In a landmark 6–3 decision, the U.S. Supreme Court upheld Tennessee’s Senate Bill 1 (SB1), a law banning gender-affirming medical treatments for minors. The ruling, which came in the case United States v. Skrmetti, grants states broad authority to regulate healthcare practices for minors, particularly those involving transgender youth. It marks the Court’s first major judgment on transgender healthcare and is expected to have wide-reaching consequences.
The Tennessee law prohibits medical professionals from providing puberty blockers, hormone therapy, and gender-affirming surgeries to individuals under 18 when such treatments are intended to facilitate gender transition. These services remain permitted only when they correspond with a minor’s sex assigned at birth.
Writing for the conservative majority, Chief Justice John Roberts stated that the law does not violate the Equal Protection Clause of the Fourteenth Amendment. According to the ruling, the statute is based on age and medical purpose rather than on sex or transgender status. Because of this distinction, the Court applied a “rational basis review,” the most lenient form of constitutional scrutiny. Roberts emphasized that it is not the Court’s responsibility to judge the wisdom of state legislation, but rather to ensure it falls within constitutional bounds.
In dissent, Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson strongly disagreed. Justice Sotomayor argued that the law discriminates on the basis of both sex and transgender status and should therefore be subject to heightened scrutiny. She expressed concern that the majority’s decision enables legislatures to enact discriminatory policies under the guise of neutrality, placing vulnerable children at risk.
This decision could serve as a legal foundation for other states. As of early 2025, 27 states have enacted similar bans, with 19 of them passed in 2023 alone. The Supreme Court’s ruling is likely to embolden those states to enforce or expand such laws and could influence debates in states where legislation is still pending.
Medical associations, including the American Academy of Pediatrics and the American Medical Association, have voiced strong opposition. They maintain that gender-affirming treatments are medically necessary and improve the mental health and overall well-being of transgender minors. Critics argue that removing access to these services can result in severe psychological harm.
The decision also reflects broader efforts, particularly under the Trump administration, to curtail transgender rights. The federal government has moved to withhold funding from hospitals that provide gender-affirming care to minors and has supported other measures restricting transgender individuals’ rights in public life.
Legal scholars suggest this ruling could shape the future of state versus federal power in healthcare regulation. While this case centered on the federal constitution, challenges may emerge under individual state constitutions or through parental rights claims.
As legal and political battles continue, the ruling in United States v. Skrmetti stands as a defining moment in the ongoing national debate over transgender rights and the limits of state power in medical decision-making.
