In a pivotal 6–3 decision released on June 18, 2025, the United States Supreme Court ruled in United States v. Skrmetti, affirming Tennessee’s 2023 law that bans gender-affirming medical treatment—including puberty blockers, hormone therapy, and surgical interventions—for minors under 18. Delivered by Chief Justice John Roberts, the majority opinion held that the law does not violate the Equal Protection Clause of the 14th Amendment, as it applies neutrally to all minors and does not target transgender youth as a protected class.
Background of the Tennessee Law
Tennessee’s Senate Bill 1 (SB1), signed into law by Governor Bill Lee on March 2, 2023, became effective July 1 of that year. It prohibits healthcare providers from prescribing puberty blockers, hormone therapy, or performing surgeries on minors to treat gender dysphoria or gender incongruence. However, it permits similar treatments for minors when diagnosing “congenital defects, precocious puberty, disease, or physical injury”.
The law also imposes legal liability on medical providers—fines of up to $25,000—if they violate its terms, while minors themselves are not held criminally liable.
The Legal Challenge
The case was brought forward by three transgender teenagers, their families, and a doctor from Memphis, with the Department of Justice under the Biden administration joining in support of the plaintiffs. They argued that the law discriminates based on sex and transgender status, effectively denying care available to cisgender youths, and should therefore be subject to heightened judicial scrutiny.
In oral arguments, Solicitor General Elizabeth Prelogar emphasized that Tennessee’s law drew distinctions between medical treatments based solely on the condition treated rather than the gender identity of the patient.
Majority Opinion: A Narrow Interpretation
Chief Justice Roberts authored the majority opinion, which adhered to a rational basis review, stating that Tennessee does not single out transgender individuals. Instead, the law withdraws specific diagnoses—such as gender dysphoria—from the realm of treatable conditions for all minors, regardless of sex.
“The Equal Protection Clause does not resolve these disagreements,” Roberts wrote, underscoring that the court’s role is limited to constitutional interpretation, not policy judgments. This minimalist stance leaves the policy debate squarely in the hands of states and their legislatures.
Chief Justice Roberts opined, “This Court’s job is not to decide the wisdom or fairness of Tennessee’s policy”—a position that reinforces a conservative jurisprudential emphasis on judicial restraint.