Last Updated: Jun 19, 2025
The U.S. Supreme Court has upheld a Tennessee state statute that banned certain medical interventions for minors for purposes of attempting to change sexual identity or to address discomfort with sexual identity. In United States v. Skrmetti, by a 6-3 vote, the Court on June 18, 2025, determined that constitutional review of the state law did not require higher-level legal scrutiny and that the state law met the applicable legal standard for constitutionality.
The statute, SB1, prohibits the use of puberty blockers or hormones for any minor for the purposes stated above. SB1 allows the use of puberty blockers or hormones for minors to treat congenital defects, precocious puberty, disease or physical injury.
Three transgender minors, their parents and a doctor claimed that the statute violated the U.S. Constitution’s 14th Amendment Equal Protection Clause claiming that the statute discriminated based on sex and transgender status. The claimants alleged such sex-based classifications required intermediate level legal scrutiny. To survive intermediate level scrutiny Tennessee would have to demonstrate that “the classification serves important governmental objectives and that the discriminatory means employed are substantially related to the achievement of those objectives.”
The federal district court that first heard the challenge issued a statewide injunction preventing enforcement of the law as to puberty blockers and hormones based on the court’s determination that intermediate level scrutiny applied, and Tennessee would not meet that standard. Tennessee appealed to the 6th Circuit Court of Appeals who reversed the lower court, finding that intermediate level review did not apply because the law was not based on a sex-based classification. Instead, the court found that the statute prohibited puberty blockers and hormones regardless of the sex of the minor. Therefore, the lowest standard of review, rational basis review, applied. Rational basis only requires “any reasonably conceivable state of facts that could provide a rational basis for the classification.” As rational basis applied, the court determined that Tennessee would likely prevail.
The U.S. Supreme Court agreed with the 6th Circuit. In affirming its decision, the Court concluded that SB1 was not subject to heightened scrutiny per the Equal Protection Clause because the classifications were age-based and medical use-based. Therefore, rational basis applied and the Court concluded that the legislature’s stated purposes for the statute—concern over the long term potential negative effects of such treatments, lack of maturity of minors to make informed care choices of such significance, and possible less invasive treatment options—clearly met the required standard.
The Court noted the contentiousness of sex identity-related medical treatments but stated that this law did not violate the Equal Protection Clause. The Court ended its opinion stating, “Questions regarding the law’s policy are thus appropriately left to the people, their elected representatives, and the democratic process.”
Chief Justice Roberts authored the opinion joined by Justices Thomas, Alito, Gorsuch, Kavanaugh and Barrett in the primary rulings. Justices Thomas, Barrett (joined by J. Thomas), and Alito filed concurring opinions. Justices Sotomayor (joined by J. Jackson and J. Kagan) and Kagan filed dissenting opinions.