What Tennessee’s Transgender Care Ban Ruling Means

Recent Development

On June 18, 2025, the U.S. Supreme Court upheld Tennessee’s ban on gender-affirming care for minors in a 6-3 ruling. The decision supports Senate Bill 1 (SB1), a 2023 law restricting transgender youth from accessing puberty blockers and hormone therapy.

This landmark case, United States v. Skrmetti, reinforces similar bans in 26 states. It’s a significant blow to transgender rights advocates. The ruling came after intense national debate over transgender healthcare.

Background of the Issue

Tennessee’s SB1, passed in March 2023, prohibits medical treatments like puberty blockers, hormone therapy, and surgeries for minors seeking gender-affirming care.

These treatments remain legal for other medical conditions, such as precocious puberty. Supporters, including Tennessee lawmakers, argue the law protects children from irreversible decisions they may regret.

Critics, including medical experts, say it denies transgender youth access to evidence-based care. The American Academy of Pediatrics supports gender-affirming care, citing reduced risks of depression and suicide. The law sparked lawsuits and became a flashpoint in the culture wars.

What the Decision Means

The Supreme Court ruled that Tennessee’s ban does not violate the 14th Amendment’s Equal Protection Clause, which guarantees equal treatment under the law.

The court’s conservative majority found the law regulates medical treatments based on age and purpose, not sex or transgender status. This allows states to limit certain healthcare for minors without being deemed discriminatory.

The decision strengthens state authority to regulate transgender healthcare. It may embolden other states to enact or enforce similar restrictions. However, it doesn’t ban gender-affirming care outright—it applies only to minors.

Case Details: United States v. Skrmetti

The case began when three transgender teenagers, their parents, and a Memphis doctor challenged SB1 in federal court. Known as L.W. v. Skrmetti in lower courts, the lawsuit argued the law discriminates based on sex and transgender status, violating constitutional rights.

A federal district court initially blocked the law, but the Sixth Circuit Court of Appeals upheld it in 2023. The Biden administration joined the case, urging the Supreme Court to strike down the ban.

The court heard oral arguments on December 4, 2024, with intense focus on medical evidence and state powers. The case drew national attention, with 24 amicus briefs filed by medical groups, states, and advocacy organizations.

What Happened in Court

Chief Justice John Roberts authored the majority opinion, joined by Justices Thomas, Alito, Gorsuch, Kavanaugh, and Barrett. Roberts wrote that SB1 is a neutral regulation of medical practice, not a sex-based restriction.

He noted that states can limit experimental treatments for minors, citing Tennessee’s evidence of potential risks. The court applied “rational basis” review, a low standard, rejecting claims of heightened scrutiny for transgender discrimination.

Justice Sonia Sotomayor dissented, joined by Justices Kagan and Jackson. Sotomayor called the ruling a “grave anomaly” that harms vulnerable youth. She argued the law singles out transgender minors, ignoring medical consensus on the safety and necessity of gender-affirming care. The dissent warned of broader implications for equal protection rights.

Impact and Reactions

The ruling directly affects transgender youth in Tennessee, where gender-affirming care is now inaccessible for minors unless privately funded or obtained out-of-state. It also bolsters bans in states like Indiana, Kentucky, and Idaho, though some face ongoing legal challenges.

The American Civil Liberties Union called it “a devastating result” and vowed to continue fighting. Transgender youth and families expressed fear and frustration, with many considering relocating.

Tennessee Attorney General Jonathan Skrmetti hailed the decision as a win for “common sense” and child safety. Medical groups, including the American Medical Association, criticized the ruling, citing studies showing gender-affirming care improves mental health outcomes.

The decision may lead to increased disparities in healthcare access, as wealthier families seek care elsewhere. It also sets a precedent for future cases on transgender rights, potentially affecting laws on sports participation or bathroom access. Advocates on both sides expect continued legal battles as states test the limits of this ruling.

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