Supreme Court Upholds Tennessee Ban on Gender Affirming Care for Minors

On June 18, 2025, the Supreme Court upheld the Sixth Circuit’s decision in U.S. v. Skrmetti, effectively paving the way for states to restrict access to gender-affirming care for minors.  The case relates to Tennessee’s Prohibition on Medical Procedures Performed on Minors Related to Sexual Identity, Senate Bill 1 (SB1), which was passed in 2023.  

SB1 prohibits healthcare providers from prescribing, administering, or dispensing puberty blockers or hormones to any minor for the purpose of (1) enabling the minor to identify with, or live as, a purported identity inconsistent with the minor’s biological sex, or (2) treating purported discomfort or distress from a discordance between the minor’s biological sex and asserted identity (i.e., gender dysphoria).  SB1 was originally challenged by three transgender minors, their parents, and a doctor under the Equal Protection Clause of the Fourteenth Amendment.  

The Supreme Court held that SB1 is not subject to heightened scrutiny because it does not classify based on sex or transgender status and only incorporates classifications based on age and diagnosis.  In reaching its decision on this point, the Supreme Court declined to address whether the Court’s holding in Bostock v. Clayton County – which determined that, in the context of employment, discrimination on the basis of sex does include discrimination on the basis of gender identity and sexual orientation – reaches beyond the context of employment.  The Supreme Court further found that SB1 satisfies rational basis review because Tennessee provided a “reasonably conceivable state of facts that could provide a rational basis” for SB1’s age- and diagnosis-based classifications.