On June 18, 2025, the U.S. Supreme Court delivered a landmark 6-3 ruling that upheld Tennessee’s 2023 law banning gender-affirming medical care for transgender minors. This decision not only solidifies Tennessee’s controversial Senate Bill 1 (SB1) but also shields similar laws in 25 other states, marking a significant setback for transgender rights across the nation.
Chief Justice John Roberts authored the majority opinion, emphasizing that the law—which prohibits treatments such as puberty blockers, hormone therapies, and surgeries for minors experiencing gender dysphoria—does not violate the Constitution’s Equal Protection Clause. Roberts acknowledged the “fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field,” but made clear that such questions are best resolved by “the people, their elected representatives, and the democratic process.” He wrote, “The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”
The case, known as United States v. Skrmetti, was brought by three transgender teenagers from Tennessee, their parents, and a physician who provides gender-affirming care. They argued that the law discriminated against transgender minors by denying them treatments allowed for other medical conditions, thus violating the constitutional guarantee of equal protection under the law. The plaintiffs also highlighted that the law restricts parents’ rights to make healthcare decisions for their children.
Roberts rejected these arguments, explaining that the law’s restrictions hinge on age and medical use rather than sex. In his view, the law applies equally to all minors, regardless of sex, and therefore warrants only the lowest level of judicial scrutiny—rational basis review. This standard requires only that the law be rationally related to a legitimate government interest, which the court found Tennessee met by citing the ongoing medical uncertainty surrounding gender-affirming treatments.
Justice Amy Coney Barrett, joined by Justice Clarence Thomas, wrote a separate opinion reinforcing that laws classifying people based on transgender status should not receive heightened judicial scrutiny. Barrett emphasized that courts must grant legislatures flexibility in policymaking on these issues.
However, the ruling sparked fierce dissent from the court’s three liberal justices. Justice Sonia Sotomayor read her dissent aloud from the bench—a rare and powerful gesture—stating the decision “authorizes, without second thought, untold harm to transgender children and the parents and families who love them.” She argued that the Tennessee law explicitly discriminates on the basis of sex and transgender status and therefore should have been subjected to heightened scrutiny. Sotomayor drew a poignant parallel to the 1967 Supreme Court ruling that struck down Virginia’s ban on interracial marriage, noting that the state had made similar arguments about scientific uncertainty and legislative authority at the time. She concluded, “In sadness, I dissent.” Justices Ketanji Brown Jackson and Elena Kagan joined her dissent, with Kagan partially joining.
The ruling comes amid a broader national climate of increasing restrictions on transgender rights. Since 2021, 27 states have enacted laws limiting or banning gender-affirming care for minors, with two additional states banning only surgeries. The Tennessee law is part of this wave, and the Supreme Court’s decision now protects these laws from constitutional challenges based on equal protection grounds.
Federal and state efforts have extended beyond medical care to regulating transgender participation in sports and access to bathrooms. For instance, in April 2025, the Trump administration sued Maine for failing to ban transgender athletes in girls’ sports, and the Supreme Court has allowed the removal of transgender service members from the military. President Donald Trump, who returned to office in 2025, has issued executive orders defining sex strictly as male or female and limiting federal funding for gender transition care for those under 19, promoting talk therapy instead.
The Biden administration, which had intervened in support of the families challenging the Tennessee law, was sidelined after the Trump administration reversed the government’s position in February 2025 and urged the court to uphold the ban. The ruling leaves unresolved how other transgender rights issues—such as military service, passport gender markers, and participation in school sports—will be addressed in future cases.
Medical groups remain divided on the issue. Major American associations like the American Academy of Pediatrics continue to endorse gender-affirming care, calling it medically necessary and supported by decades of research. Dr. Susan J. Kressly, president of the American Academy of Pediatrics, stated the organization “stands with pediatricians and families making health care decisions together and free from political interference.” Conversely, Tennessee’s Attorney General Jonathan Skrmetti hailed the decision as a “landmark victory” and a triumph for “evidence-based medicine” and democracy, arguing that the ban protects children from irreversible treatments.
Advocates for transgender rights expressed deep disappointment. Chase Strangio, an American Civil Liberties Union lawyer representing the plaintiffs, called the ruling “a devastating loss for transgender people, our families, and everyone who cares about the Constitution.” Mo Jenkins, a 26-year-old trans woman from Texas who began hormone therapy at 16, described the decision as disheartening but vowed resilience, saying, “Trans people are not going to disappear.”
The ruling will have a profound impact on an estimated 300,000 transgender youths aged 13 to 17 and 1.3 million transgender adults in the U.S., according to the Williams Institute at UCLA. With a patchwork of laws now governing transgender care, families in restrictive states often face difficult choices, including traveling out of state for care or relocating entirely. Some providers, like Penn Medicine in Philadelphia, have already ceased offering surgeries to patients under 19 in response to the shifting legal landscape.
The political fallout has been mixed. While some Democrats like Senator Chuck Schumer denounced the ruling as part of a “cruel crusade against trans Americans,” others have been more cautious, focusing on other issues or acknowledging the complex public sentiment. Polls show a majority of Americans, including many Democrats, support restrictions on transgender female athletes in women’s sports and bans on certain treatments for transgender minors. This has complicated efforts by some liberal politicians to champion transgender rights without alienating moderate voters.
Meanwhile, LGBTQ advocacy groups like the Human Rights Campaign have mobilized protests and public education campaigns, drawing parallels between the current fight and the long struggle for marriage equality. Jay Brown, chief of staff for the Human Rights Campaign, compared the present moment to the early years of the marriage equality movement, emphasizing the need for continued advocacy and coalition-building.
Looking ahead, legal experts anticipate that the Supreme Court’s ruling will influence numerous ongoing and future challenges to transgender-related laws. Cases involving bans on transgender participation in school sports and military service are already pending before the court. The decision also leaves open questions about the rights of transgender adults and the extent to which states may regulate medical care for them.
Ultimately, the Supreme Court’s ruling underscores the deep divisions within American society over transgender rights and the role of courts versus legislatures in resolving these contentious issues. As Justice Roberts noted, these debates carry “profound” implications and “sincere concerns” on all sides, but the court has chosen to defer to the democratic process, leaving the fate of transgender youths’ medical care largely in the hands of state governments and political battles ahead.
