On July 3, 2025, the U.S. Supreme Court issued a landmark 6–3 decision in United States v. Skrmetti, upholding Tennessee’s 2023 law that prohibits gender-affirming medical treatments for minors. The ruling has ignited widespread concern among civil rights advocates, medical professionals, and LGBTQ+ organizations, who argue that it infringes upon individual rights and sets a precedent for similar legislation across the country.
The Tennessee law, known as Senate Bill 1 (SB1), bans healthcare providers from administering puberty blockers, hormone therapy, or gender-affirming surgeries to individuals under 18 when such treatments are intended to address gender dysphoria. While these interventions remain permissible for other medical conditions, their use for gender identity-related care is explicitly prohibited. The law also imposes penalties on medical professionals who violate its provisions, including potential fines up to $25,000.
Chief Justice John Roberts, writing for the majority, stated that the law does not constitute discrimination based on sex or transgender status. Instead, he characterized the statute as a regulation based on age and the specific medical purpose of the treatments, thereby subjecting it to a “rational basis” review—the most deferential standard of judicial scrutiny. Roberts emphasized that the Equal Protection Clause does not resolve the complex debates surrounding gender-affirming care and that such policy decisions are best left to the legislative process.
In a dissenting opinion, Justice Sonia Sotomayor, joined by Justices Elena Kagan and Ketanji Brown Jackson, argued that the law discriminates against transgender youth by denying them medically necessary care. Sotomayor contended that the statute’s restrictions are a clear example of sex-based discrimination, as they prohibit treatments solely when used for gender dysphoria. She warned that the ruling “abandons transgender children and their families to political whims,” undermining constitutional protections.
The decision has significant implications beyond Tennessee. Currently, 25 other states have enacted or are considering similar bans on gender-affirming care for minors. Legal experts suggest that the Supreme Court’s ruling may embolden these states to implement or enforce such laws, potentially limiting access to care for transgender youth nationwide.
Medical organizations have expressed strong opposition to the ruling. The American Academy of Pediatrics, the Endocrine Society, and the American Psychiatric Association, among others, have consistently supported gender-affirming care as evidence-based and essential for the well-being of transgender adolescents. In response to the decision, Dr. Susan Kressly, president of the American Academy of Pediatrics, stated that the organization remains “unwavering” in its support for families making healthcare decisions free from political interference.
The ruling also reflects broader policy shifts under the Trump administration, which has taken steps to restrict transgender rights. In January 2025, President Trump signed Executive Order 14187, directing federal agencies to withhold funding from institutions that provide gender-affirming care to individuals under 19. This executive action has led several hospitals, including Stanford Medicine and Children’s Hospital Los Angeles, to pause or cease offering such treatments to minors, citing legal and financial pressures.
Advocacy groups have vowed to continue challenging these restrictions. Chase Strangio, an attorney with the American Civil Liberties Union who represented the plaintiffs in the Tennessee case, described the Supreme Court’s decision as a “devastating loss” but emphasized that the fight for transgender rights is far from over. He noted that ongoing legal battles at the state level, as well as public advocacy, remain crucial avenues for protecting access to gender-affirming care.(politico.com)
The Supreme Court’s ruling arrives amid a series of legal and political conflicts over transgender rights in the United States. In addition to healthcare, debates continue over issues such as participation in sports, access to bathrooms, and military service. The Court is scheduled to hear cases in its next term concerning state laws that ban transgender athletes from competing in sports consistent with their gender identity, further highlighting the ongoing national discourse on these matters.(theguardian.com, reuters.com)
As the legal landscape evolves, families of transgender youth face increasing uncertainty. Some are considering relocating to states with more protective laws, while others are seeking out-of-state medical care or turning to support networks for assistance. Organizations like the Trans Youth Emergency Project and Trans Lifeline continue to provide resources and advocacy for those affected by these legislative changes.(them.us)
The Supreme Court’s decision in United States v. Skrmetti marks a pivotal moment in the national conversation on transgender rights, with far-reaching consequences for healthcare access, legal protections, and the broader struggle for equality.(wired.com)
