United States v. Skrmetti
Overview
Overview
The Supreme Court upheld Tennessee's SB 1, which bans gender-affirming medical care (puberty blockers and hormone therapy) for minors, ruling 6-3 that the law does not violate the Equal Protection Clause.
Overview
The Supreme Court considers whether Tennessee's law banning gender-affirming medical care for minors, including puberty blockers and hormone therapy, violates the Equal Protection Clause. The Biden administration challenged the law on behalf of affected families. The case marks the Court's first direct ruling on transgender-specific healthcare restrictions.
The Facts
Facts
Tennessee enacted SB 1, prohibiting healthcare providers from administering puberty blockers or cross-sex hormone therapy to minors for the purpose of gender transition. Families of transgender minors and a physician sued Tennessee Attorney General Jonathan Skrmetti, arguing the law discriminated on the basis of sex and transgender status. The Sixth Circuit upheld the law, reversing a preliminary injunction. The United States joined the case as a plaintiff, challenging the law under the Equal Protection Clause of the Fourteenth Amendment.
Facts
Tennessee enacted SB1 in 2023, prohibiting healthcare providers from administering puberty blockers or hormone therapy to minors for the purpose of gender transition. The law created criminal penalties for providers and civil liability. Transgender adolescents and their parents, represented by the United States, challenged the law as discriminatory sex classification under the Fourteenth Amendment. The Sixth Circuit upheld the law, creating a circuit split with the Fourth Circuit, which had struck down a similar Virginia provision.
The Issue
Issue
Whether Tennessee's SB 1, which prohibits healthcare providers from administering puberty blockers or cross-sex hormone therapy to minors for gender transition purposes while permitting identical treatments for other medical purposes, constitutes sex discrimination in violation of the Equal Protection Clause or Title IX.
Issue
Whether a state law categorically prohibiting medical care that is sex-specific. Permitted for one sex but forbidden for another when sought for gender transition. Constitutes sex discrimination subject to heightened scrutiny under the Equal Protection Clause.
The Rules
Rule
Equal Protection Clause (U.S. Const. Amend. XIV, § 1) prohibits state laws that classify on the basis of sex without satisfying intermediate scrutiny. The state must show the law serves an important governmental interest through substantially related means. Bostock v. Clayton County (2020) interpreted Title VII's sex discrimination bar to encompass gender identity discrimination.
Rule
Under United States v. Virginia, 518 U.S. 515 (1996), sex-based classifications must substantially serve important governmental interests and must not rely on overbroad generalizations about gender differences. Bostock v. Clayton County, 590 U.S. 644 (2020), held that discrimination based on gender identity or transgender status constitutes sex discrimination under Title VII. Title IX (20 U.S.C. § 1681) prohibits sex discrimination in educational programs receiving federal funding and has been construed in parallel with Bostock. Equal Protection analysis requires that similarly situated individuals be treated alike absent a sufficient governmental justification.
The Application
Analysis
Under Virginia and Bostock, SB 1's restriction raises sex-discrimination concerns because it effectively bars only transgender minors from accessing treatments available to others, potentially relying on sex-based generalizations about gender identity. The Supreme Court, however, applied rational basis review by characterizing the law as regulating medical treatment by purpose (gender transition) rather than by sex, and found Tennessee's interests in protecting minors and regulating experimental medical treatments sufficiently important to justify the differential impact. The dissenters argued Bostock required heightened scrutiny, viewing the law as discriminating against transgender minors, a proxy for sex, regardless of its formal neutrality. The majority's choice of rational basis thus allowed the restriction despite its disparate impact on the basis of sex and gender identity.
Analysis
The Court examined whether Tennessee's prohibition on puberty blockers and hormone therapy for transgender minors constitutes a sex-based classification under the Equal Protection Clause. The majority concluded the law does not facially discriminate on the basis of sex, reasoning that the restriction targets the medical purpose of gender transition rather than the sex of the patient, because these treatments are permitted for other medical conditions in both male and female minors. By treating the classification as purpose-based rather than sex-based, the Court avoided applying intermediate scrutiny and upheld the law under rational basis review. This framing effectively shields transgender healthcare restrictions from Equal Protection sex discrimination challenges by characterizing gender identity-related classifications as separate from sex classifications.
The Conclusion
Conclusion
The Supreme Court upheld Tennessee's SB 1 in a 6-3 decision authored by Chief Justice Roberts, holding that the law does not facially discriminate on the basis of sex under the Equal Protection Clause because it applies equally to all minors regardless of sex. The Court applied rational basis review, finding Tennessee's asserted interests in protecting minors and regulating experimental medical treatments sufficient. Justices Sotomayor, Kagan, and Jackson dissented, arguing the law discriminates based on sex and transgender status and should receive heightened scrutiny. The decision leaves states broad authority to regulate or ban gender-affirming care for minors.
Conclusion
Decided June 18, 2025. The Supreme Court upheld Tennessee's ban 6-3, with the majority holding the law does not facially discriminate on the basis of sex. Justice Kavanaugh wrote for the Court. The ruling allows similar state bans to remain in effect and forecloses federal Equal Protection challenges to transgender healthcare restrictions on this theory.
Summary
The Supreme Court considers whether Tennessee's law banning gender-affirming medical care for minors, including puberty blockers and hormone therapy, violates the Equal Protection Clause. The Biden administration challenged the law on behalf of affected families. The case marks the Court's first direct ruling on transgender-specific healthcare restrictions.
Facts
Tennessee enacted SB1 in 2023, prohibiting healthcare providers from administering puberty blockers or hormone therapy to minors for the purpose of gender transition. The law created criminal penalties for providers and civil liability. Transgender adolescents and their parents, represented by the United States, challenged the law as discriminatory sex classification under the Fourteenth Amendment. The Sixth Circuit upheld the law, creating a circuit split with the Fourth Circuit, which had struck down a similar Virginia provision.
Issue
Whether a state law categorically prohibiting medical care that is sex-specific. Permitted for one sex but forbidden for another when sought for gender transition. Constitutes sex discrimination subject to heightened scrutiny under the Equal Protection Clause.
Conclusion
Decided June 18, 2025. The Supreme Court upheld Tennessee's ban 6-3, with the majority holding the law does not facially discriminate on the basis of sex. Justice Kavanaugh wrote for the Court. The ruling allows similar state bans to remain in effect and forecloses federal Equal Protection challenges to transgender healthcare restrictions on this theory.
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