The Supreme Court ruled Wednesday that a Tennessee law banning transgender medical procedures for adolescents in the state is not discriminatory, ruling 6-3 to uphold the law.
At issue in the case, United States v. Skrmetti, was whether Tennessee’s Senate Bill 1, which “prohibits all medical treatments intended to allow ‘a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex’ or to treat ‘purported discomfort or distress from a discordance between the minor’s sex and asserted identity,'” violates the Equal Protection Clause of the Fourteenth Amendment.
Writing for the majority, Chief Justice John Roberts ruled that the law question is not subject to heightened scrutiny “because it does not classify on any bases that warrant heightened review.”
“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,” he said. “The voices in these debates raise sincere concerns; the implications for all are profound.”
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United States v. Skrmetti was one of the most closely watched cases of the Supreme Court’s term, with potential ripple effects for ongoing legal battles over transgender rights – including bathroom access and participation in school sports.
The ruling could also serve as a legal pretext in future cases involving LGBTQ+ protections, including whether sexual orientation qualifies as a “protected class” on par with race or national origin.
“The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best,” he added. “Our role is not ‘to judge the wisdom, fairness, or logic’ of the law before us … but only to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
All three liberal justices notably dissented in the case.
Justice Sonia Sotomayor issued a scathing dissent that cited a long history of laws discriminating against others, noting that transgender persons in the U.S. make up less than 1% of the country’s population. There are an estimated 1.3 million adults and 300,000 adolescents aged 13 to 17 who identify as transgender, according to the UCLA law school’s Williams Institute.
She noted that SB1 “expressly classifies on the basis of sex and transgender status, so the Constitution and settled precedent require the Court to subject it to intermediate scrutiny.”
“The majority contorts logic and precedent to say otherwise, inexplicably declaring it must uphold Tennessee’s categorical ban on lifesaving medical treatment so long as ‘any reasonably conceivable state of facts’ might justify it,” Sotomayor said, adding: “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims.”
“In sadness, I dissent,” she said.
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That law in question prohibits states from allowing medical providers to deliver puberty blockers and hormones to facilitate a minor’s transition to another sex.
It also targets healthcare providers in the state who continue to provide such procedures to gender-dysphoric minors – opening these providers up to fines, lawsuits and other liability.
The court’s ruling comes after many other states have moved to ban or restrict medical treatments and procedures for transgender adolescents, drawing close attention to the case.
During the December oral arguments, justices on the Supreme Court appeared reluctant to overturn Senate Bill 1, with Chief Justice Roberts and Justice Brett Kavanaugh suggesting that state legislatures, rather than courts, are best equipped to regulate medical procedures.
Roberts noted at the time that the Constitution leaves such questions “to the people’s representatives,” rather than to nine justices on the Supreme Court, “none of whom is a doctor.”
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Justice Samuel Alito cited “hotly disputed” medical studies on the alleged benefits of such medical treatments, and told the government’s attorney that those studies “found a complete lack of high-quality evidence showing that the benefits of the treatments in question here outweigh the risks.”
“Do you dispute that?” Alito asked during oral arguments.
Justice Sonia Sotomayor, however, countered that with evidence from underage individuals who were denied treatment.
“Some children suffer incredibly with gender dysphoria, don’t they? I think some attempt suicide?” she asked.
“The state has come in here and, in a sharp departure from how it normally addresses this issue, it has completely decided to override the views of the parents, the patients, the doctors who are grappling with these decisions and trying to make those trade-offs,” she said then.
The American Civil Liberties Union (ACLU) had asked the Supreme Court to hear the case on behalf of the parents of three transgender adolescents and a Memphis-based doctor who treats transgender patients.
The Biden administration had previously joined the petitioners in the case via a federal law that allows the administration to intervene in certain cases certified by the attorney general to be of “general public importance.”
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However, the Trump administration notified the Supreme Court in February that the government would be changing its stance on the constitutionality of the law, saying the Tennessee law does not violate the equal protection clause.
Also at issue was the level of scrutiny that courts should use to evaluate the constitutionality of state bans on transgender medical treatment for minors, such as SB1, and whether these laws are considered discriminating on the basis of sex or against a “quasi-suspect class,” thus warranting a higher level of scrutiny under the Equal Protection Clause of the Constitution.
That was another focus of the oral arguments in December, as petitioners and respondents battled for more than two hours over the level of scrutiny that the court should apply in reviewing laws involving transgender care for minors, including SB1.
Tennessee argued then that its law can still withstand even the test of heightened scrutiny, contending in a court brief that it does have “compelling interests” to protect the health and safety of minors in the state and “in protecting the integrity and ethics of the medical profession.”
Speaking to reporters after oral arguments in December, Tennessee Attorney General Jonathan Skrmetti said that the Constitution “alows the states to protect kids from unproven, life-altering procedures based on uncertain science.”
The high court’s decision comes at a time when transgender rights are a hotly contested topic.
President Donald Trump cracked down on the issue almost immediately after being sworn in to his second White House term in January.
Just weeks after his inauguration, Trump signed an executive order preventing biological men from competing in women’s sports.
The order, titled “Keeping Men Out of Women’s Sports,” was signed on National Girls and Women in Sports Day. It prohibits schools and colleges that receive federal funds and are subject to Title IX from allowing transgender-identifying biological men onto women’s sports teams and into women’s locker rooms and restrooms.
The Trump administration’s policies on transgender rights have inevitably become the targets of legal challenges launched by advocacy groups, medical organizations and individuals who claim they are discriminatory.
