The U.S. Supreme Court released its ruling Wednesday morning for U.S. v. Skrmetti, upholding a Tennessee law prohibiting doctors from providing puberty blockers and hormone replacement treatments to minors with gender dysphoria or conducting surgeries on them to modify their sexual characteristics.
The law, passed in Tennessee in 2023, was intended to bar the practice of “gender-affirming healthcare”—which includes using cosmetic surgery and hormone replacement therapies to increase the physical similarity of transgender individuals to their desired sexual appearance—on minors in the state. The legislature argued that the procedures are dangerous to the health of children, citing a number of European studies that concluded the practice is experimental and lacks scientific support, and that minors are incapable of consenting to the potential consequences of the procedures, which are severe and permanent. The bill explicitly permits hormone replacement therapies for other medical uses such as precocious puberty.
The state was sued later that year by three transgender youth affected by the law, along with their families and a doctor who performed the affected procedures for minors. The plaintiffs alleged that the law was discriminatory and a violation of the Equal Protection clause. The Biden Administration also joined the suit, alleging that the law was discriminatory on the basis of sex.
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The judgement, written by Chief Justice John Roberts, upheld the constitutionality of the ban, noting that the relevant criteria for the law was not sex but the diagnosis and treatment of gender dysphoria. Roberts noted that even a transgender minor is eligible for puberty blockers if administered for precocious puberty rather than gender dysphoria treatment.
Finally, the court held that the law satisfies the standards for a rational basis view, in light of the procedures’ permanent medical consequences, such as infertility, and the continued disagreements over the scientific status of transgender medical procedures.
Roberts was joined by the five other conservative members of the court, with the three liberal justices dissenting.
