U.S. v. Skrmetti and the care the Court let states ban
A 6-3 Supreme Court ruling upheld Tennessee's ban on gender-affirming care for minors, holding the law triggers only the weakest form of constitutional review.
On June 18, 2025, the Supreme Court upheld Tennessee's ban on gender-affirming medical care for transgender minors. The vote was 6-3, splitting along the Court's conservative-liberal line. United States v. Skrmetti is the most significant ruling on transgender rights the Court has issued, and it cut against transgender youth and their families.
The law at issue is Tennessee Senate Bill 1, enacted in 2023. SB1 bars healthcare providers from prescribing puberty blockers or hormones to minors when the purpose is to let a minor live consistent with a gender identity different from their birth sex. The catch is that the same drugs remain legal for minors prescribed for other conditions, such as early-onset puberty.
The Biden administration's Justice Department challenged SB1, joined by transgender adolescents and their parents. Their argument: the law discriminates based on sex and transgender status, which would require courts to apply heightened scrutiny, a demanding standard the state must overcome with strong justification.
The Court rejected it. Chief Justice John Roberts wrote the majority opinion, holding that SB1 does not classify based on sex or transgender status at all. Instead, the Court ruled, the law draws lines based on age and medical use: it permits certain treatments for some purposes and bars them for others, regardless of the patient's sex.
That framing decided everything. Having found no suspect classification, the Court applied rational basis review, the most deferential standard in equal protection law. Under rational basis, a law survives if the state has any legitimate reason for it, and Tennessee cleared that bar easily.
The three liberal justices dissented. Justice Sonia Sotomayor wrote the principal dissent, joined by Justices Elena Kagan and Ketanji Brown Jackson. Sotomayor argued the majority had looked away from what the law plainly does: it permits a teenager assigned female at birth to receive testosterone for one reason and forbids it for another, a distinction that turns on sex.
The practical reach is wide. More than 20 states had enacted similar bans before the ruling. Skrmetti did not strike them down; it removed the strongest federal constitutional argument against them. After the decision, those laws stand on firmer ground, and families in those states have far less recourse in federal court.
What the Court did not do also matters. It did not rule that transgender status can never trigger heightened scrutiny in any context. It did not touch bans on care for adults, sports participation, bathroom access, or identity documents.
By recasting a ban aimed at transgender minors as a neutral regulation of age and medical procedure, the Court let states prohibit a category of care sought almost entirely by transgender youth, while insisting the prohibition has nothing to do with being transgender. The majority called it judicial restraint. The families affected call it a closed door.