The Supreme Court has upheld Tennessee’s ban on “gender affirming care” for minors, a decision that addresses a constitutional challenge to Senate Bill 1. The law prohibits medical procedures aimed at enabling minors to identify with an identity inconsistent with their sex or treating discomfort from such discordance. In a 6-3 opinion authored by Chief Justice Roberts, the Court ruled that the law does not violate the Equal Protection Clause and does not require heightened scrutiny judicial review. Instead, it requires only rational basis review, which Tennessee met.
Three minors, their parents, and a doctor had challenged the law, arguing it violated the Equal Protection Clause. The United States joined the case after then-Attorney General Merrick Garland deemed it of “general public importance.” Initially, a district court found that while plaintiffs lacked standing to challenge bans on surgery, they could likely succeed in challenging drug bans. It recognized transgender individuals as a quasi-suspect class and said SB1 discriminated based on sex and transgender status.
The Sixth Circuit reversed this decision, concluding that SB1 did not classify based on sex and would survive rational basis scrutiny. The Supreme Court affirmed this ruling, noting that SB1 applies equally to all minors regardless of sex and does not classify based on transgender status.
Justice Barrett concurred with Justice Thomas in noting that transgender individuals do not constitute a suspect class due to lack of immutable characteristics like race or sex. She argued against courts overseeing policy decisions usually left to legislatures.
The Court differentiated its decision from Bostock v. Clayton County (2020), which held firing someone for being gay or transgender violated Title VII’s prohibition on sex discrimination. The Skrmetti ruling declined to extend Bostock’s reasoning beyond Title VII.
Justice Thomas concurred separately, cautioning against relying solely on expert opinions in contentious debates with scientific uncertainty. He referenced standards by the World Professional Association of Transgender Health (WPATH) as lacking evidence for certain treatments’ efficacy.
Justice Alito also concurred in judgment but noted he would have avoided discussing whether SB1 constituted a sex-based classification.
In dissent, Justice Sotomayor argued SB1 is a sex-based classification because it treats minors differently based on birth-assigned gender. She cited Bostock as supporting her view that SB1 necessarily involves sex-based classifications.
Justice Kagan also dissented separately but did not take a stance on how SB1 should fare under heightened scrutiny.
Pending cases related to this issue include L.W. v. Skrmetti and Doe 1 v. Commonwealth of Kentucky ex rel. Cameron, both challenging state laws banning gender-affirming care for minors under equal protection and parental rights grounds. These are scheduled for consideration shortly after this decision.