrench the concept. Practically any description of “gender identity” will aid the ACLU in its quest to make it seem real, as opposed to what it actually is in its lawsuits, a rhetorical device that turns boys into girls (the kid is a “girl” thanks to a “female gender identity”). How can a lawyer argue gender identity is a meaningless term if the Supreme Court has declared that everyone has one?

I’ve come to believe the legal theories in Skrmetti aren’t that important. First, wording and definitions matter more. Second, if the Supremes understand what’s really going on with PGM, it will be game over. They won’t rule for Dr. Crotch Talk just because her legal argument is clever. And third, if they don’t figure out what’s going on, and issue a funky decision in 2025, I still think we can defeat the gender doctors on the ground. The courts will eventually catch up.

America can get by with some busted Constitutional doctrine for a few years. The most important thing is not that five of nine justices figure out the gender grift, but that a majority of people in every city and town do.

Americans will sort out the truth about trans thanks to government investigations, medical malpractice lawsuits, media exposes, conversations between friends, and activism by detransitioners. They will sort out the truth when they realize that gender doctors are seedy; that parents are asking their 9-year old daughters whether they’d like to avoid menstruating; that esteemed leaders like Merrick Garland are not exercising independent judgment.

Americans will figure out the truth about gender medicine when they get to know the people who are fighting for it. That won’t happen inside the Supreme Court on December 4.

Unless Chase Strangio brings her full self to work that day.

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Learn about the legal arguments in Skrmetti

• X Space hosted by DIAG. Panelists are Elspeth Cypher (retired appellate court judge), Kara Dansky, and me.

• My discussion with LGB Alliance.

  Typo fixed and link changed after publication.