The Supreme Court Upheld a State Ban on Transgender Care for Minors
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Diverging Reports Breakdown
U.S. Supreme Court upholds ban on child sex-change surgeries
The U.S. Supreme Court upheld Tennessee’s law in a 6-3 decision in United States v. Skrmetti. The majority opinion, authored by Chief Justice John Roberts, held that the Tennessee law “is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review” The plaintiffs in the Tennessee case—three minors who identify as transgender, their parents, and a doctor—argued the law discriminated based on sex and transgender status. Justice Sonia Sotomayor disagreed, writing that the court”s majority “subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims” Justice Clarence Thomas wrote the evidence not only showed that no such consensus exists, but that “there are particularly good reasons to question the expert class here’”
Oklahoma has a similar law that has also been challenged in court.
The U.S. Supreme Court upheld Tennessee’s law in a 6-3 decision in United States v. Skrmetti, breaking along ideological lines, with court conservatives finding the Tennessee law (Senate Bill 1) to be constitutional.
The majority opinion, authored by Chief Justice John Roberts, held that the Tennessee law “is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review.”
“Tennessee determined that administering puberty blockers or hormones to minors to treat gender dysphoria, gender identity disorder, or gender incongruence carries risks, including irreversible sterility, increased risk of disease and illness, and adverse psychological consequences,” Roberts wrote. “The legislature found that minors lack the maturity to fully understand these consequences, that many individuals have expressed regret for undergoing such treatments as minors, and that the full effects of such treatments may not yet be known. At the same time, the State noted evidence that discordance between sex and gender can be resolved through less invasive approaches. SB1’s age- and diagnosis-based classifications are rationally related to these findings and the State’s objective of protecting minors’ health and welfare.”
The plaintiffs in the Tennessee case—three minors who identify as transgender, their parents, and a doctor—argued the law discriminated based on sex and transgender status, and that individuals who identify as transgender are a protected class.
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X Logo “In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct.” —Justice Clarence Thomas
But the court majority held that the Tennessee law is based on only two classifications—one based on age and the other based on medical use.
In a dissent, Justice Sonia Sotomayor disagreed.
Sotomayor wrote that the court’s majority “subjects a law that plainly discriminates on the basis of sex to mere rational-basis review. By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims.”
Sotomayor was joined in her dissent by Justice Ketanji Brown Jackson and Justice Elena Kagan.
The plaintiffs’ and the dissenting justices’ arguments relied heavily on a purported consensus among medical experts that sex-change surgeries, cross-sex hormones, and puberty blockers are appropriate treatments for children with gender dysphoria who identify as members of the opposite sex.
But in a concurring opinion, Justice Clarence Thomas wrote the evidence not only showed that no such consensus exists, but that “there are particularly good reasons to question the expert class here, as recent revelations suggest that leading voices in this area have relied on questionable evidence, and have allowed ideology to influence their medical guidance.”
Thomas stated that “this case serves as a useful reminder that the American people and their representatives are entitled to disagree with those who hold themselves out as experts, and that courts may not ‘sit as a super-legislature to weigh the wisdom of legislation.’”
Thomas said the phrase “gender-affirming care” is a “sanitized description” that “obscures the nature of the medical interventions at issue.”
He noted the use of cross-sex hormones can involve giving a female child (who identifies as a male) dosages of testosterone that are up to 100 times greater than native levels, while the dosage of estrogen given to boys (who identify as girls) can be up to 43 times greater than the normal range.
He noted that puberty blockers, cross-sex hormones, and sex-change surgeries are all associated with lifelong impacts on patients that include significant negative physical and mental health outcomes.
“Setting aside whether sex-transition treatments for children are effective, States may legitimately question whether they are ethical,” Thomas wrote (emphasis in original).
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X Logo “This ruling is a tremendous victory for Oklahoma’s children, ensuring they will not be subjected to the consequences of these life-altering surgeries.” —Oklahoma Attorney General Gentner Drummond
And he stressed that the voices of individuals who have undergone the procedures championed by the plaintiffs should not be ignored.
“The voices of ‘detransitioners’—individuals who have undergone sex-transition treatments but no longer view themselves as transgender—provide States with an additional reason to question whether children are providing informed consent to the medical interventions described above,” Thomas wrote.
Roberts raised a similar issue in the majority opinion.
“The plaintiffs and the dissent, however, contort the meaning of the term ‘medical treatment,’” Roberts wrote. “Notably absent from their framing is a key aspect of any medical treatment: the underlying medical concern the treatment is intended to address.”
Thomas also noted that “when this Court has nonetheless given exalted status to expert opinion, it has been to our detriment,” noting that supposed expert authority played a role in the U.S. Supreme Court’s 1927 decision upholding Virginia’s forced-sterilization law, which bolstered the cause of the pseudoscientific eugenics movement.
“This case carries a simple lesson: In politically contentious debates over matters shrouded in scientific uncertainty, courts should not assume that self-described experts are correct,” Thomas wrote.
Impact on Oklahoma
More than 20 states, including Oklahoma, have enacted laws banning the performance of sex-transition efforts on minors.
In 2023, Oklahoma state lawmakers passed and Gov. Kevin Stitt signed into law Senate Bill 613, which states, “A health care provider shall not knowingly provide gender transition procedures to any child.”
The Oklahoma law defines “gender transition procedures” to include surgical procedures that alter or remove physical or anatomical characteristics or features that are typical for the individual’s biological sex, or the provision of puberty-blocking drugs and cross-sex hormones. The restrictions apply to patients younger than 18.
The American Civil Liberties Union and like-minded groups sued, seeking to have the law overturned.
The plaintiffs in Peter Poe v. Gentner Drummond included five youth who claim to be transgender, their parents/guardians, and one doctor.
The Oklahoma Council of Public Affairs (OCPA) joined with Do No Harm, a group of medical professionals, to defend SB 613 in an amici curiae brief filed in the case.
“No reliable scientific evidence justifies the use of puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria in minors. To the contrary, such treatments carry harmful lifelong consequences, including infertility, total loss of adult sexual function, and increased risk of several other serious medical conditions,” OCPA and Do No Harm’s brief stated.
The Oklahoma law was upheld by a district judge, but the plaintiffs have appealed the decision to the U.S. Court of Appeals for the Tenth Circuit. On Oct. 29, 2024, the Tenth Circuit issued an order stating that the court would take no action on the case “pending the Supreme Court’s issuance of a decision in United States v. Skrmetti.”
Stitt welcomed news of the U.S. Supreme Court’s ruling.
“Kids can’t smoke, drink, or get a tattoo—who in their right mind thinks it’s a good idea for kids to permanently alter their bodies?” Stitt wrote on X. “We passed the ban in Oklahoma, and I’m glad to see Tennessee’s law upheld at the Supreme Court.”
Oklahoma Attorney General Gentner Drummond said the U.S. Supreme Court’s decision upholding the Tennessee law in Skrmetti is a significant victory for Oklahoma as well.
“This ruling is a tremendous victory for Oklahoma’s children, ensuring they will not be subjected to the consequences of these life-altering surgeries,” Drummond said. “The practice is unconscionable, and I appreciate the court’s ruling that we as a state have the right to protect Oklahoma children from this irreparable harm.”
Supreme Court upholds Tennessee ban on youth gender-affirming care
The Supreme Court on Wednesday issued a highly anticipated ruling upholding a Tennessee law banning gender-affirming care for minors. The court voted 6 to 3, with the court’s three liberal justices dissenting. Tennessee argued that the ban protected children from unproven medical treatments, a position echoed by the Trump administration. The decision comes amid a growing debate about how to care for transgender minors. Since 2021, 26 states have passed bans onGender-affirmed care for children, according to a tracker maintained by the Human Rights Campaign. In the dissenting opinion, Justice Sonia Sotomayor said the majority’s logic did not stand up to scrutiny. In a separate case, the Supreme Court ruled in favor of a ban on the use of puberty blockers for transgender patients under the age of 18. In that case, a federal judge ruled that the law violated the equal protection clause of the 14th Amendment and discriminated on the basis of sex.
Dive Brief:
The Supreme Court on Wednesday issued a highly anticipated ruling upholding a Tennessee law banning gender-affirming care for minors. The court voted 6 to 3, with the court’s three liberal justices dissenting.
Tennessee’s law, SB1, prohibits providers from offering transgender patients under the age of 18 medical treatments like puberty blockers or hormone therapy for gender dysphoria.
In the majority opinion, Chief Justice John Roberts said the ruling returned the question of youth gender-affirming care to “the people, their elected representatives, and the democratic process.”
Dive Insight:
United States v. Skrmetti was filed last year by families of transgender children and a provider in Tennessee, who argued that the state’s law violated the equal protection clause of the 14th Amendment and discriminated based on sex.
The law prohibited minors from seeking gender-affirming care to receive medications, including puberty blockers and hormone therapies, to treat gender dysphoria — a condition that causes patients to feel their biological sex does not match their gender expression.
Tennessee argued that the ban protected children from unproven medical treatments — a position that has been echoed by the Trump administration this year, even though most medical organizations in the U.S. and medical researchers endorse the treatments.
Justices Clarence Thomas, Samuel Alito, John Roberts, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett sided with the state, ruling the law does not bar patients from treatment based on sex, but on age and medical condition. Under that framework, the law needed to meet a lower legal threshold to be deemed constitutional, according to the justices.
“SB1 prohibits healthcare providers from administering puberty blockers or hormones to any minor to treat gender dysphoria, gender identity disorder, or gender incongruence, regardless of the minor’s sex; it permits providers to administer puberty blockers and hormones to minors of any sex for other purposes,” Roberts wrote.
The majority also expressed skepticism about the validity of gender-affirming care for minors, calling it an evolving field. Roberts said the evidence supporting the use of puberty blockers and hormone therapies was “remarkably weak” in the majority opinion.
In the dissenting opinion, Justice Sonia Sotomayor said the majority’s logic did not stand up to scrutiny.
Under Tennessee’s ban, two patients seeking treatment for unwanted facial hair, for example, would be treated or turned away depending entirely on their sex. SB1 allows a minor girl to receive puberty blockers for the symptoms, because facial hair does not align with her sex, while a male patient who wished to suppress the same trait would not qualify for care, she wrote.
“The problem with the majority’s argument is that the very ‘medical purpose’ SB1 prohibits is defined by reference to the patient’s sex,” Sotomayor wrote. “Key to whether a minor may receive puberty blockers or hormones is whether the treatment facilitates the ‘medical purpose’ of helping the minor live or appear ‘inconsistent with’ the minor’s sex. That is why changing a patient’s sex yields different outcomes under SB1.”
Liberal Justices Elena Kagan and Ketanji Brown Jackson joined Sotomayor in dissenting.
The decision comes amid a growing debate about how to care for transgender minors. Since 2021, 26 states have passed bans on gender-affirming care for children, according to a tracker maintained by the Human Rights Campaign.
Even in states without bans, pressure has increased on providers to offer conversational therapy instead of medications. Last month, the CMS demanded hospitals that offer gender-affirming care for children turn over financial information and clinical protocols related to the services. In the same week, the HHS implored hospitals to update protocols to more heavily utilize the Trump administration’s preferred treatment of talk therapy.
Losing access to gender-affirming care treatments can have health impacts for patients, patient advocates have warned. In a dissenting opinion, Sotomayor cited evidence finding the lifetime prevalence of suicide attempts for transgender individuals can be as high as 40%.
“By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims,” Sotomayor said.
Supreme Court upholds state bans on transgender care for minors
Supreme Court upholds state bans on transgender care for minors. The vote was 6-3, along ideological lines. Chief Justice John Roberts rejected that argument entirely. Justice Sonia Sotomayor said the court abandons children and their families to “political whims””The court really abdicated its responsibility to protect a vulnerable group,” Justice Elena Kagan said in a rare dissent. “There’s no sugar coating this opinion,” said Jennifer Levi, a senior director at GLAD Law, an advocacy organization for LGBTQ rights. “It means that in more than half the states where the care is banned, families won’t be able to get the care that their children need,” she said. “In sadness, I dissent,” Justice Ketanji Brown Jackson said in her dissent, adding, “I think there would be a rational basis to be a ruling against” the state law in the first place. “The court will be back Friday with more opinions,” Justice Samuel Alito said in his dissent.
The U.S. Supreme Court on Wednesday upheld laws in roughly half the states that ban gender affirming medical care for transgender minors. The vote was 6-3, along ideological lines.
The case was brought by transgender children and their parents in Tennessee who claimed that the state’s ban on hormone treatments and puberty blockers for transgender minors discriminated on the basis of sex. They contended that they were being denied equal protection of the law because the same medications that are banned for minors with gender dysphoria, are permitted for other minors with conditions such as endometriosis and early or late onset puberty.
But writing for the conservative court’s supermajority, Chief Justice John Roberts rejected that argument entirely.
He said that laws like Tennessee’s that turn on age or medical use, are not subject to the kind of heightened legal scrutiny that courts use to look at workplace sex discrimination, for instance. Instead, the court applied the lowest level of legal scrutiny, called rational basis, meaning that if there is any rational justification for the law, it passes constitutional muster.
Acknowledging what he called “the fierce scientific and policy debates about the safety, efficacy and propriety of medical treatments in an evolving field,” Roberts said that it is not the court’s job to judge “the wisdom or fairness” of Tennessee’s law.
The court’s job, he said, is only to determine whether the law violates the constitution’s guarantee of equal protection of the law. Having concluded that the law does not unconstitutionally discriminate, he said, the court leaves these policy questions “to the people, their elected representatives, and the democratic process.”
Reaction to the decision was swift. “There’s no sugar coating this opinion,” said Jennifer Levi, a senior director at GLAD Law, an advocacy organization for LGBTQ rights. “It means that in more than half the states where the care is banned, families won’t be able to get the care that their children need.”
“The court really abdicated its responsibility to protect a vulnerable group,” she added.
In a rare dissent, read from the bench, Justice Sonia Sotomayor echoed that sentiment. Because the Tennessee law explicitly classifies its ban on the basis of sex and transgender status, she said, both the constitution and precedent require that the court subject the law to a higher level of scrutiny.
Instead, she said, the majority “contorts logic and precedent to say otherwise,” retreating from meaningful judicial review “exactly when it matters most.”
To make her point, Sotomayor noted that judicial scrutiny has long played an essential role in guarding against legislative efforts to impose the state’s view on how people of a particular race or sex should live, or look or act. Pointing to what she called a “hauntingly familiar passage” in Virginia’s 1967 brief defending its ban on interracial marriage, Sotomayor noted that the court did not “defer to the wisdom of the state legislature.” Indeed, the court’s 1967 landmark ruling struck down the ban on interracial marriage.
Contrary to that decision, she said that the court now abandons children and their families to “political whims,” adding, “In sadness, I dissent.”
Joining her in full was Justice Ketanji Brown Jackson. Justice Elena Kagan partially joined. She too would have required a higher level of scrutiny, but she would have stopped there. Given the extensive, and disputed evidence presented in the lower courts, she said, the court should have sent the case back down to determine whether the state law was based on stereotypes and prejudices or legitimate state interests.
While the court’s majority opinion gave states broad powers to ban or regulate transgender medical care for minors, it left unresolved a number of questions that very likely will reach the Supreme Court next term.
Among them is a challenge to the Trump administration’s ban on transgender people in the military, and a challenge to the administration’s policy denying passports for transgender individuals, unless they list as their gender as their sex at birth.
Also not resolved by Wednesday’s ruling are cases involving bans on transgender participation in school sports. Federal law bars discrimination based on sex in any education program or activity that receives federal funding.
John Bursch, who argued and won the case on behalf of the conservative Alliance Defending Freedom said that “about half the states have adopted laws that prohibit boys who identify as girls from participating in girls sports teams.”
As he noted, two of those cases are currently pending before the Supreme Court.
Farther down the road is another question — whether states can ban medical care for transitioning adults.
“I think there would be a rational basis to also prohibit it for adults, and that would be up to the states to decide,” said Bursch.
The court will be back Friday with more opinions.
Supreme Court upholds Tennessee ban on gender-affirming care for trans youth
The U.S. Supreme Court upheld a Tennessee law banning all gender affirming care for minors in a 6-3 majority ruling. The ACLU of Idaho considers the decision part of a “larger campaign to target trans folks.” Medical research shows it can relieve emotional distress like depression and anxiety.
The Idaho Family Policy Center, a conservative Christian policy platform, believes the ruling will protect children.Blaine Conzatti, the president of the center, said “we’re celebrating the decision of the US Supreme Court to uphold the Tennessee state law.”
The American Psychiatric Association supports access to gender affirming care for youth. Medical research shows it can relieve emotional distress like depression and anxiety.
The ACLU of Idaho considers the decision part of a “larger campaign to target trans folks.”
Emily Croston, staff attorney of the ACLU of Idaho, called the ruling disappointing.
“It’s a painful setback. But we’re not going to stop fighting for trans communities in Idaho.”
Croston said the ruling will not affect the current cases of Hecox v. Little , which deals with trans athletes, or Robinson v. Labrador , which is focused on incarcerated individuals having access to gender-affirming medical care.
“The ACLU is going to continue to mobilize our community members to stop the further attacks on trans youth, their access to care, and their ability to live a life free from government overreach. And that doesn’t change,” she said.
Trump administration live updates: Pete Hegseth faces Senate questions; Supreme Court upholds ban on transgender care
All student and exchange visitor visa applicants will soon be subject to a new online presence review. Consular officers at U.S. missions and consulates overseas will conduct the reviews. The official said in a statement that applicants will be made to set any profiles to
Consular officers at U.S. missions and consulates overseas will conduct the reviews, which will include all social media. The official said in a statement that applicants will be made to set any profiles to “public.” Not doing so could be construed as an effort to evade the screening process or hide certain activity.
The new guidance will apply to all student and exchange visitor applicants in the F, M and J nonimmigrant classifications, per the official, and overseas posts have been instructed to resume scheduling those visa applications under the new procedure. Appointments were paused in late May pending this new guidance.
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Source: https://www.nytimes.com/2025/06/18/briefing/scotus-transgender-care-trump-iran.html