The U.S. Supreme Court on Wednesday upheld Tennessee’s ban on so-called “gender-affirming care” for minors, in a pivotal ruling that is expected to preserve similar laws in other Republican-led states.
The court ruled 6-3 in Skrmetti v. United States that the ban does not violate the Equal Protection Clause of the U.S. Constitution and does not constitute discrimination on the basis of transgender identity.
Writing for the majority, Chief Justice John Roberts acknowledged that the case “carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field.”
But the court’s only role, Roberts explained, was to ensure that Tennessee’s law did not violate anyone’s Constitutional right to equal protection.
“Having concluded that it does not,” he wrote, “we leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
The Tennessee statute prohibits doctors from prescribing irreversible medical interventions like hormone therapy and puberty blockers to minors.
“Many pediatricians have expressed serious concerns about the use of transition surgery, puberty blockers, and hormone therapy in minors,” wrote Rep. Andy Harris, MD (R-Md.) on X following the ruling. “This is a major victory for protecting children from irreversible and experimental medical practices.”
Polls have consistently shown that a majority of Americans oppose access to these types of medications for children, as they are too young to understand the lasting consequences. Over two dozen Republican-led states, including Texas, have enacted laws similar to the one in Tennessee.
In June of 2024, the Texas Supreme Court upheld the state’s law, ruling 8-1 that the right of parents to make medical decisions for their children was not absolute in the face of “new and previously unconsidered questions.”
The three liberal justices dissented Wednesday, with Justice Sonia Sotomayor writing that the ruling “abandons transgender children and their families to political whims.”
A comprehensive review conducted by the Department of Health and Human Services (HHS)earlier this year found that “puberty blockers, cross-sex hormones, and surgeries have very weak evidence of benefit, but carry risk of significant harms, including sterilization.”
In light of these findings, HHS Secretary Robert Kennedy Jr. sent a letter to health care providers, risk managers, and state medical boards on May 28, urging them to provide “immediate updates to treatment protocols for minors with gender dysphoria.”
“Providers should no longer rely on discredited guidelines that promote these dangerous interventions for children and adolescents based on ideology, not evidence,” Kennedy said.
In Wednesday’s ruling, Justice Clarence Thomas appeared to question why these discredited pediatric medical practices have continued, writing, “the experts appear to have compromised their credibility.”