The US Supreme Court upheld a Tennessee law restricting gender-affirming medical care for minors, ruling 6–3 that the measure did not violate the Constitution’s guarantee of equal protection. The decision left Tennessee’s restrictions in place and was expected to affect legal challenges involving similar laws in other states. At the time of the ruling, 25 states had enacted comparable measures. [Source 5676]
The case, *United States v. Skrmetti*, concerned Tennessee’s 2023 law, known as SB1. The legislation prohibits medical procedures intended to enable a minor to identify or live as an identity inconsistent with the minor’s sex, or to address distress attributed to a difference between sex and asserted identity. Its restrictions include access to puberty blockers and hormone therapies for gender transition. [Source 5676]
Three transgender teenagers, their parents and a doctor who provides transition medication challenged the law. They argued that it discriminated on the basis of sex because medications barred for gender-transition purposes could still be provided to minors for other medical needs. The families also raised parents’ interest in obtaining care they considered necessary for their children. The federal government under former President Joe Biden joined the litigation in support of the challengers. President Donald Trump’s administration later withdrew support for the previous administration’s position while allowing the case to proceed. [Source 5676]
Chief Justice John Roberts wrote the majority opinion. He said SB1 did not discriminate against transgender people and pointed to an ongoing medical debate about the benefits and risks of using puberty blockers and hormones to treat gender dysphoria, gender identity disorder and gender incongruence. In the majority’s view, Tennessee’s restrictions responded to that uncertainty rather than creating a classification requiring the court to strike down the law. [Source 5676]
The court’s three liberal justices—Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson—dissented. Sotomayor, who wrote the dissent and read it from the bench, concluded that the law imposed medical discrimination based on sex. She warned that the ruling left transgender children and their families exposed to decisions made through the political process. [Source 5676]
Tennessee Attorney General Jonathan Skrmetti welcomed the outcome as a victory for state authority and what he described as evidence-based medicine. Tennessee defended the ban in part by emphasizing what it called the irreversible nature of some transition treatments. Transgender-rights advocates disputed that characterization, including for puberty blockers, and argued that denying care creates its own risks. [Source 5676]
The Human Rights Campaign called the ruling devastating, saying medical choices should remain with doctors, patients and families rather than politicians. The judgment marked the first time the Supreme Court had considered a case focused on transgender healthcare and established an important precedent for disputes over state restrictions, without resolving the broader medical and political debate surrounding such care. [Source 5676]
