People hold signs as the U.S. Supreme Court hears arguments over an appeal by then-U.S. President Joe Biden's administration of a lower court's decision upholding a Republican-backed ban in Tennessee on gender-affirming medical care for transgender minors, in Washington Dec. 4, 2024. The nation's highest court on June 18, 2025, upheld the Tennessee state law. (OSV News photo/Benoit Tessier, Reuters)
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The U.S. Supreme Court on June 18 upheld a Tennessee state law banning certain types of medical or surgical gender reassignment procedures for minors who identify as transgender.
The question at issue in the case -- United States v. Skrmetti, the Biden administration's challenge to a law in Tennessee restricting gender transition treatments, including puberty blockers for minors -- was whether Tennessee's law, Senate Bill 1, violates the equal protection clause of the 14th Amendment. The high court's ruling said that it did not.
In a majority opinion, Chief Justice John Roberts wrote, "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. The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best."
"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," he continued. "Having concluded it does not, we leave questions regarding its policy to the people, their elected representatives, and the democratic process."
In a dissenting opinion, Justice Sonia Sotomayor argued that "the majority refuses to call a spade a spade" and did "irrevocable damage to the Equal Protection Clause."
The majority, she said, "invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight."
"It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them," she said. "Because there is no constitutional justification for that result, I dissent."
At least 25 Republican-led states have adopted laws restricting or banning gender reassignment surgery or related hormonal treatments for minors, although not all of those bans are currently in effect amid legal challenges, according to data from the Movement Advancement Project, an LGBTQ+ policy group. But the court's decision will likely offer protection to those laws.
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Tennessee Attorney General Jonathan Skrmetti said in a statement that "the common sense of Tennessee voters prevailed over judicial activism."
"A bipartisan supermajority of Tennessee's elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand," Skrmetti said. "I commend the Tennessee legislature and Governor (Bill) Lee for their courage in passing this legislation and supporting our litigation despite withering opposition from the Biden administration, LGBT special interest groups, social justice activists, the American Medical Association, the American Bar Association, and even Hollywood."
Supporters of banning gender transition surgeries or hormonal treatments for minors who identify as transgender say such restrictions will prevent them from making irreversible decisions as children that they may come to regret as adults. Critics of such bans argue that preventing those interventions could cause other harm to minors, such as mental health issues or increase the risk of physical self-harm.
A 2022 study by the UCLA Williams Institute found there are approximately 1.6 million people in the U.S. who identify as transgender, including about 300,000 youth (those 13-17 years old) who identify as transgender.
A recent JAMA Pediatrics study found 926 U.S. adolescents with commercial insurance and a gender-related diagnosis received puberty blockers from 2018 through 2022, and none of them were under the age of 12. The study did not include minors covered by Medicaid.
In guidance on health care policy and practices released in March 2023, the U.S. Conference of Catholic Bishops' Committee on Doctrine stated the church's opposition to interventions that "involve the use of surgical or chemical techniques that aim to exchange the sex characteristics of a patient's body for those of the opposite sex or for simulations thereof."
"Any technological intervention that does not accord with the fundamental order of the human person as a unity of body and soul, including the sexual difference inscribed in the body, ultimately does not help but, rather, harms the human person," the document states.
