On Wednesday, June 18, 2025, the U.S. Supreme Court delivered a landmark 6-3 ruling in United States v. Skrmetti, upholding Tennessee’s controversial law prohibiting gender-affirming care for minors. The decision marks a significant moment in the ongoing national debate over transgender rights and healthcare, affirming states’ authority to restrict access to puberty blockers, hormone therapy, and related treatments for transgender youth.
The Tennessee law, passed in 2023, bans healthcare providers from administering puberty blockers or hormones to minors for gender dysphoria or related diagnoses. The legislation excludes treatments for congenital defects or physical injuries, as well as gender-affirming care for minors whose gender identity aligns with their sex assigned at birth. The Supreme Court’s ruling overturns a lower court’s finding that the law violated constitutional rights, particularly under the Equal Protection Clause of the Fourteenth Amendment.
Chief Justice John Roberts, writing for the majority, emphasized that the law does not discriminate based on sex because it prohibits the treatments for all minors, regardless of gender. “Rather, it removes one set of diagnoses—gender dysphoria, gender identity disorder, and gender incongruence—from the range of treatable conditions,” Roberts wrote. He noted that the Court’s role is not to judge the wisdom or fairness of the law but to ensure it does not violate constitutional protections.
The plaintiffs in the case included three transgender teenagers, their families, and a Memphis doctor, with the Biden administration’s Department of Justice supporting their challenge. They argued that the law discriminates against transgender youth by denying them medically necessary care that other minors can access. The Court’s three liberal justices dissented, expressing deep concern that the decision abandons transgender children and their families to “political whims.”
The ruling has far-reaching implications beyond Tennessee. According to the Movement Advancement Project, 25 states currently have laws banning gender-affirming care for transgender youth, while two additional states ban gender-affirming surgeries. The decision effectively upholds these bans and sets a precedent allowing states to continue restricting access to such care.
More than 100,000 transgender youth live in states with gender-affirming care bans, according to the Williams Institute at UCLA School of Law. For many of these young people, the ruling represents a significant barrier to treatments deemed medically necessary by themselves, their families, and healthcare providers.
Healthcare professionals and advocates have voiced strong opposition to the ruling. Dallas Ducar, a registered nurse and nurse practitioner with extensive experience in transgender health, described the decision as a violation of the “fundamental right” of bodily autonomy. She stressed that gender-affirming treatments like puberty blockers and hormone therapy are safe, effective, and have been used for decades to treat both transgender and cisgender children with various medical conditions. Major medical organizations, including the American Academy of Pediatrics and the American Medical Association, support gender-affirming care as appropriate and necessary for transgender youth.
In an interview last year, L.W., one of the transgender teens who brought the Skrmetti case, described the state regulating her medical care as “body horror.” She explained, “It’s a very terrifying thought that I could have to go off this medical care, because my dysphoria was horrible before [I started]. I was really isolated because of it, which tended to hurt my mental health. Obviously, you’re not yourself. It’s real-life body horror, essentially: Body horror is a genre of horror that’s particularly terrifying because it’s about the lack of autonomy over your own body.”
For transgender youth facing these bans, experts advise continuing to work with qualified healthcare providers, documenting medical needs, and exploring options such as consulting providers in other states or telehealth services where legal. Financial assistance programs like the Trans Youth Emergency Project and support organizations such as Trans Lifeline can provide resources to help navigate these challenges.
Mental health care remains available and is critical during this time. Dr. Kaiyti Duffy, Chief Medical Officer at the Los Angeles LGBT Center, compared the loss of gender-affirming care to an asthma patient losing access to an inhaler, emphasizing that gender-affirming care is medically necessary and lifesaving. She cautioned that therapy alone cannot substitute for medical treatments and highlighted the increased risk of suicidality among transgender youth denied access to care.
Parents of transgender children are also grappling with the ruling’s implications. Dr. Duffy noted that the decision effectively strips parents of their authority to consent to gender-affirming care for their children, a development she described as deeply troubling. She urged families who can consider moving to states with protective “shield laws” that safeguard access to gender-affirming care, acknowledging that such moves are difficult but sometimes necessary to protect their children’s wellbeing.
The Tennessee Equality Project, an LGBTQ advocacy group, expressed profound disappointment with the ruling, stating, “We are grateful to the plaintiffs, families, and the ACLU for fighting on behalf of more than 1.3 million transgender adults and 300,000 youth across the nation.” They emphasized that gender-affirming care saves lives and is supported by leading medical organizations worldwide.
Conversely, Tennessee’s House Republican Caucus hailed the decision as “a proud day for the Volunteer State and for all who believe in protecting the innocence and well-being of America’s children.” Senate Majority Leader Jack Johnson, who sponsored the legislation, praised the ruling, saying it affirmed states’ authority to protect children from “irreversible medical procedures.” Tennessee Attorney General Jonathan Skrmetti also lauded the outcome, claiming that “Tennessee voters’ common sense won over judicial activism” despite opposition from various groups and the Biden administration.
U.S. Senate Minority Leader Chuck Schumer condemned the ruling as “an awful decision,” criticizing the Supreme Court for failing to protect individual rights against discrimination. He indicated that Democrats would explore all possible solutions to counteract the decision’s effects.
This Supreme Court ruling represents a pivotal moment in the contentious national debate over transgender rights and healthcare access. While it upholds states’ rights to restrict gender-affirming care for minors, it also leaves many young people, families, and medical professionals navigating uncertain and often difficult paths forward.
