The US Supreme Court’s conservative majority on Wednesday upheld the state of Tennessee’s ban on gender-affirming care for minors.
In a 6–3 decision in United States v. Skrmetti, the justices found that Tennessee’s law is not unconstitutional. The central issue of the case was whether Tennessee’s ban violates the equal protection clause of the 14th Amendment, which states that the government cannot discriminate against individuals based on their race, gender, or other characteristics. The ruling does not affect states where gender-affirming care for youth remains legal, but establishes the precedent that states can ban this kind of treatment.
The lawsuit was brought to the court by three transgender teenagers and their parents, as well as a doctor, with the Biden administration’s Department of Justice joining the plaintiffs. They argued that the Tennessee law discriminates based on sex and gender status by denying medical care to transgender youth that is available to other minors. This is the first case the Supreme Court has taken up on the issue of gender-affirming care for minors.
Gender-affirming care includes a variety of medical services meant to help align a person’s body more closely with their gender identity. It can include hormone therapy, puberty blockers, and surgeries.
Tennessee enacted its law in 2023, which prohibits health care providers from prescribing medication or offering gender-affirming surgical procedures to minors whose gender identities are different from their assigned sex at birth. The law excludes procedures that address congenital defects or physical injuries, as well as gender-affirming medical care for minors whose gender identity conforms with their designated sex at birth. It means, for instance, that a cisgender boy with gynecomastia, a hormonal condition that causes enlarged male breast tissue, could receive medication or undergo surgery to remove breast tissue to conform to their gender identity, but a transgender individual could not receive the same treatment for gender dysmorphia.
Today’s Supreme Court ruling, delivered by Chief Justice John Roberts, maintains that Tennessee’s law is not discriminatory because it “prohibits healthcare providers from administering puberty blockers or hormones to any minor to treat gender dysphoria, gender identity disorder, or gender incongruence, regardless of the minor’s sex.” According to the justices, the Tennessee law does not exclude any individual from medical treatments based on their transgender status. “Rather, it removes one set of diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—from the range of treatable conditions,” the ruling says.
Since 2021, more than two dozen states have adopted laws or policies that prohibit or severely limit gender-affirming care for people under the age of 18. Many of those states also penalize health care practitioners for providing or offering this type of care to minors. According to the health policy nonprofit KFF, 40 percent of trans youth between the ages of 13 and 17 live in a state that has enacted a policy against gender-affirming care.
Though several states were facing legal challenges to their bans, today’s Supreme Court decision means those laws will likely remain intact.
Leading medical organizations—including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association, American College of Obstetricians and Gynecologists, and the World Health Organization—support access to gender-affirming care for transgender and gender-diverse youth, which they say is backed by scientific evidence. One study from 2022 surveyed nearly 12,000 transgender and nonbinary youth aged 13 to 24 and found that those who received gender-affirming hormone therapy had lower rates of depression, thoughts of suicide, and attempted suicide than those who had not received hormone therapy.
“Today’s Supreme Court decision is a devastating blow to transgender youth and the families who love them,” said Kelley Robinson, president of the Human Rights Campaign, an organization that promotes LGBTQ+ civil rights, in a statement. “Families may now have to make the heartbreaking choice to leave their state or split their families, or take on extensive financial burdens, in order to ensure that their kids can access medically necessary care.”
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