Supreme Court Upholds Tennessee Law Banning Transgender Care for Minors

In United States v. Skrmetti, 605 U.S. ____ (2025), the U.S. Supreme Court held that Tennessee’s law prohibiting certain medical treatments for transgender minors is not subject to heightened scrutiny under the equal protection clause of the 14th Amendment. The Court further held that the law is constitutional under rational basis review.

Facts of the Case

In 2023, Tennessee joined the growing number of States restricting sex transition treatments for minors by enacting the Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity, Senate Bill 1 (SB1). SB1 prohibits healthcare providers from prescribing, administering, or dispensing puberty blockers or hormones to any minor for the purpose of (1) enabling the minor to identify with, or live as, a purported identity inconsistent with the minor’s biological sex, or (2) treating purported discomfort or distress from a discordance between the minor’s biological sex and asserted identity. At the same time, SB1 permits a healthcare provider to administer puberty blockers or hormones to treat a minor’s congenital defect, precocious puberty, disease, or physical injury.

Three transgender minors, their parents, and a doctor challenged SB1 under the Equal Protection Clause of the Fourteenth Amendment. The District Court partially enjoined SB1, finding that transgender individuals constitute a quasi-suspect class, that SB1 discriminates on the basis of sex and transgender status, and that SB1 was unlikely to survive intermediate scrutiny. The Sixth Circuit Court of Appeals reversed, holding that the law did not trigger heightened scrutiny and satisfied rational basis review.

Supreme Court’s Decision

The Supreme Court affirmed by a vote of 6-3. Chief Justice Roberts wrote on behalf of the majority.

The Supreme Court first found that SB1 does not classify on the basis of sex and, thus, is not subject to heightened scrutiny under the Equal Protection Clause. According to Chief Justice Roberts, SB1 instead “prohibits healthcare providers from administering puberty blockers and hormones to minors for certain medical uses, regardless of a minor’s sex.” He further explained:

Both puberty blockers and hormones can be used to treat certain overlapping indications (such as gender dysphoria), and each can be used to treat a range of other conditions. These combinations of drugs and indications give rise to various medical treatments. When, for example, a transgender boy (whose biological sex is female) takes puberty blockers to treat his gender incongruence, he receives a different medical treatment than a boy whose biological sex is male who takes puberty blockers to treat his precocious puberty. SB1, in turn, restricts which of these medical treatments are available to minors: Under SB1, a healthcare provider may administer puberty blockers or hormones to any minor to treat a congenital defect, precocious puberty, disease, or physical injury; a healthcare provider may not administer puberty blockers or hormones to any minor to treat gender dysphoria, gender identity disorder, or gender incongruence. The application of that prohibition does not turn on sex

The Supreme Court also rejected the argument that SB1 warrants heightened scrutiny because it discriminates against transgender individuals as a quasi-suspect class. According to the Court, SB1 includes only two classifications: healthcare providers may not administer puberty blockers or hormones to minors (a classification based on age) to treat gender dysphoria, gender identity disorder, or gender incongruence (a classification based on medical use). “The plaintiffs do not argue that the first classification turns on transgender status, and our case law forecloses any such argument as to the second,” Chief Justice Roberts explained.

The Supreme Court went on to uphold the Tennessee law under the rational basic standard, under which courts must uphold a statutory classification so long as there is “any reasonably conceivable state of facts” that could provide a rational basis for the classification.“Tennessee concluded that there is an ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder, and gender incongruence,” Roberts wrote. “SB1’s ban on such treatments responds directly to that uncertainty.”

Finally, the Court acknowledged the significance of the case, while also noting that its job was only to ensure that the law does not violate the equal protection guarantee of the Fourteenth Amendment. “This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound,” Chief Justice Roberts wrote. “The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”